FOCUS TOPICS COMPLIANCE • DIAGNOSTICS
Your Middle TN Source for Professional Healthcare News ON ROUNDS
The Future of Precision Medicine The field of precision medicine is growing at an astronomical pace, with nearly a dozen new tests hitting the market daily. Tracking what’s out there … and how effective it is … is a big task, and it’s one being tackled by Nashvillebased Concert Genetics ... 7
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Rapid RNA Testing Dials Up Quicker Diagnostics By CINDY SANDERS
It’s hard to make an informed decision without having all the information. A suspicion of an infectious disease or autoimmune disorder … even if grounded in clinical experience … still requires confirmation. Some tests take days, weeks or months to hone in on a specific virus or bacterium. In the case of autoimmune disorders, landing on a solid diagnosis could take years. Technology, however, is speeding up the process. Researchers are beginning to unlock the potential of RNA as a diagnostic tool capable of getting answers more rapidly and in a cost effective manner.
IQuity Senior Scientist John T. Tossberg, analyzes the genes in a patient sample using a QuantStudio Real-Time PCR system.
Reforming Healthcare Reform As the July issue of Nashville Medical News was going to press, the U.S. Senate had just decided to defer a vote on their Obamacare ‘repeal and replace’ strategy amid dissension in the ranks ... 9
Finding a Healthcare Home Safety Net Consortium Initiative Links Community to Primary Care While the debate over access to healthcare rages on nationally, a collaborative partnership in the Nashville area is fostering increased awareness and utilization of area resources and services to promote a healthier community ... 10
For nearly three decades, scientists from around the world have contributed to the body of knowledge surrounding CRISPR – Clustered Regularly Interspaced Short Palindromic Repeats, which were originally discovered as DNA sequences in bacterial genomes. However, it has only been in the last few years that scientists have shown how to engineer CRISPR-Cas9 to more effectively and efficiently edit the genome in both mouse and human cells. (CONTINUED ON PAGE 6)
Death Master Crime Fighters By Moni J. Cook, CPA
Superheroes are often thought of as fictional, costumed crusaders who battle villains, but you need not open a comic book to marvel at the employees in various industries (including healthcare and government) who are fighting crime every day. Their weapon of choice? The Death Master File (DMF).
What is the Death Master File?
The Social Security Administration (SSA) maintains an electronic database called the NUMIDENT (short for “numerical identification”) containing information on everyone who’s received a social security number (SSN) since issuance began in 1936. The DMF, a subset of the NUMIDENT, contains more than 86 million death records that the SSA has received from a variety of sources, (CONTINUED ON PAGE 4)
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A Sense of Security
New CPEO Designation Holds Professional Co-Employers to a Higher Standard By CINDY SANDERS
In late 2014, the IRS established the voluntary Certified Professional Employment Organization (CPEO) program. Last month, the government agency issued notices to the first of only 84 PEOs in the nation who have met the rigorous standards required to earn the designation of CPEO. Local firm LBMC Employment Partners, a member of the LBMC Family of Companies, is among those first 84. “We are very excited to be included in the first group to be awarded the CPEO designation by the IRS,” said Sharon Powlus, partner with the firm. Although the appliSharon Powlus cation and review process was complex – and the ongoing compliance requirements to maintain CPEO status rigorous – Powlus said LBMC Employment Partners, along with other PEOs across the nation, have long supported the idea of certification. “We want our clients to be confident that they have an entrusted and dedicated business partner with the financial backbone to act as their co-employer,” she stated.
What is a PEO?
Professional Employment Organizations have been around in one form or another for several decades. “A PEO is where we enter into a co-employment relationship with a client,” explained Powlus. “We pay all of their employees under the PEO’s tax ID so basically we become the administrative employer, and the client remains the worksite employer.” Key functions of a PEO include oversight of payroll functions and securing benefits. Powlus said the arrangement is particularly beneficial for small-to-midsize businesses. “You get the economies of scale with all these employees coming together,” Powlus said of the negotiating power the entire group enjoys when it comes to purchasing benefits for their employees. “Our sweet spot is physician practices and professional services,” she noted, adding LBMC has clients in their PEO with employees across 42 states. A third critical function is the human resources piece. Powlus said PEOs carry employment practices liability insurance (EPLI), which they extend to clients. The PEO also offers support in the event an employee is terminated to help ensure employers are compliant with state and federal regulations.
Why the Specialty Designation?
The CPEO Difference
Strongly supported by the National Association of PEOs (NAPEO), Powlus noted, “They’ve been lobbying the IRS for some time for a certification or designation.” The reason? While certainly most PEOs work hard on behalf of their clients, Powlus noted that, as with any industry, there are some who are “not in it for the right reason.” When that happens, significant sums of money could be impacted. Part of a PEO’s function is to collect money from a client to pay required taxes and premiums. That money is combined with other clients’ payments and submitted under the PEO’s tax ID number. “When PEOs were started, there were some who took the dollars but didn’t submit the money for payroll tax or premiums for benefits,” she said. By the time a client finds out their obligations haven’t been met, the dollar amount owed would have snowballed through fines and penalties. NAPEO pushed for a professional designation so clients would have an additional layer of confidence in the financial and operational compliance of the CPEO. “If we chose, as we did, to go through the onerous process of certification, our clients would have confidence in the fact that we are remitting payments on their behalf,” Powlus said of the impetus to achieve certification.
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In order to obtain the new designation, PEOs must submit an application, have a surety bond in place that must be activated within 30 days of certification approval, submit an annual financial audit to the IRS, submit quarterly reports to the IRS based on additional guidelines, keep positive working capital, and create and execute a CPEO contract with clients, among other requirements. While PEOs have technically had responsibility for employees’ wages and taxes under the client contract, the CPEO program formally specifies who assumes liability for federal taxes in the relationship between the CPEO service provider and their clients. CPEOs must meet the strict auditing and reporting standards of the Small Business Efficiency Act (SBEA) and assume financial responsibility for federal employment tax payments for its eligible clients’ worksite employees. Additionally, federal payroll tax liability payments must be guaranteed. If, for example, a client owed additional taxes due to a calculation mistake made by the CPEO, the client wouldn’t have to worry about penalties. “We’d collect the additional taxes from the client because they were owed, but we would pay any penalties or interest,” Powlus explained. Other benefits include client access to additional tax credits including the Work Opportunity Tax Credit and no longer having to restart the payroll tax wage base if a client joins a CPEO midyