FOCUS TOPICS CARDIOLOGY • LEGISLATIVE AGENDAS
Your Middle TN Source for Professional Healthcare News
PHYSICIAN SPOTLIGHT PAGE 8
Kristen Kerr, MD
Ifetroban for Treating DMDAssociated Cardiomyopathy Last fall, the U.S. Food and Drug Administration (FDA) announced $15 million in grant funding in support of 12 new clinical trials through the Orphan Products Clinical Trials Grant Program funded by Congress ... 10
Endocrine Society Celebrates Progress from Bench to Bedside The Endocrine Society is a global community of 18,000 researchers, physicians and healthcare professionals focused on advancing hormone science from bench to bedside ... 11
Bringing Eye Health into Focus in 2020 The Harris Poll recently conducted a survey on behalf of the American Academy of Ophthalmology (AAO) to assess knowledge of visual health ... 13
February 2020 >> $5
THA, TMA, TNA Outline Legislative Priorities CON, Telehealth, Scope of Practice Lead Concerns By CINDY SANDERS
The Tennessee General Assembly reconvened on Jan. 14, 2020 for the second half of the 111th session. 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. From consensus items to those causing some consternation, Medical News recently had the opportunity to chat with the leadership of THA, TMA and TNA to discuss their 2020 priorities and key advocacy issues.
Tennessee Hospital Association
The Tennessee Hospital Association has new leadership but ongoing priority concerns. Wendy Long, MD, MPH, was named president and CEO for the statewide organization last fall, taking the reins from Craig Becker, (CONTINUED ON PAGE 4)
Cardiac Innovation in Nashville
Technology, Trials Make Middle Tennessee a Hub for Heart Health By MELANIE KILGORE-HILL
the patient is the focus of our attention and evaluation.” Prior to transcatheter valve procedures, patients Home to multiple large cardiology practices and prooften lacked an alternative to open heart surgery due to grams, Middle Tennessee physicians keep heart health on age, co-morbidities or prior heart surgeries, and an aging the cutting edge. population has forced surgeons to think outside the box when it comes to repairing or replacing diseased valves. Valve Innovation at Saint Thomas Heart Now offered at Saint Thomas Heart, minimally invasive Transcatheter valve therapies are a welcome alternaMitraClip transcatheter mitral valve repair uses ultrative to open heart surgery, and Ascension Saint Thomas sound of the heart to guide the clip to the leaky valve, is paving the way. M. Andrew Morse, MD, interventional which is essentially stapled shut. cardiologist at Saint Thomas Heart, said the program has “The MitraClip allows us to go in and visualize Dr. M. Andrew Morse morphed organically into one of the region’s largest for and repair the valve directly, which improves quality transcatheter valve therapy. of life and typically gets patients out of the hospital the next day,” “It really is a full team approach,” said Morse. “Transcatheter said Morse. “It’s a game changer, because patients recovery quickly therapies are at the forefront of innovation for heart valve disease, and (CONTINUED ON PAGE 6)
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Transmyocardial Laser Revascularization
An Option to Significantly Reduce Angina and Improve Quality of Life Patients with refractory angina often have a limited exercise tolerance and poor quality of life. These patients may not be responsive to antianginal medication, or candidates for percutaneous coronary angioplasty or coronary artery bypass. Transmyocardial Laser Revascularization (TMR) can be a good option for patients By V Seenu with this difficult clinical Reddy MD picture. MBA FACS It has been over a decade since TMR was approved Cardiovascular for clinical use in the United Surgeon States and numerous studies in NEJM, Lancet and JACC have demonstrated the effectiveness of the procedure, yet it remains significantly underutilized. TMR, as a sole surgical technique is typically performed through a left thoracotomy, which uses a laser to bore channels in surfaces of the heart muscle and through the left ventricular myocardium of the beating heart to improve blood flow to ischemic myocardial territories not being reached by diseased arteries. TMR is a promising therapy option for patients with refractory angina and as an adjunct to coronary artery bypass graft surgery for patients with angina who cannot be completely revascularized surgically or with PCI alone. When performing TMR cardiac surgeon delivers precise laser therapy directly to target areas of the heart muscle. When performed as a primary therapy, it is done through a thoracotomy with the patient under general anesthesia. TMR can also be performed as a secondary procedure in patients that have ischemic heart disease with areas of the heart that cannot be bypassed. The Yag Holmium laser therapy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 10 –40 channels are made in each targeted region of the heart muscle. The channels in the heart muscle seal over almost immediately with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately. In order to reduce risk of arrhythmia, the laser system is linked to an ECG to monitor what the heart is doing, and pulses only when the heart is at its maximum expansion. It is believed that the therapy works by triggering the body’s own ability to grow new blood vessels in the heart improving blood flow to those areas.
TMR is a treatment option for patients who: • Have severe chest pain (Class III and IV angina), which limits their daily activities or causes them to wake from pain at night, despite maximal medication therapy • Have pre-operative tests that show ischemia and have EF greater than 35% • Have a history of previous bypass surgery or angioplasty, and no further intervention is available. • Have been told by their doctor that there is nothing that can be further done to help their symptoms. Most of the time, the best treatment for angina is either PCI or coronary artery bypass surgery, but for some patients with very serious heart disease or other health problems, bypass surgery may be too dangerous. Some patients may have had previous stents or coronary artery bypass operations and be unable to have more procedures. For many of these complex patients, TMR offers relief from the pain of angina and in many of my patients has significantly improved their quality of life, allowing them to return to work and other activities of daily living while reducing medications and recurrent visits to the ER. For more information, call 615.342.6900 or go to TriStarCardiovascularSurgery.com.
A Modern Love Story: Where Technology, Healthcare & Construction Go Hand-in-Hand Technology has changed every aspect of our lives. In fact, I had a healthy laugh a few weeks ago when I showed my children an old rotary phone and, get this, they did not know what it was. You see, they are now part of a generation that is accustomed to pulling out a smart phone BY MATT DEVRIES to have dinner delivered by a complete stranger, groceries packed for pick-up within two hours, or even a potential spouse connection made online. In the construction world, that same generation is communicating about project details via text and instant messages, checking on the status of material delivery trucks by GPS, and identifying design conflicts through 3-D and 4-D modeling. In the healthcare arena, technological advances are improving diagnostics, treatment and patient care, as well as access to and storage of confidential patient information. The healthcare industry remains one of the most regulated ones in the nation, which can present some special challenges for design and construction. Nonetheless, when you marry technology,
healthcare and construction, you have a real opportunity for success. Here are five lessons to remember when dealing with either new construction or renovation projects involving hospitals or other medical care facilities: It is imperative to get your information technology team involved in the design process, as well as a seat at the table during weekly construction meetings. It is no secret that technology changes on a regular basis … Just check how much your laptop is worth two months after you purchase a new one! In the healthcare industry, the available technology can radically change from the time the design is finished to the time of substantial completion of the construction or renovation. By bringing the IT folks to the design table, you can begin to prepare for many of the changes in technology. It is important for all the players to be ﬂexible. Since technology changes so rapidly (see above), flexibility is key to a successful implementation of new equipment, renovation of entire floors, or new construction of a medical facility. I worked on a particular project involving a design change during construction of the in-room work stations, which allowed physicians and nurses to face the patient while reviewing and charting information, as opposed to having their back to the patient, as originally designed. Choose equipment that allows all systems to communicate with each other. Although systems are begin-
ning to be more compatible, it is important to talk with your vendors and specialty suppliers to make sure the various systems can integrate properly. You don’t want to enter the commissioning period to learn that late in the game that software conflicts may require costly patches in terms of time and money to get a fully integrated system working. Get the end-users involved in the design and construction process. This does not mean your nurses will be carrying around hammers and nails. It means that the design team needs to understand the work flow of the end users and be ready to adapt to that information learned in the design process. It is equally important to understand the expectations of the end users and to implement those expectations into the end result. Prepare a contingency plan for your IT needs. Stated another way, don’t put all your eggs in one basket. While this may seem to be a no-brainer, the entire team needs to talk through contingencies. These contingencies can involve problems, emergencies or expenses. The real lesson is to make sure each player (owner, architect, engineer, contractor) is talking about the same contingency and then to plan for that contingency. The goal of each of the above tips is to provide consideration and integration of technology, design and construction for the unique challenges in a healthcare project. One of the most important ways to implement these tips, as an owner, is to consider
alternative contract delivery methods when you hire your design and construction team. You may be familiar with the traditional design-bid-build method where you hire an architect to design your project, look to potential contractors who will bid on the work, and ultimately hire a contractor to build the project. Other approaches include integrated project delivery (IPD) and design-build. An IPD approach actually involves a multi-party agreement where the owner, designer and contractor are all work together during design and construction, but each is ultimately responsible for their own work. Under a design-build model, there is one single source of responsibility for the design and construction (i.e., a designbuild contractor) throughout the entire process. This includes preparation of the estimate, to assessments and pre-construction activities, to architectural design, schematics, and engineering, to material selection and subcontractor/vendor selection, to construction, to completion and commissioning. Again, under a designbuild approach, everything you need to successfully complete the project on time and within budget is management by one party at risk — the design-builder. Matt DeVries is a partner in the Nashville ofﬁce of Burr & Forman and the former chair of the ﬁrm’s Construction Practice Group. He is also founder of bestpracticesconstructionlaw.com, a construction-related blog that focuses on technology, project management, legal trends in the industry and lessons learned along the way. For more information, go to burr.com.
The Nashville Medical News Blog features additional insights and information from a crosssection of industry leaders. The blog can be accessed directly through NashvilleMedicalNews. Blog or from the homepage of the main website. NEW IN FEBRUARY: Industry pundits predict that 2020 will be a watershed year in the meaningful adoption of healthcarebased Internet of Things (IoT) applications, AI-powered health technology and other data-driven health related technologies. But this adoption isn’t without risk and comes with significant regulatory and compliance rules and regulations. In this article Ernest Sampera, chief marketing officer for vXchnge explores advances, challenges and vulnerabilities to consider. Physicians and practices are always looking for effective ways to attract new patients in a highly competitive market. Don Baham and the crew at Kraft Technology Group share “Eight Effective Marketing Tactics for Reaching Out to Patients Online.”
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THA, TMA, TNA Outline Legislative Priorities, continued from page 1 who retired after leading THA for more than 25 years. Among continuing concerns are maintenance of the state’s certificate of need program, the voluntary hospital assessment and supDr. Wendy Long port for rural hospitals. Additionally, THA is focused on measures to improve telehealth laws as usage continues to increase. CON: THA is a strong supporter of Tennessee’s certificate of need program, believing the regulations help level the playing field and dissuade “cherry picking” the commercially insured patients that keep hospitals financially viable. “We do definitely believe the CON program is absolutely essential,” said Long. “We think it helps in managing healthcare cost, workforce demands and making sure access to quality healthcare services is available throughout Tennessee.” She added the CON program was a hot topic last year and expects legislation to be introduced again this session. “We agree there are some improvements that could be made in the CON process or operation of the program, and we hope that is the focus.” Long noted THA is happy to work with the Legislature to improve the efficiency and transparency of the program in a way that isn’t detrimental to the underlying reasons certificates of need were originally implemented. “We certainly worry very much about rural hospitals if there are changes to the CON program,” she said. Hospital Assessment: Long said THA will once again voluntarily bring the annual hospital assessment legislation to Tennessee lawmakers. The assessment at the state level draws down matching federal dollars for the TennCare program. Long noted the idea of hospitals picking up what had traditionally been funded by the state first occurred in 2010 at the height of the recession. “We were looking at substantial changes to services and benefits in TennCare. As a result of that set of dire circumstances, hospitals came forward and voluntarily offered to put up the necessary funding.” She continued, “That assessment today generates $602 million in state funding, which draws down a federal grant for a total of $1.7 billion.” The rate of assessment will remain at the current rate of 4.87 percent of a hospital’s net patient revenue. The funding, Long explained, averts limits on certain benefits, including physical, speech and occupational therapy, for TennCare enrollees. It also avoids a 7 percent reduction in TennCare provider rates. Although hospitals have agreed to the assessment annually for the last decade, Long said it shouldn’t be considered an automatic conclusion. “It’s something we discuss each and every year. I would not characterize it as an easy decision,” she noted. “Hospitals continue to hope at some point the state might begin to replace this money with other revenue 4
sources, but that has not happened so each and every year, hospitals have to reassess the issue.” Rural Hospital Support: In 2018, the General Assembly created the Rural Hospital Transformation Program to support work between at-risk rural hospitals and consultants who would assess the facilities and formulate strategies to improve hospital viability and access to care. As a result of this program, Long said several hospitals have completed the work with consultants and now have a list of recommendations in hand. “Some good suggestions were made … but in many, if not all, cases, there was a need for funding resources,” said Long. “This was a great first step to do the analysis to come up with these plans,” she continued. “Now we’d like to see funding be directed to help the hospitals be in a position to implement those plans.” Telehealth: THA is working in concert with a number of provider organizations to tweak Tennessee telehealth laws. Long, who previously served as director of TennCare, noted she has been involved in telehealth for many years. Originally, technology was the big obstacle. As tech improved, the next question was whether or not patients would use it. “People really do like it,” she noted. “Now, I think our focus is on reimbursement.” Long continued, “We’re working the Tennessee Medical Association on legislation to try to make sure payment is there. The vast majority of insurers do pay on the originating end – but not all – so that’s one of the areas we’d like to clean up.” In addition to codifying facilities that host the patient encounter receive a site origination fee, other desired modifications include establishing infrastructure and payment parity for provider-based telehealth services to enable patients to receive ongoing care from their existing physicians via a telehealth encounter and ensuring coverage for remote patient monitoring in a manner consistent with current Centers for Medicare and Medicaid Services policy. TennCare: While not a legislative agenda item, Long said keeping hospitals in mind as TennCare begins the bid process for managed care contracts is definitely an advocacy issue for THA. “This is a ‘once-in-a-not-very-often’ bid,” said Long, adding the hope is appropriate language is included in the RFP and awarded contracts to ensure hospitals are fairly considered and compensated. Improving access to care is another key advocacy issue. “We would still love to see expansion of the number of people with access to insurance in the state, but we don’t see any kind of appetite for traditional Medicaid expansion,” Long explained. “But, we do perceive the block grant the state proposed as a step in the right direction and will continue to be very engaged as the proposal moves forward.”
Tennessee Medical Association
The Tennessee Medical Association has a number of priorities on the table for 2020. Balance billing, telehealth and
the state professional privilege tax are all on the organization’s radar. And, after a three-year moratorium, the contentious issue of scope-of-practice regulations has returned in 2020. TMA CEO Russ Miller, CAE, shared insights on his organization’s stance on all four topics. Balance Billing: Although no related bills gained traction in the Tennessee General Assembly last year, Miller said the U.S. Congress is looking at the issue of ‘surprise medical bills.’ He added he believes solutions ultimately will happen at both a federal and state level. “Whatever happens at Russ Miller the federal level, we’ll try to improve upon at the state level to best serve our physicians and their patients,” said Miller. “Nobody should be caught by a surprise bill and be stuck with tens of thousands of dollars. We’ve got to help the patients who get caught in that situation.” While everyone has an example of a patient caught in a situation that is often out of their control, Miller said such surprises are still fairly rare in comparison to the normal delivery of care. However, he added, out-of-network surprise billings seem to be increasing in frequency and becoming more expensive for the patient responsible for payment. He cited a narrowing of insurance networks as a key contributing factor to the problem. “This is not about doctors or hospitals gouging patients, it’s about this insurance network wrinkle,” Miller said. He said TMA is advocating for a solution that exonerates patients from the financial burden of these surprise out-of-network charges while ensuring physicians are paid appropriately for services provided. Miller said a solution is to create an average cost for services, but he doesn’t believe insurers should be in charge of the benchmarking. “There needs to be a non-biased, third party benchmark set,” he explained. “There must also be some type of independent dispute resolution,” he continued. Citing New York as an example, Miller said disputes happen in less than 2 percent of cases. When a third party arbitrator has been called in to adjudicate, he said the decisions have been split almost dead evenly in favor of payers or providers. Telehealth: A bill supported by TMA in 2019 to ensure telehealth services were reimbursed at the same rates as inoffice visits didn’t pass. However, Miller said it did advance the conversation about rules and reimbursement governing the technology that has become increasingly critical for access to care, particularly in rural and underserved areas or for specialties with a shortage of providers. “There are times you need emergent care, but we’re trying to afford convenience to established patients,” Miller said of using the technology to support medically appropriate encounters, including follow-up appointments. Telehealth interactions are typically
defined as synchronous or asynchronous. The former utilizes audio and video technology, along with encryption, to facilitate real-time consults. The latter, also known as ‘store and forward’ applications have delayed communication and are used to transport images or in a messaging type of format. “Right now, you have a lot of services provided in one of those formats without a lot of regulation around it,” Miller said, adding the goal is to facilitate access to the technology while putting up some guardrails to ensure appropriate use. Tennessee Professional Privilege Tax: “It is a privilege to be a doctor, but we shouldn’t be taxed on that,” Miller stated. Prior to adjourning the 2019 session last May, the General Assembly exempted several professions from paying the state’s professional privilege tax, but physicians weren’t included in that group. TMA has advocated for a reduction or removal of the tax for years, and Miller said they would continue working with state lawmakers on the issue. Scope of Practice: After previous talks led nowhere, a three-year moratorium was instituted from 2017-2019 on any scope-of-practice legislation redefining supervisory parameters for advanced practice nurses. With the end of the moratorium, the issue is again at the forefront of discussions between TMA and TNA. “We were at great odds, and the debate was pretty raw,” Miller said of where things left off in the fall of 2016. Since last summer, the two groups have been working toward finding some resolution to the debate. Miller said he perceives some small progress has been made. “There are some things we agree on; some things we’re far apart on; and some things we need to get back to them on,” he said of the current status. While the statutory relationship between physicians and advanced practice nurses changed from being called ‘supervision’ rules to ‘collaborative’ rules in 2016, Miller said there was no real substantive change other than nomenclature. Now the goal of both organizations is to meaningfully modernize and enhance that collaborative arrangement, but there is still significant disagreement on how updated regulations ultimately look. Independent practice for nurses remains the sticking point. “There are situations when care can be delivered efficiently by advanced practice nurses, but we don’t think those instances mean that you can do everything, all the time independently,” Miller said of the physician viewpoint. However, he continued, physicians recognize some of the current rules need updating. Particularly in areas of shortage, it can be difficult for nurses to secure a collaborative agreement with a physician prepared to come onsite for chart reviews monthly. While TMA isn’t willing to abandon collaborative arrangements completely, Miller said there might be ways to build in some flexibility. “We’re trying to modify the relationship. For (CONTINUED ON PAGE 5) nashvillemedicalnews
Reeves/Smith Bill to Prevent Next Generation of Nicotine Addiction Garners Broad Industry Support In late January, a group of more than 25 organizations from across Tennessee announced their support for legislation that seeks to prevent the next generation of nicotine addicts in the state. The bill (SB2079/HB2114), sponsored by State Senator Shane Reeves and State Representative Robin Smith, intends to: • Bring state law into compliance with federal law setting the purchase age for tobacco and cigarettes at 21; • Strengthen enforcement of the purchase age law by creating a license for retailers to sell tobacco products; • Move fines for non-compliance from the consumer to the retailer; and • Tax vape cartridges at $0.62, the same rate as a pack of cigarettes. “I am pleased that our federal Congressional leadership has made the critically-important move to raise the legal age to purchase tobacco and e-cigarette products from 18 to 21,” said NashvilleHealth Founder and Board Chair Sen. Bill Frist, MD. “Now, I encourage our state’s leaders to take the necessary steps to smartly implement this federal law and protect Tennessee’s youth.” According to a 2019 statewide poll, Sen. Bill Frist nearly 80 percent of
Tennessee voters said they are concerned about vaping and the use of e-cigarettes among young people in the state. More than 60 percent of Tennesseans support increasing the minimum age for tobacco sales from 18 to 21, and 86 percent believe vaping products and e-cigarettes should be included. “Tennessee is currently ranked 43rd in life expectancy with a very high presence of heart disease, COPD, cancer and stroke compared to other states,” said Sen. Shane Reeves, PharmD (R-14). “Increasing the purchase age to 21 will have a dramatic impact on those disease states over the next couple of decades.” Nicotine addiction directly impacts state spending as TennCare reports Sen. Shane Reeves expenditures of nearly $150 million in 2018 for members’ tobacco-related illness. This cost represents $147 million for members 21 years and older and $1.7 million for members under age 21. A former critical care and transplant nurse, Rep. Robin Smith (R-26) said, “The very concentrated forms of nicotine available via electronic cigarettes are quickly ensnaring teens and young adults. This bill
works to establish an enforcement mechanism of the federal law that protects against addictions.” Nearly 95 percent of adults who smoke began before the age of 21. In Tennessee, Rep. Robin Smith teen use of e-cigarettes has doubled in the past two years, and more than 20 percent of high school students report smoking cigarettes or cigars or using smokeless tobacco or electronic vapor products in the last 30 days. According to the Centers for Disease Control, nicotine, the addictive substance in tobacco, e-cigarette and vape products, can harm adolescent brain development, specifically the parts of the brain that control attention, learning, mood, and impulse control. Using nicotine in adolescence may also increase risk for future addiction to other drugs. Currently in Tennessee, e-cigarette and vape products are not taxed, while traditional tobacco products are – cigarettes at 62 cents per pack of 20 cigarettes and all other tobacco products at 6.6% of the wholesale price. Tennessee ranks 43rd lowest in the nation for its 62 cents per pack tax. Twenty-one other states currently tax e-cigarette and vape products.
Organizations Supporting the Reeves Smith Legislation: American Heart Association Amerigroup BlueCross BlueShield of Tennessee Boys & Girls Clubs Tennessee Alliance Children’s Hospital Alliance of Tennessee Cigna Coalition for Better Health Delta Dental March of Dimes Mental Health America of Middle Tennessee Nashville Area Chamber of Commerce NashvilleHealth Saint Thomas Health State Collaborative on Reforming Education (SCORE) Tennessee Academy of Family Physicians Tennessee Afterschool Network Tennessee Chapter of the American Academy of Pediatrics Tennessee Charitable Care Network Tennessee Dental Association Tennessee Hospital Association Tennessee Medical Association Tennessee Pharmacists Association Tennessee Primary Care Association Tennessee’s Public and Teaching Hospitals Tennessee Oncology Practice Society Tennessee Section of American College of Obstetricians and Gynecologists Tobacco-Free Chattanooga United Ways of Tennessee Vanderbilt University Medical Center
THA, TMA, TNA Outline Legislative Priorities, continued from page 4 those APRNs with a lot of experience, reduce the amount of interaction and oversight for them, but those new to practice still need some hours of behind-thewheel mentoring,” he said. Although the level of oversight could be less for experienced nurses, the TMA stance is that it would never reduce to zero. “Having a physician in the arrangement serves as a vital backstop when there are conditions they (APRNs) are not able to take care of. It’s not good enough to say you’ll refer it,” Miller stated. “We have a hard time understanding why practicing alone will improve the environment when the entire industry is moving to teambased care.” While completely independent practice is a non-starter for physicians at this point, Miller said there are a number of areas TMA agrees should be addressed. “We need to do a better job of monitoring and regulating those who serve as collaborating physicians,” Miller noted of one frustration nurses have voiced. He added the bureaucracy governing collaborative agreements certainly could be improved, and the willingness to lower the level of oversight for demonstrably experienced APRNs is a shift from even a few years ago. “They (TNA) want to know if whatever we are working on now will lead to an independent pathway, but TMA physicians won’t accept that as a solution.” nashvillemedicalnews
Tennessee Nurses Association
The Tennessee Nurses Association has been clear their focus is on addressing scope of practice for 2020 now that the moratorium has been lifted. “TNA priority legislation this year will be to update the nurse practice act to remove antiquated and unnecessary barriers to advanced practice registered nurses’ practice,” stated Tina Gerardi, MS, RN, CAE, executive director for TNA. Gerardi said at the heart of the issue is access to care for Tina Gerardi patients. “Tennessee has a primary care physician shortage and some of the poorest health outcomes in the country,” she noted. “APRNs want to provide the healthcare services they are educated and trained to provide in the communities where they live and work, while doing so at a reasonable cost,” she continued. “There are so many in Tennessee not receiving care. Rural areas come up as an example, but there is opportunity to improve outcomes and provide access to care in urban, as well as rural, areas throughout the state,” Gerardi said. “The Tennessee Legislature must modernize the nurse practice act to remove barriers that have been in place for decades,” she continued. Gerardi
added this isn’t a groundbreaking request. Currently 25 states plus the District of Columbia and much of the VA Healthcare system either have implemented full practice authority or have removed many of the barriers that limit APRN practice. Armed with multiple studies, Gerardi said research has found little difference between primary care provided by physicians and APRNs. However, she said it’s a mischaracterization that nurses want to ‘do it all’ or provide care beyond their ability. “Part of the education and training (for APRNs) is appropriately referring and collaborating with physicians and other healthcare professionals. Full scope of practice doesn’t mean we do it all ourselves, but we do what we can and then we consult and refer.” She added, “We always want to have a collegial relationship with physicians and other healthcare providers. That’s not the point … it’s whether collaboration takes place because of law rather than patient need. It doesn’t require law to work collaboratively.” In the current system, which requires a physician be onsite with the APRN at least once every 30 days and review a minimum of 20 percent of charts, Gerardi pointed out the APRN has already made the clinical decisions in real time within their abilities or referred to a higher level of care days or weeks beforehand. “The
vast majority, if not all, chart review is done after the fact,” she said. Another growing concern is simply being able to find and afford a collaborating physician. Gerardi said as doctors retire or hospitals close and physicians relocate, APRNs find it increasingly difficult to secure physician oversight. With supply tight and demand high, monthly fees to contract with physicians have increased, as well. “Eventually that contributes to increased cost of care,” she pointed out. While TNA is working with lawmakers to introduce legislation this session to move to full practice authority, she is prepared for a fight. “There hasn’t been a single state that has passed scope of practice laws on the first try,” she said. “It’s more of a marathon than a sprint. I’d love for Tennessee to be the first state to sprint to passage.” The organization is also prepared to continue looking for consensus with TMA. Gerardi said the Coalition for Access to Care for Tennessee, a group of APRN organizations in the state along with TNA, last met with TMA representation in the late summer, providing them with more information but have yet to hear back with their proposal. “We’re still open to negotiating with TMA to remove barriers to APRNs practicing to their full education and training, but the ball is really in their court,” she concluded. FEBRUARY 2020
Cardiac Innovation in Nashville, continued from page 1
without spending a month healing after rates, streamline TAVR procedures and surgery. It’s been an amazing transition.” expand access to treat patients even with While the MitraClip became comchallenging anatomies. Now the team is mercially available in 2013, Saint Thomas looking at treatment options for tricuspid Heart had already played a pivotal role in valves. “The tricuspid valve is often forgotthe MitraClip COAPT clinical research ten, but clinically it’s very important and trial. Nearly seven years later, treated has never had a good catheter-based therpatients are still going strong and the apy,” said Morse, who’s involved in a TriMitraClip has proven to be a sustainable luminate clinical study involving an Abbott therapy long term. “That was an increddevice similar to the MitraClip. ibly powerful trial for patients, and we were “Today’s therapies and screening tools fortunate to be the first to use the MitraClip are better, so we can identify valve probin the trial and then again once it became lems earlier and send patients to a valve commercially available,” said Morse. center of excellence,” Morse continued. Saint Thomas Heart recently became “We have numerous transcatheter valve the 17th heart center in the U.S. to exceed 300 options to keep us robust and innovative in MitraClip procedures. “Mitral valve therapy our approach, so we can continue to offer is quickly evolving, and there are now hunnew technology to our patients. Unless you dreds of companies working on different stay at the forefront you don’t have every technologies in that space,” Morse said. option to serve the community.” “The clip is wonderful but can’t treat every anatomy, so it’s a disease that still Robotics at TriStar needs more innovation.” Centennial To that end, Saint Robotic technology has Thomas Heart is involved in a been a game changer for mininumber of minimally invasive mally invasive procedures, and valve trials, including the SUMcardiac surgery is no excepMIT Trial for Abbott Tendyne tion. “Robotic systems have Transcatheter Mitral Valve evolved a lot in recent years, Replacement. Saint Thomas with refinements in endoHeart was also the first in scopic technology that allow Tennessee to implant the better visualization of the ACURATE neo2Aortic Valve operative field and minimizaSystem, a new generation tion of tissue trauma enabling of transcatheter aortic valve faster recovery,” said Sreekureplacement (TAVR) designed mar “Kumar” Subramanian, ACURATE neo2 Aortic Valve System to further reduce complication MD, cardiac surgeon at TriS-
Do you have your finger on the pulse of your practice?
tar Centennial Medical Center. In December 2019, Subramanian became the first TriStar heart surgeon to use the da Vinci Xi robotic surgery system to operate on an uncontrolled diabetic patient with severe coronary artery disease. Using the robot, Subramanian is able to harvest internal mammary arteries from the chest wall without having to use a specific Dr. Kumar Subramanian open surgical retractor. “Being able to harvest an artery without lifting the chest wall reduces tissue trauma, as well as the risk of sternal fractures, especially in patients with diseased bone,” said Subramanian, who also plans to use the robotic system for valve surgery, removal of intracardiac tumors, atrial fibrillation ablation surgery and other procedures. While the system has notable advantages, Subramanian said the department is being intentionally conservative in rolling out the new technology. We have a very cohesive team in place and are trying to use this discriminately, as technology can sometimes increase healthcare costs, decrease efficiency and be no better for the patient in the long-run.” Subramanian said patient satisfaction has been very high among those who have undergone robotic-assisted heart surgery. “We are patient-centric, and the high patient satisfaction is ultimately the reason that we will continue to expand our program.” Subramanian anticipates the hospital will perform 100 robotic-assisted heart surgeries in the next year, with an increased focus on low risk patients with three-vessel coronary artery disease. Traditionally, patients with the diagnosis receive stenting on all three vessels. More recently, hybrid procedures, which involve minimally invasive surgical bypass using the left internal mammary artery (LIMA) to the left anterior descending (LAD) and stenting of the other vessels, have become more popular. “Robotics facilitates the minimally invasive LIMA-LAD bypass by avoiding rib spreading and may also be beneficial in some patients where a sternotomy approach is best avoided,” he explained. “I am committed to the safe and effective implementation of new technology as our program continues to grow.”
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Vanderbilt University Medical Center is breaking records for innovation in heart care. “One of our biggest priorities as an academic center is to be on the leading edge of discovery and innovation in cardiovascular care, whether in delivering life-saving therapies to patients with advanced heart disease or in delivering innovative preventive care to help keep patients free of heart disease,” said Daniel Muñoz, MD, MPA, Dr. Daniel Muñoz
associate executive medical director of the Vanderbilt Heart & Vascular Institute and medical director for the Cardiovascular ICU at VUMC.
In 2019, VUMC tied for first place as the busiest heart transplant program by volume in the United States, performing a record 118 heart transplants — 96 adult and 22 pediatric patients — topping the previous year’s record of 109. It tied with Cedars-Sinai Medical Center in Los Angeles for the busiest heart transplant center in the country. “Beyond the numbers is a remarkable story of quality outcomes and of missioncritical collaboration between a world-class team of cardiac surgeons, cardiologists, nurse professionals, and others,” Muñoz said. The Medical Center was ranked as the No. 2 heart transplant center by volume for the previous three consecutive years. The center’s adult heart transplant program began in 1985, followed by the opening of the pediatric program in 1987. “Our remarkable year also reflects how much heart transplantation has changed and the advantages of our size,” said VUMC cardiac surgeon Ashish S. Shah MD. “Frankly, modern heart transplantation demands high performing, experienced teams. Our high volume has opened opportunities to use new organ preservation technology and to help the most complex patients. It has been immensely satisfying to help patients in our region and to also have a world-wide impact with our research and clinical innovation.”
“For several decades, the number of heart transplants performed annually in the United States has been relatively stagnant,” said Kelly Schlendorf, MD, MHS, medical director of VUMC’s Adult Heart Transplant Program. “Over the past few years, however, heart transplant volumes are on the rise, due in part to transplantation using hepatitis C-positive donors. These donors offer a stratDr. Kelly Schlendorf egy to safely expand the donor pool and allow more patients to undergo transplant. When you consider the alternative, that’s a big deal.” Between 2016 and 2018, 37 percent of Vanderbilt’s heart transplants were from hepatitis C-positive donors, a factor that allowed Vanderbilt to double the number of heart transplants, from 130 between 2013 and 2015 to 260 between 2016 and 2018. Vanderbilt is now the largest heart transplant program by volume in the country. According to VUMC study results published recently in JAMA Cardiology, heart recipients from hepatitis C-positive
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Middle Tennesseeâ€™s leader in cardiac surgery The specialists at Ascension Saint Thomas Heart are known for their leading-edge and innovative technologies. From the simple to the complex, our specialists are here, and have been caring for the hearts of this region for over 40 years.
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A Heart for Healing
Kristen Kerr Committed to Education, Better Cardiac Outcomes By MELANIE KILGORE-HILL
others that they ignore symptoms, which can be exacerbated by menopause and hormonal changes that occur later in life. According to the AHA, a decline in the natural hormone estrogen may be a factor in heart disease increase among post-menopausal women. That’s because estrogen is believed to have a positive effect on the inner layer of artery wall, helping to keep blood vessels flexible. Menopause also can drive up blood pressure and LDL cholesterol, putting older women in the same (or higher) risk bracket as men.
In the United States, one in four women die from heart disease. Those are odds TriStar Summit Medical Center cardiologist Kristen Kerr, MD, hopes to change.
Originally from Southern Alabama, Kerr said the greatest influence in her decision to pursue medicine was her father, a primary care physician in their small hometown of Andalusia. “My first taste of medicine was growing up and seeing those relationships my dad had with his patients,” she said. “You learn to appreciate that, especially in a small town like ours.” Kerr received her undergraduate degree from Birmingham-Southern College and remained in the city to receive her medical degree and complete her internship, residency and fellowship at the University of Alabama at Birmingham. As a med student, Kerr’s first rotation was the cardiac care unit, where she found she could have a tremendous impact in patients’ lives. “These patients were recovering from heart attacks, and I’d see them the next day on rounds and they were so grateful for advice and support after such a huge life event,” she said. “I was able to counsel them on smoking cessation, diet and exercise, and they were willing to listen.”
Women’s Heart Health
Kerr made the move to Nashville in September 2019, joining the staff at Centennial Heart at TriStar Summit Medical Center. She said the hospital – and city – provide a perfect work-life balance while still preserving a taste of the South. Kerr practices general, non-invasive cardiology with a focus on heart disease prevention, particularly among women. “Women’s heart health has gained some traction thanks to the (American Heart Association’s) ‘Wear Red for Women’ campaign, but I still don’t think enough people are aware that heart disease is the number one cause of death for women,”
AAC.20 • March 28-30 The American College of Cardiology together with the World Congress of Cardiology are preparing for the 69th Annual Scientific Session. ACC.20/WCC is set for March 28-30 in Chicago at the McCormick Place Convention Center. For more information or to register, go online to accscientificsession.acc.org.
Finding What Works
Kerr said. “Women don’t present like men, and I’ve seen several who’ve had atypical symptoms for a long time and just taken aspirin hoping it would get better. If you have symptoms that concern you enough to take aspirin, you need to talk to someone.” Women are often so busy caring for
When discussing preventative care and lifestyle changes, Kerr said she learned quickly that recommendations aren’t one-size-fits-all. “You really have to find the strategy that the patient is going to respond best with, and that will encourage compliance,” said Kerr. She has found apps for weight loss, exercise and smoking cessation highly successful among patients who like to visually track their progress. “I’ve had a great response from patients using these apps,” she said. “Others need me to tell them exactly what to eat and how to exercise. There are different strategies for different people, but you have to figure out
how to get them on board with those small changes, from walking once a day to moving more at work. Little things add up.” Those small steps include dietary changes, and Kerr said it’s important to realize that not every patient will adhere to the same menu. “The best diet is the one you can stick to,” she advised. “Find the least processed and most natural source of foods possible and avoid saturated fats.” A certified yoga instructor, Kerr also speaks to patients about mindfulness and incorporates those practices into her own busy life.
She’s also seeing a high volume of patients with atrial fibrillation and said the diagnosis is becoming much more common among an aging baby boomer population affected by co-morbidities such as high blood pressure and diabetes. “Patients are living longer, and I’m often reminding them that AFib needs to be taken seriously since it dramatically increases the risk of stroke,” Kerr said. “A lot of times AFib patients don’t have symptoms so they underestimate that risk, so I try to get that message out every day and let them know there are small steps they can take.”
Cardiac Innovation in Nashville, continued from page 6 donors had comparable outcomes after one year to patients who received hearts from donors that didn’t have the disease. Using such hearts, which would have been largely discarded a few years ago before direct-acting antiviral therapies were proven effective, presents an opportunity to expand the donor pool, shorten wait times for organs and ensure that fewer people die waiting for them. Mean wait time once patients agreed to receive a hepatitis C-positive heart was only four days, compared with national reported median wait times between 70 and 535 days. “Vanderbilt’s pioneering role in transplantation of hearts from hepatitis C virus-infected donors has allowed many waitlisted patients, who may otherwise not have survived, to be transplanted successfully,” noted Schlendorf, who served as lead author on the study.
VUMC Researchers: Polypills for Prevention
A single pill containing low doses of three medications to treat high blood pressure and one to lower cholesterol reduced the estimated risk of cardiovascular disease by 25 percent, according to a study published in the New England Journal of Medicine (NEJM). “Polypills” for prevention of cardiovascular disease have previously been studied in low- and middle-income
countries where other healthcare barriers exist, according to senior author Thomas Wang, MD, chief of the Division of Cardiovascular Medicine at VUMC. However, the U.S. study released last September of mostly low income, primarily black adults from a community health Dr. Thomas Wang center in Mobile, Ala., sets up a conversation about how to extend these findings to other settings. “The pill may address some of the barriers that contribute to disparities in health based on geography, socioeconomic class and other parameters that we know have existed in this country and other countries for a while now,” Wang said. “Despite advances in the prevention and treatment of cardiovascular disease, it remains the No. 1 global killer of both men and women.” The randomized, controlled trial of adults without cardiovascular disease enrolled 303 adults – 96 percent black, 60 percent female and 75 percent with an annual income below $15,000 – with half assigned to take a daily polypill for 12 months and the other half assigned to continue their usual routine medical care. Half of the study participants came from
the Southern Community Cohort Study, co-led by William Blot, PhD, a research professor of Medicine at VUMC and cosenior author of this study. Adherence was 86 percent after one year, based on pill counts. Participants underwent a standard medical exam, blood pressure measurement, and blood cholesterol testing during their initial visit, a two-month visit, and a 12-month visit. At the end of the year, study participants who had taken the polypill had decreased blood pressure by an average of 7 mm Hg and reduced LDL cholesterol levels as compared with participants in the usual care group, translating to an estimated 25 percent reduction in the risk of experiencing a cardiovascular event. “Patients seeking care at community health centers have traditionally been under-represented in clinical trials. We need to better understand what works and what doesn’t in these settings so we can improve outcomes for our fellow citizens who may be the most vulnerable,” said VUMC cardiologist and lead author Daniel Muñoz, MD. “We think there are advantages to combining populationbased strategies like the polypill with all of the virtues of precision medicine. It is a running start for people who need access to some medical care, but precision medicine should still be used to add therapy and adjust therapy.” nashvillemedicalnews
Heart Monitor AHA Celebrates Heart Month
The Middle Tennessee American Heart Association keeps the focus on cardiac care all year long, but February always holds a special place in their hearts. A number of educational events will occur throughout Heart Month focused on teaching blood pressure monitoring, hands-only CPR and general health messaging. This year, National Wear Red day is slated for Friday, Feb. 7. Knowing there are few sights cuter than babies and puppies, both will be decked out in red for 2020. The Babies Go Red initiative at Ascension Saint Thomas highlights CHD awareness along with the importance of healthy moms. Coming on the heels of recent research about the health benefits of man’s best friend, Go Red is going to the dogs. The study, published in Circulation: Cardiovascular Quality and Outcomes, showed dog ownership was associated with a 24 percent reduced risk of all-cause mortality and a 31 percent lower risk of death by heart attack or stroke compared to non-owners. In a classic win/win, Middle Tennessee AHA is working with the Nashville Humane Society to photograph adoptable dogs wearing red bandanas to reinforce the message that pets are good for the soul … and the heart.
Roden Wins Cardiology’s Prestigious Schottenstein Prize
On Nov. 18, officials with The Ohio State University Wexner Medical Center’s Heart and Vascular Center announced Dan Roden, MD, senior vice president for Personalized Medicine at Vanderbilt University Medical Center has been awarded the 2019 Jay Dr. Dan Roden and Jeanie Schottenstein Prize in Cardiovascular Sciences. Awarded biennially, the Schottenstein Prize honors leaders in the cardiovascular sciences who have made extraordinary and sustained contributions to improving healthcare. “I am deeply honored to have been nominated and selected for this very prestigious award,” said Roden, who holds the endowed Sam L. Clark, MD, PhD Chair in the Vanderbilt University School of Medicine. “I am especially grateful to the Schottenstein family for their continued support of the academic mission. He added, “This award also recognizes our institution’s long-standing commitment to the ideas around personalized medicine, and to the many people with whom I have been privileged to work over my time here.” NASHVILLEMEDICALNEWS
The Montreal native arrived at Vanderbilt in 1978 as a research fellow in the Division of Clinical Pharmacology and later as a fellow in cardiology. Since joining the Vanderbilt faculty in 1981, Roden has become internationally recognized for his studies of the mechanisms and treatment of abnormal heart rhythms and variability in drug response. One major interest has been pharmacogenomics — and especially the role genetic variations play in adverse drug reactions such as druginduced arrhythmias. Roden directed the Division of Clinical Pharmacology from 1992 to 2004 when he became founding director of the Oates Institute for Experimental Therapeutics. A fellow of the American Association for the Advancement of Science, he is professor of Medicine, Biomedical Informatics and Pharmacology and the author of more than 700 peer-reviewed scientific papers. He is also a leader in VUMC’s PREDICT project (Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment), which since 2010 has applied genomic testing to drug prescribing in an effort to avoid adverse drug reactions. He co-directs the Improving Prediction of Drug Action program, part of the Pharmacogenetics Research Network funded by the National Institutes of Health (NIH), is co-principal investigator for the VUMC site of the NIH Electronic Medical Records and Genomics Network and is principal investigator for the medical center’s DNA databank, BioVU.
Barker Leads VUMC Interventional Cardiology
Colin Barker, MD, a national leader in percutaneous heart valve therapies, joined VUMC as the new director of Interventional Cardiology last summer. Barker’s clinical interest is interventional cardiology, including complex percutaneous interventions (left main disease, multi-vessel disease, total occlusions), structural heart disease and percutaneous heart valve therapy (valvuloplasty, repair, percutaneous valve replacement, TAVR), and management of cardiogenic shock. His research interests include optimizing therapy for older adults with heart and vascular disease, new technology and device development and the pharmacogenomics of anti-platelet therapy. Barker is the principal investigator on several clinical trials investigating novel therapies for coronary artery disease, heart valve disease and high blood pressure. He received his medical degree from Boston University and completed his internship and residency training in internal medicine at VUMC. Barker completed
his fellowship in cardiovascular disease at the New York University Medical Center and completed advanced training in interventional cardiology, as well as peripheral and endovascular interventions at Scripps Clinic/ Green Hospital in La Jolla, Calif. Barker is a member of the Council on Cardiovascular Care for Older Adults at the American College of Cardiology (CCCOA) and a fellow of The American College of Cardiology and the Society for Coronary Angiography and Interventions.
McMullan First in State to Place New Type of Stent
In late December, officials with Saint Thomas Midtown Hospital said Paul McMullan, MD, became the first physician in Tennessee and in Ascension nationally to place an R2P MISAGO® RX Self-expanding Peripheral Stent, a newly launched product by Terumo Interventional Systems. The outpatient procedure to treat peripheral artery disease was a success with the patient being discharged less than 2 hours post-surgery. With treatment options such as
atherectomy and stent placement, physicians can improve blood circulation, diminish the likelihood of clot occurrence, and decrease the patient’s risk of having a heart attack. The R2P (Radial to Peripheral) portfolio allows doctors to treat peripheral artery disease with fewer complications than traditional methods by accessing the patient’s radial artery in the wrist, rather than through the groin or leg. Studies have shown that radial intervention lowers the chances of increased blood loss, reduces recovery time, and accelerates the discharge process.
Bonus Beats For extended Heart Monitor information featuring additional news and studies from the American Heart Association, go online to NashvilleMedicalNews.com
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Ifetroban for Treating DMD-Associated Cardiomyopathy Cumberland Pharmaceuticals Gears up for Phase II Clinical Trial By CINDY SANDERS
Last fall, the U.S. Food and Drug Administration (FDA) announced $15 million in grant funding in support of 12 new clinical trials through the Orphan Products Clinical Trials Grant Program funded by Congress. The grants aim to determine the benefit of various treatment options for patients with rare diseases. Cumberland Pharmaceuticals, a Nashville-based specialty pharmaceutical company, received $1 million as one of the 12 recipients to help fund a new Phase II clinical trial studying the use of ifetroban to treat cardiomyopathy associated with Duchenne Muscular Dystrophy (DMD). Ifetroban is a potent antagonist of the thromboxane prostanoid (TP) receptor, which has various functions including smooth muscle contraction, platelet aggregation and inflammation. “It is not currently approved by the FDA but is a candidate for orphan drug status because DMD meets the U.S. definition of a rare disease,” explained Ines Macias-Perez, PhD, principal scientist for Cumberland Pharmaceuticals. She added the drug is being developed for several other indications recognized as unmet medical needs, as well. “We were studyDr. Ines ing it originally for Macias-Perez pulmonary arterial hypertension,” Macias-Perez continued, “and found ifetroban could prevent fibrosis in the heart.” That observation led the publicly traded company – which has successfully brought a number of other drugs to market to treat a range of unmet needs – to consider ifetroban as a possible therapy for DMD patients. Typically diagnosed between the ages of three and five and affecting one in 3,500 to 5,000 male children, DMD is a fatal neuromuscular disease caused by a genetic mutation that prevents the body from producing dystrophin, which is critical for muscles to function properly. Characterized by muscle weakness and the progressive loss of muscle, cardiomyopathy leading to arrhythmias and heart failure has emerged as the leading cause of death in DMD patients. “DMD is a devastating X-linked disease affecting primarily boys and leads to losing their ability to walk between ages eight and 12, respiratory failure and cardiomyopathy at any age, and inevitably premature death in their 20s or early 30s,” explained Macias-Perez. “Many other drug development efforts are focused on restoring dystrophin and prolonging ambulation. With no specific cardiac treatments to extend life, our study aims to address this unmet need using a new therapeutic strategy for patients with DMD.” 10
Cumberland Pharmaceuticals is working in collaboration with scientists at Vanderbilt University Medical Center evaluating ifetroban in mouse models of DMD. They hypothesized TP signaling contributes to DMD-associated cardiomyopathy since activation of TP can create fibrosis in the heart, and therefore blocking TP signaling with ifetroban might decrease the cardiac fibrosis and dysfunction, which could ultimately help those with the disease live longer. Results of the preclinical studies affirmed those conclusions with all mice in the ifetroban arm surviving to the end of the study compared to 60 percent, 43 percent and 90 percent in the various mouse models treated with placebo. Additionally, TPr antagonism improved cardiac output in two models of severe DMD and increased ejection fraction while decreasing fibrosis in the third. The team from Vanderbilt, Cumberland Pharmaceuticals and Indiana University School of Medicine – where Larry Markham, MD, a former clinician at Vanderbilt and primary investigator on the ifetroban trial, is located – recently published these successful results. “Antagonism of the Thromboxane-Prostanoid Receptor as a Potential Therapy for Cardiomyopathy of Muscular Dystrophy” appeared in the December 2019 issue of the Journal of American Heart Association. Although the Phase II trial hasn’t yet begun recruiting, Macias-Perez said the first site at Children’s National in
Washington, D.C., will begin this month. The plan, she continued, is to have six to nine sites across the country participate to quickly enroll 48 DMD patients. The boys in the study must be at least seven years old and have stable heart disease. Although this is the first ifetroban trial for DMD patients, Macias-Perez noted the safety profile of ifetroban is well established with more than two dozen clinical trials, including Cumberland Pharmaceutical’s ongoing trials in scleroderma and aspirin-exacerbated respiratory disease (AERD). “We worked with families, patient advocacy groups and caregivers to help us design a study that focuses most importantly on the patient and their families,” Macias-Perez said. For this reason, she continued, study participants only have to visit the clinician at least three times within a 12-month period to minimize the burden of travel. Additionally, a travel stipend will be provided for those traveling more than 50 miles to the clinical sites in an effort to keep participation from becoming a financial burden. “Cumberland also designed a new method of measuring ifetroban pharmacokinetics for the DMD trial using a finger-stick method that can be done at home. We were informed during the study design review process that traditional methods using multiple blood draws over 24 hours is a challenge for DMD patients and their families,” said Macias-Perez.
“The patient families also told us that having the option of continuing on ifetroban after completing the trial is important to them when considering participation on a clinical trial. We changed our protocol to include an optional, open-label extension for all patients that complete the initial 12 months of treatment. “Incorporating patient feedback into our DMD trial design has added greater value and meaning. We are so grateful to our DMD community for their support of our clinical trial,” she added. “This new program is an excellent strategic fit for our company given our mission to develop new medicines that address unmet medical needs,” said Cumberland Pharmaceuticals CEO A.J. Kazimi. “As ifetroban may uniquely address the heart failure associated with this deadly disease, we very much appreciate the FDA grant support of our novel treatment for these critically ill patients.” A.J. Kazimi He added, “The FDA’s involvement through the Orphan Drug Grant is the first time they have gotten involved with DMD from a financial support standpoint.” Kazimi said it is exciting the FDA believed this was the right program, the right product and the right clinical sites to move forward.
Other News of Note from Cumberland Pharmaceuticals In November, data from 964 patients across 45 U.S. sites in the Telavancin Observational Use Registry (TOUR™) confirmed positive clinical outcomes for ‘real world’ usage of Vibativ® (telavancin) in a number of infection types. The FDA-approved anti-infective is used to treat a range of Gram-positive bacterial pathogens, including those considered difficult-to-treat or multidrug-resistant. The recently released information found overall positive clinical response rates by infection type were comparable at 74 percent in patients with bacteremia or endocarditis, 79 percent in patients with bone and joint infections, 80 percent in patients with complicated skin and skin structure infections, and 67 percent in patients with lower respiratory tract infections. On Jan. 7, Cumberland Pharmaceuticals announced the national launch of a new Caldolor® (ibuprofen) injection in a ready-to-use bag that may be administered without dilution for pain relief. The launch followed FDA approval in 2019 of the product’s new delivery method, which is designed to help address the national opioid crisis. A non-steroidal anti-inflammatory drug (NSAID), Caldolor could be used as the sole method of treatment for mild to moderate pain or as part of a multi-modal treatment for severe pain. Recognizing even short-term opioid use after surgery could lead to long-term addiction, Cumberland Pharmaceuticals is positioning Caldolor – which has the three therapeutic properties of being anti-inflammatory, analgesic and antipyretic – as a viable option for prompt and appropriate pain management. Published data for Caldolor supports administration just prior to surgery and throughout the postoperative period. As a result, patients experienced significantly less pain upon awakening and remained in significantly less pain post-op, while also reducing their opioid consumption. “We have been encouraged by the significant number of physicians who have incorporated Caldolor into their pain management regimens as a way to combat the negative effects of opioid use,” said Cumberland Pharmaceutical CEO A.J. Kazimi. “The new ready-to-use presentation of Caldolor offers hospitals and other medical facilities a proven product that is now easier to administer and, thus, has the potential to further reduce opioid use.” The new formulation of Caldolor comes in a pre-mixed bag containing 800 mg of ibuprofen in a 200 mL patented low sodium formulation for injection that is ready to use. It is the first and only FDA-approved pre-mixed bag of ibuprofen. Caldolor is still available as an 800 mg/8mL single–dose vial (100mg/mL) for dilution in addition to the ready-to-use bag (4 mg/mL).
Endocrine Society Celebrates Progress from Bench to Bedside By CINDY SANDERS
The Endocrine Society is a global community of 18,000 researchers, physicians and healthcare professionals focused on advancing hormone science from bench to bedside. The Society supports and shares the work of an international coalition of basic and clinical scientists conducting research across the full spectrum of chemical signals, conditions and disease states tied to the endocrine system. In addition, the organization provides evidence-based practice guidelines, publishes major developments across a series of peer-reviewed journals, advocates for public policy beneficial to patients and practitioners, and conducts public education and outreach through the Hormone Health Network. The annual ENDO conference brings together the full complement of members to discuss the latest new news and breakthroughs in the field. Robert W. Lash, MD, chief professional and clinical affairs officer for the Endocrine Society, recently sat down with Medical News to share what’s on tap for ENDO 2020 and other ways the Society supports researchers and works with providers. “The Endocrine Society over the past Dr. Robert W. Lash century has had members who have won six Nobel Prizes. We have a strong history of basic science,” Lash noted. A general endocrinologist who spent two decades on faculty at the University of Michigan before accepting the newly created Endocrine Society staff position in 2017, Lash is responsible for leading major initiatives designed to accelerate scientific breakthrough, interacting with strategic partners and policymakers, communicating with the public and serving as a content expert. While diabetes and thyroid conditions tend to be the most recognizable endocrine conditions, he added the Society has expertise in research and practice from adrenal disease and bone health to obesity and transgender medicine.
Taking the Message on the Road
“One of our goals is for the next generation of basic scientists to feel as connected to the Endocrine Society as previous generations,” said Lash. To help build that relationship, staff and volunteer leadership have taken the show on the road to a number of academic centers to share scientific insights and information on grant programs and meetings with scientists in the field. “We talk about how we can help them, particularly early in their careers, become successful basic science investigators,” Lash added. The Society has already traveled to Baylor, Southwestern and the University of Michigan. Nashville was on the schedule for Feb. 5-7 to meet with scientists from Vanderbilt and Meharry, and a trip to the nashvillemedicalnews
Royal Veterinary College in London is slated for later in the year. Whether it’s young scientists or physicians, Lash said, “We want to make sure our trainee members are prepared to make the transition to becoming independent practitioners.”
The biggest ‘road show’ each year is the annual ENDO conference. This year, more than 9,500 attendees are expected to attend the March 28-31 meeting in San Francisco. Nearly 40 percent of those registered are international members with the balance coming from across the United States. “What’s always exciting about ENDO is it’s where the world comes to learn about the latest in endocrinology,” said Lash. “If you’re a scientist, it’s your chance to see the latest research being done by your colleagues. If you’re a clinician, you are going to hear about the latest clinical studies on endocrinology and sit down with the experts in the field.” Plenary sessions cover science, clinical application and societal implications of endocrinology. “This year two Nobel Laureates are coming,” Lash said of general sessions featuring Robert J. Lefkowitz, MD, of Duke and Brian K. Kobilka, MD, of Stanford discussing surface receptor signaling. Big data, genome vs. epigenome in cancer battles, bridging the translational divide, how the microbiome modulates metabolism, and new approaches to treating diabetes round out the 2020 plenary sessions. “Meet the Professor” breakout sessions take a deeper dive on 15-20 topics of interest. “We actually publish a book and videos of the Meet the Professor sessions,” Lash said of the recognition that there is broad interest in much more content than can be fit into an individual’s onsite schedule. To help navigate a packed agenda, he added ENDO 2020 also features pathways by topic of interest. “We’re also livestreaming sessions for the first time this year.” Lash added 2020 marks the 25th anniversary of the Society’s formalized commitment to diversity and inclusion and noted there is an exciting slate of pre-conference activities including an early career forum and a hands-on thyroid ultrasound workshop, among other offerings.
other more,” he said. While most patients with type 1 diabetes will see an endocrinologist, Lash said those with type 2 who are not as easily controlled are good candidates, as well. When it becomes difficult to hit on the right combination of insulin alongside other medications … or when the diabetes conversation begins to eat up most of the appointment … Lash noted, “It might be time to refer to an endocrinologist, so as a primary care provider, you can focus on the whole patient.” Another area where providers might not immediately think to refer to an endocrinologist is with transgender patients. Yet, Lash said the Society has significant expertise in this growing field. “We have some of the best-regarded guidelines on transgender medicine,” he stated, adding Society guidelines have already been translated into Spanish and are in the process of being translated into Mandarin and Portuguese. Providers in Vietnam have asked to translate the guidelines for use in their country, as well. Lash noted the Endocrine Society has held briefings with policymakers on Capitol Hill about gender-affirming care for transgender and gender incongruent individuals that is grounded in science and meant to dispel myths that persist in the public arena. “This is an area where we really believe we’ve been leaders. The Society’s resources
ENDO 2020 March 28-31
San Francisco • Moscone Center • Pre-conference events March 26-27. • Advanced registration deadline to receive best price Feb. 13. • For more information or to register, go to endocrine.org/ENDO2020
are state-of-the-art, and our members who practice transgender medicine are really the leaders in the field,” he said. While diabetes plays a big role in the field, Lash pointed out the endocrine system impacts a wide range of conditions from cardiovascular health to fertility. Whether it’s cholesterol that’s unresponsive to medication or a newly diagnosed cancer patient trying to figure out how to achieve parenthood after treatment, Lash said endocrinologists welcome the opportunity to offer their expertise. “We look forward to helping our colleagues help patients live their best possible lives,” he said. “There’s never anything wrong with asking for help,” Lash concluded. “Medicine is practiced best when it’s practiced as a team, and endocrinologists really relish being part of that team.”
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On the practice side, Lash said there are a number of endocrine diseases where other providers routinely refer patients to an endocrinologist, including those with thyroid cancer or pituitary and adrenal gland concerns. “Then there’s the part of endocrinology where other physicians often don’t refer and are probably right not to refer,” he continued of patients with wellmanaged type 2 diabetes or hypothyroidism. “Where it gets interesting is that gray zone. Who with diabetes really needs to see an endocrinologist? Who with thyroid disease might need to be referred? And that’s where I think endocrinologists and primary care physicians need to be talking to each
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NMGMA: 10 Minute Takeaway Sharing Your Story through Effective Communications By CINDY SANDERS
the practice’s logo is everywhere, it’s equally important The second Tuesday of “to make sure it’s in a quality the month, practice managers environment,” Hutzel said. and industry service providers Using Apple as an example, gather for an educational Nashhe pointed out the comville Medical Group Managepany takes as much care in ment Association (NMGMA) their packaging as with their meeting to hear from experts commercials because every on a variety of topics designed element is meant to convey to improve the efficiency and their corporate axioms of success of medical practices. quality and sophistication. In January Erin George, senior For medical practices, advisor for Lovell CommuniHutzel suggested thinking cations, and Michael Hutzel, about what you want to conchief creative officer at FoxFuel vey to a patient coming in for Creative, shared insights on a service. How do you want effectively telling an organizathem to feel? What would tion’s story from brand integyou like them to share with rity and digital engagement to someone who asked about Pictured L-R: Michael Hutzel with Fox Fuel; Laura Watkins, NMGMA media outreach and reputation their experience? Hutzel said president; and Erin George with Lovell Communications. management. everything from forms filled With the specialized and out upon arrival to email highly regulatory nature of healthcare, sprint, it’s a marathon’ – applies. “I think reminders to a post-visit survey should the tendency is to think of the industry for a lot of people when they establish a be examples of the quality you hope to as being different from other consumer new business or medical practice, they do share. “All of those things are unbelievexperiences. Yet, whether it’s a medical a lot of great work on the up front,” he ably important in today’s world to make practice or a clothing store, the doors only said. “And then, what can be forgotten in sure you are consistently saying the same stay open as long as customers continue to the long term, is you have to constantly be thing,” he stated. walk through them. looking for ways to get your message out George discussed ways to get your When it comes to building a brand, there and refine it.” brand out into the community. The first Hutzel said the old adage – ‘It’s not a While it’s important to make sure step, she noted, is to identify who are your audiences and then consider the most effective ways to reach those groups. Most practices, even small ones, have multiple audiences – from current and potential new patients to referring physicians and provider plans. George said community relations, media relations, social media channels and an informative website are all part of an integrated communications plan. “On the messaging piece, when you’re thinking about how you talk about your practice, consistency is incredibly important,” said George. “How are you differentiated from others in the market?” However, she continued, the way you tweak and position that message varies by audience and media source. George suggested doing a bit of homework and reading other types of stories on various media outlets before sending out a pitch or press release. What works well for consumer media might not be the right fit for an industry publication. She also added, Tuesday, March 31, 2020 Tuesday, March 31, 2020 not everything has to be a formal press 7:30 am 7:30 a.m. release. Sometimes, George said, a phone r TheCal Cal Turner Turner Family The FamilyCenter Center call or email outlining the idea to one or Meharry Medical Medical College two media outlets might make more sense. Meharry College Taking a reputational hit, particularly through bad online reviews, is an increasGuest Speaker Guest Speaker ing concern for many practices. “People Patrice Harris, MD Patrice Harris, MD are motivated to speak when they have a ciation President, American Medical Association President, American Medical Association bad experience,” said Hutzel. “Nothing can empower somebody more than anger.” When a scathing online comment happens in a vacuum, where there is no offsetting positive content, Hutzel said the power of the negative review is exponentially amplified. “They’ve got 100 percent of the marketplace,” he pointed out. To lessen the impact, Hutzel said practices
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should proactively grow their digital presence by publishing content, being active on social media channels and engaging in goodwill efforts to get patients with positive experiences to post reviews, as well. Inevitably, most businesses have to face some level of ‘crisis’ from the stumbling block of a bad review to much larger issues. “The most important thing is to have some kind of plan in place before these things happen,” said George. “You don’t want to be caught flat-footed because then you’re playing catch-up from the beginning.” Having a crisis plan doesn’t cover every possible scenario, George continued, but it does provide a general roadmap of how to respond. She added the first step is fact-finding to have a better idea of what happened and how it happened. Once that information is in hand, the severity of the issue might require pulling in outside resources including a public relations firm or legal assistance. George added if outside help is going to be required, making that decision early allows your communications partners both internally and externally to coordinate messaging and rapidly address the issue.
Upcoming Events February 11 “Hiring Smart: Best Practices to Identify, Screen and Onboard Candidates for Your Practice” – Join Valora Gurganious, MBA, CHBC partner and senior management consultant at Doctors Management for a discussion on the profiles and expectations of different generations and how that impacts the ways in which candidates are hired and managed.
March 10 “Driving Quality in Healthcare: Avoiding the Ditch” – Paul Gentuso, MD, FACP, CPE, chief medical officer for Heritage Medical Associates draws parallels between driving a car in challenging conditions and driving quality in a challenging healthcare environment.
Attend a Meeting The February and March meetings will be held at Saint Thomas West Conference Rooms with free parking in the Seton Garage. The luncheon program runs from 11:30 am-1 pm. To register, members should go online to nashvillemgma.org. Nonmember practice administrators interested in attending an event, please email NMGMA President Laura Watkins at website@ nashvillemgma.org for a guest registration.
Bringing Eye Health into Focus in 2020 By CINDY SANDERS
The Harris Poll recently conducted a survey on behalf of the American Academy of Ophthalmology (AAO) to assess knowledge of visual health. The results were eye-opening. With the number of people affected by potentially blinding eye diseases expected to double in the coming years, AAO is urging individuals to fill in key knowledge gaps and address risk factors within their control and asking physicians to help in education efforts. “Medical professionals in Tennessee need to work together to educate our patients that vision loss can also amplify the adverse effects of other illnesses,” said Rebecca Taylor, MD, an ophthalmologist with Saint Thomas West Hospital and Nashville Vision Associates. “Only one in four of those surveyed Dr. Rebecca Taylor knew that vision loss
in adults is associated with psychological problems such as social isolation and depression.” Other key findings from the online survey of more than 3,500 U.S. adults included: • While 83 percent of Tennesseans say they are knowledgeable about eye/ vision health, less than 1 in 5 (19 percent) were able to correctly identify the three main causes of blindness in the U.S., which are glaucoma, age-related macular degeneration (AMD) and diabetic eye disease. • Less than half (47 percent) of respondents nationally were aware that vision loss and blindness do not affect all people equally. • Only around one-third of adults (37 percent) know you do not always experience symptoms before you lose vision to eye diseases. • Less than half (43 percent) of Tennesseans surveyed were aware your brain can make it difficult to know if you are losing your vision by adapting to vision loss. “The discrepancy between what Tennesseans think they know about vision
health compared to what they actually know is alarming,” noted Taylor. “The year 2020 is the perfect time to encourage your patients to see their ophthalmologist for a baseline eye exam.” AAO recommends that healthy adults see an ophthalmologist for a comprehensive, baseline eye exam by age 40 and have their eyes checked every year or two at age 65 or older. Getting ahead of eye issues is critical. “Far too often, we witness the consequences of patients entering the ophthalmologist’s office too late to avoid severe vision loss,” said AAO President Anne L. Coleman, MD, PhD. “In 2020, we want all Americans to have clear vision when it comes to eye health.” Multiple studies have shown people fear vision loss more than many other diseases and serious health problems. The new study shows Americans are scared about an issue they know very little about. Physicians are encouraged to direct patients to ophthalmologist-reviewed information about eye health, diseases and treatment options by going online to AAO.org/EyeSmart.
degree from the University of Memphis. Active in the community, he is a member of Leadership Health Care and is the board president and past treasurer of Rebuilding Together Nashville.
Roberts Announces Departure from TennCare
TriStar Southern Hills Names Reed CNO TriStar Southern Hills Medical Center has appointed Laura Reed, MSN, RN, CCRN, NEA-BC, as its chief nursing officer. Reed brings more than 28 years of nursing experience within HCA to her new role. After beginning her Laura Reed career with HCA as a staff nurse in 1991, Reed moved into leadership roles at Reston Hospital Center where she became vice president of Critical Care Services and Chippenham Hospital where she served as assistant chief nursing officer. Both medical facilities are located in Richmond, Va. Reed holds a Master of Science in Nursing Administration from George Mason University and earned her undergraduate degree from the University of Virginia School of Nursing.
Nalley Named Member at KraftCPAs Scott Nalley, CPA, CISA, CIA, CCSFP, has been named the newest member of KraftCPAs. Nalley is in the Risk Assurance & Advisory Services Practice where his primary focus includes internal audit and internal control consulting projects. Scott Nalley Previously, he worked in the private sector as an internal auditor for Vanderbilt University for six years. He earned his accounting nashvillemedicalnews
Greene Named CEO of TriStar Skyline
Dustin Greene, FACHE, has been appointed CEO of TriStar Skyline Medical Center effective Feb. 1 where he will be responsible for operations of the 278-bed hospital, as well as the 121-bed behavioral health hospital TriStar Skyline Madison and related care ar- Dustin Greene eas serving communities in and around Middle Tennessee and Southern Kentucky. For the past five years, Greene had served in the same role with sister hospital TriStar Horizon Medical Center in Dickson. During his tenure, TriStar Horizon expanded its clinical capabilities through recruitment of key physicians, earned level III trauma designation, opened a Level II Neonatal ICU, expanded interventional cardiology, and opened a free-standing ER at the Natchez campus. Greene’s 18year tenure with HCA Healthcare has included serving as COO at TriStar Skyline Medical Center and as COO at HCA Healthcare’s Eastside Medical Center in the Atlanta area. Greene is a Fellow of the American College of Healthcare Executives. He earned his bachelor’s degree from Samford University and his MBA from Belmont University.
Last month, Tennessee’s Division of TennCare director Gabe Roberts announced he is leaving Tennessee state government to return to the private sector. His anticipated last day will be Monday, March 2, 2020. At press time, Governor Bill Lee had not yet Gabe Roberts named a successor to the position. Roberts’s service in Tennessee state government began in 2013 when he joined TennCare as general counsel. He was promoted to deputy director and chief operating officer in 2016, and Roberts was subsequently appointed as director of TennCare in January 2019 by the governor. During his tenure Roberts has been instrumental in the design and implementation of many of the agency’s initiatives. Most recently under Roberts’s leadership, TennCare submitted two proposals – Tennessee’s Katie Beckett program and Tennessee’s Block Grant plan – which are both pending approval by the federal government.
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Mark Your Calendars Our Kids Soup Sunday • February 23 Nissan Stadium Club Level West Celebrating its 27th year, this popular annual event is slated for 11 am-2 pm to benefit the work of Our Kids, which provides medical evaluations and crisis counseling for children and families struggling with child sexual abuse. In addition to delicious offerings by more than 30 local restaurants and caterers, the day features a silent auction, celebrity and culinary judges, activities for children, sweet treats and more. Tickets may be purchased online: $25 for adults and $5 children (ages 4-17). The event will be held inside Club Level West at the stadium with parking in Lot H. For more information or to purchase tickets, go online to OurKidsCenter.org to follow the event link or Eventbrite.com and search for Soup Sunday.
Dr. Matthew Walker, Sr. Legacy Breakfast • March 31 Cal Turner Family Center at Meharry Medical College American Medical Association President Patrice Harris, MD, is the keynote speaker for this exciting breakfast event benefiting the Matthew Walker Community Health Center. This year’s theme is 2020 Vision: Focus on Our Health. In addition to the keynote address, the morning honors community members carrying on Dr. Walker’s vision and a scholarship award. The 7:30 am event is free, but donations are appreciated and reservations required. For more information, go to MWCHC.org.
Friends & Fashion • April 6 Music City Center Don’t miss the 30th year celebrating Friends & Fashion benefiting Monroe Carell Jr. Children’s Hospital at Vanderbilt. Marketplace shopping begins at 10 am with the luncheons and fashion show running from 11:30 am-1 pm. For more information, go to ChildrensHospitalVanderbilt.org/ friendsandfashion.
2020 Walk to Cure Arthritis • May 3 & 17 Middle Tennessee State University Murphy Center (May 3) Vanderbilt University Recreation & Wellness Center (May 17) Join forces with other Middle Tennesseans to battle arthritis in the fight for a pain-free future. This year’s combined fundraising goal for the two events tops $160,000. To register, donate or learn more about the 2020 Murfreesboro event, go to Walkto CureArthritis.org/Murfreesboro. For the Nashville event, go to WalktoCureArthritis.org/Nashville.
Ruby, Playle Join Waller Waller Lansden Dortch & Davis, LLP recently announced Abbey Mansﬁeld Ruby has joined the firm’s Nashville office. Representing global, national and regional lenders, agents, private equity sponsors and corporate borrowers in commercial financings Abbey Mansﬁeld Ruby and restructurings, Ruby has extensive experience in finance transactions spanning a wide range of industries, with a particular focus on healthcare including loans to owners and operators of skilled nursing and other senior living facilities. In 2018, she was recognized by M&A Advisor with an Emerging Leader award for her work in acquisition financing and turnaround transactions. Previously, Ruby was a principal in the Washington, D.C. office of Miles & Stockbridge PC, after beginning her legal career in the New York offices of international law firms. After earning her undergraduate degree from Michigan State University, Ruby graduated from Vanderbilt University Law School in 2008. Additionally, Angela M. Playle has joined the firm’s Healthcare Real Estate Practice in the Angela M. Playle
Nashville office. Previously, she served as senior vice president and deputy general counsel at HCP, Inc., a NYSE-listed real estate investment trust (REIT) now known as Healthpeak Properties. At Waller, Playle will represent REITs, hospitals and health systems, healthcare investors and other healthcare organizations with transactions and operations involving medical office buildings and senior living communities, skilled nursing facilities and other healthcare properties. Playle earned her law degree in 1997 from Emory University School of Law where she received the Commercial Real Estate Award. Prior to that, she earned her undergraduate degree, cum laude, from Vanderbilt University in 1994.
Permobil Taps Witkowski to Lead Business in the Americas At the end of last year, Swedishbased Permobil announced Charles ‘Chuck’ Witkowski, II as executive vice president for the Americas. A leading producer of motorized wheelchairs and mobility solutions with a factory in Lebanon, Permobil selected NashChuck Witkowski, II ville-based Witkowski to advance its mission of moving people forward, literally and figuratively. Witkowski is a strategic and opera-
20 20 NOMINATIONS ARE NOW OPEN To nominate, please visit nashvillemedicalnews.com and click the Women to Watch icon. Nomination Deadline: March 13, 2020
tional executive with diverse experience building and leading medical device, healthcare service and life sciences businesses. He comes to Permobil from Hillrom (NYSE: HRC), a mission-driven medical device company with approximately $3 billion in sales and 10,000 employees, where he was a corporate vice-president and global general manager for the past four years. Prior to Hillrom, he was the founding president and CEO of Hubble Telemedical, a national telemedicine provider and medical device start-up focused on eradicating diabetic vision loss and blindness. Hubble was acquired by Hillrom in 2015. Witkowski, a Tennessee native, holds a degree in economics from the University of Montana, Missoula, and an MBA from the Haslam School of Business at the University of Tennessee.
Ryan Offering Advanced Carotid Stent System Nashville Vascular and Vein Institute (NVAVI) founder Patrick C Ryan, MD, FACS, FSVS, a boardcertified vascular surgeon who holds several national roles focused on quality metrics and performance in the field, has joined a very small group in the region of- Dr. Patrick Ryan fering TransCarotid Artery Revascularization (TCAR). An early adopter of the hybrid technology, Ryan said TCAR uses a unique surgical approach to stenting the carotid artery to minimize complications. He added, the clinically proven procedure allows many patients with high-risk lesions or severe medical problems, who previously weren’t candidates for open surgery due to stroke risk, to undergo the less invasive, potentially life-saving intervention to remove plaque. NVAVI cares for patients in Middle Tennessee, North Alabama and Kentucky.
Jones Named TDH CMO Tim Jones, MD has been named chief medical officer for the Tennessee Department of Health where he will serve as an advisor to the commissioner on matters of health policy and assist in setting priorities for the department. Jones Dr. Tim Jones has been serving as acting chief medical officer since the retirement of David Reagan, MD. Jones first came to TDH in 1997 as a Centers for Disease Control and Prevention Epidemic Intelligence Service assignee. Following this assignment, he joined TDH as a general medical epidemiologist. He has served as Tennessee’s state epidemiologist and director of the TDH Communicable Environmental Disease and Emergency Preparedness division since 2007 and was promoted to assistant commissioner in 2012.
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GRAND ROUNDS An internationally recognized expert in epidemiology and communicable and foodborne diseases, Jones has been a subject matter expert and consultant to the World Health Organization, has worked as a CDC advisor in numerous countries and served as a Polio Eradication Project Consultant in the Republic of Yemen. He has authored more than 150 peer-reviewed publications and has won multiple awards for his work. Jones received his medical degree from Stanford University and completed postgraduate training in family medicine and maternal and child health.
Prior to joining LBMC, Brandt was partner at a large healthcare valuation company where she developed and managed multiple services including a global life sciences service line. A frequent speaker, she has authored multiple articles and book chapters.
Saint Thomas Rutherford Announces CFO, CNO
Scott Furniss, MBA, CPA, began serving as chief financial officer on Jan. 13. He has more than a decade of executive leadership experience at fellow Ascension hospitals, most recently hold-
ing a dual role as CFO of Saint Agnes Healthcare and Hospital in Baltimore and Providence Health System and Hospital in Washington, DC. After graduating with Scott Furniss honors from the University of Baltimore, Furniss earned his MBA at Loyola College of Maryland. The hospital also introduced industry veteran Teresa Collins, MSN, RN, NEA-BC, as its new chief nursing officer, effective Feb. 3. Her 28-year healthcare
career includes adult and pediatric critical care, emergency services, acute and postacute clinical care quality oversight, and extensive executive leadership experience. She most Teresa Collins recently served as CNO for the Duke/LifePoint Rutherford Regional Health System in Rutherfordton, NC. Collins earned her undergraduate nursing degree and Master of Science in Nursing-Healthcare Administration from Walden University in Minneapolis.
First Horizon Healthcare News
Sameer Gupta has been appointed managing director of First Horizon’s Specialty Healthcare Group in Nashville. Based at the bank’s Hill Center – Brentwood office, he will report to Leslie Pack, group head of Specialty Healthcare. With more than 12 years of experi- Sameer Gupta ence as an investment banker, Gupta is responsible at First Horizon for providing commercial lending and depository services to private equity-backed, middle-market healthcare companies in the U.S. He earned his bachelor’s degree from Vanderbilt University and most recently was a director with a leading investment bank in New York. In other news, the bank appointed Glenn Bradley as senior vice president, private client relationship manager for Middle Tennessee’s Medical Banking Group. Bradley previously served as vice president. A veteran of the financial services industry since 1985, Brad- Glenn Bradley ley assists physicians, their practices and other medical-related businesses in reaching their short and long-term financial goals with lending and cash management. The UT-Knoxville graduate is a board member of the Nashville General Hospital Foundation and the Nashville Medical Group Managers Association.
Brandt Named Director of LBMC Life Sciences LBMC recently announced Ann S. Brandt, PhD, as director of the firm’s new Life Sciences Valuation and Consulting service line within the company’s national healthcare practice. Brandt brings more than 25 years of healthcare experience to her role leading the new ser- Dr. Ann Brandt vice line, which leverages existing LBMC resources to provide a full range of valuation and consulting services to life science companies, with a focus on pharmaceutical, medical device, and biotechnology companies. nashvillemedicalnews
Foresight in 2020. We believe that your malpractice insurance team should be ready and available when you need them most. SVMIC is built on this kind of reliable and dedicated relationship, so you can focus on your practice and we can focus on protecting it.
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Last month, AdvancedHEALTH, Middle Tennessee’s largest, independent, multi-specialty practice, announced the addition of Quoc Jonathan Tran, MD, pain management, to its growing group of providers. Tran, whose areas Dr. Jonathan Tran of clinical interest include regenerative and interventional procedures to treat pain utilizing ultrasound and ﬂuoroscopy, sees patients at The Pain Management Group. He received his medical degree from the University of Texas Southwestern Medical School in Dallas before beginning his internal medicine residency at the University of Alabama, Birmingham. He then completed a physical medicine and rehabilitation residency at Carolinas Rehabilitation in Charlotte and a NASSrecognized fellowship in interventional spine and musculoskeletal medicine at Alabama Orthopedic, Spine and Sports.
Let’s Give Them Something to Talk About! Awards, Honors, Achievements
Arun Christian Habermann, AB, Vanderbilt University Medical Center, was recently recognized by the Pulmonary Fibrosis Foundation during the PFF Summit in San Antonio for his poster presentation “Single-cell Analysis of Lung Epithelial Remodeling in Pulmonary Fibrosis.”
Father John Raphael, staff chaplain at Saint Thomas West Hospital, has been named North America’s best chaplain by the Catholic Medical Association. In addition to ministering to the hospital’s patients and employees, Father Raphael divides his busy schedule between counseling medical students, writing published pieces on cultural issues, and serving on the hospital ethics committee. He holds an undergraduate degree from the University of Notre Dame and two master’s degrees – one from DeSales School of Theology and one from the University of San Francisco. Susie Adams, PhD, FAANP, FAAN, professor of Nursing at the Vanderbilt University School of Nursing has been named 2019 Psychiatric Nurse of the Year by the American Psychiatric Nurses Association (APNA). APNA is the largest organization of psychiatric men- Dr. Susie Adams tal health nurses in the world, with more than 12,500 members.
Beth Chase has been renamed chair for the Nashville Entrepreneur Center Board of Directors. She will lead the 31-person board, which Beth Chase includes seven new directors. Bill Brown and Michael Burcham are among the new appointees with healthcare industry ties. Tennessee Quality Care, a division of Franklin-based American Health Partners (AHP) received the Fazzi 2019 Home Care Patient Satisfaction Award of Distinction for being in the top 25 percent in patient surveys from Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). In other news, AHP Director of Talent Acquisition Anita Moore Lemmings was recently recognized as a finalist for the 2019 Human Resources Professional Award from the Anita Moore Middle Tennessee SociLemmings ety for Human Resource Management. Heather Pua, MD, PhD, assistant professor of Pathology, Microbiology and Immunology at Vanderbilt, has received a 2019 National Institutes of Health (NIH) Director’s New Innovator Award. The award, part of the High-Risk, High-Reward Dr. Heather Pua Research Program, is designed to support “unusually innovative research from early career investigators.” Pua will explore a new form of cell signaling involving ribonucleic acids (RNAs) in allergic airway inﬂammation. She is one of 60 investigators to receive the 2019 award, which provides $1.5 million in direct research support over five years. Mike Mayernick, wealth management advisor at Mayernick & Associates with Northwestern Mutual in Nashville, won the 2019 Invest in Others Global Impact Award, one of five national community service awards recently presented at Mike Mayernick the 13th Annual Invest in Others Awards Gala in Boston. Mayernick earned the honor for his charitable work with Love One International, which received a $45,000 donation from the Invest in Others Charitable Foundation. Betsy Weiner, PhD, FACMI, FAAN, senior associate dean for Informatics at Vanderbilt University School of Nursing, was recently honored by the Friends of the National Library of Medicine with its Nursing Informatics award during the organization’s Annual Awards Dinner in Washington, D.C. Wein- Dr. Betsy Weiner er received the award in recognition of her contributions to the field of informatics and innovation in developing nursing education technology.
TriStar Ashland City Medical Center was recently recognized by The Chartis Center of Rural Health and the National Organization of State Offices of Rural Health (NOSORH) for overall excellence in quality, reﬂecting top quartile performance among all rural hospitals in the nation.
Cumberland Pharmaceuticals Receives FDA Approval for RediTrex At the end of 2019, Nashvillebased Cumberland Pharmaceuticals announced approval from the U.S. Food and Drug Administration for RediTrex™, its new line of methotrexate products. RediTrex (methotrexate) injection is designed for the treatment of adult and pediatric patients with rheumatoid arthritis, as well as adults with psoriasis.
Off Call: Explore Tennessee All work and no play is no fun at all. The new Tennessee Vacation Guide is out with information on all there is to explore across the state. From the mountains of East Tennessee to the blues of Beale Street, the new guide outlines great options for a short getaway. And with more than 15 million visitors annually headed to Middle Tennessee, be sure to check out backyard vacation ideas perfect for an evening out or weekend adventure. To order a free printed copy or download the e-guide, go online to tnvacation.com/guide.
Ribbon Cuttings Middle Tennessee has welcomed several new facilities and colleagues to the area in recent weeks. Last month, Pinewood Springs, a new joint venture behavioral health hospital in Columbia operated by HCA Healthcare’s TriStar Division and Maury Regional Medical Center, hosted a ribbon-cutting and open house. The 60-bed, 49,000-square-foot facility provides acute behavioral healthcare for adolescents (18 beds) and adults (42 beds), including those with psychosis, schizophrenia, and other acute episodes of mental illness; mood disorders including depression, anxiety and bipolar disorder; and co-occurring disorders. The hospital provides tailored plans that may include comprehensive assessments, individual and group therapy, psychiatric evaluation, physical therapy, therapeutic activities, family therapy, access to 12-step meetings, medical evaluation and management, cognitive and dialectical behavioral therapies, and a treatment “mall” that allows patients to select from numerous skillsHeather J. Rohan, president, HCA Healthcare TriStar Division, and Troy based classes. Each program emphasizes assessChisolm, CEO, Pinewood Springs, ment, treatment and aftercare to enhance quality celebrate the opening of the new behavioral health hospital in Columbia. of life. This month, Nashville welcomes Siskin Children’s Institute, which has opened a location in the Medical Plaza at 2201 Murphy Ave. The non-profit organization, headquartered in Chattanooga, provides services for children with special needs ranging from developmental pediatrics, early education and intervention, and therapy. Medical services at the Nashville location include developmental diagnosis, treatment, and support for children with special needs in a clinic-based setting led by James Van Decar, MD, FAAP, a neurodevelopmental pediatrician with more than 30 years of experience serving children with developmental disabilities. Additionally, the center will offer Applied Behavior Analysis (ABA), an evidencebased form of therapy foSiskin Children’s Institute at 2201 Murphy Ave. cused on increasing positive behaviors while decreasing unwanted behaviors in children with a developmental disorder or delay, including children diagnosed with Autism Spectrum Disorder. ABA has been shown to help increase language and communication skills, improve focus, memory, and academic performance, as well as enhance social skills. On Jan. 29, TriStar Centennial Medical Center cut the ribbon on their new one-million-square-foot parking garage that adds 2,284 parking spaces to serve the 43-acre campus. The eight-level garage includes a pedestrian bridge to allow easy access to the medical center’s central tower and garden court.
PHOTO: JEFF ADKINS
Tran Joins AdvancedHEALTH
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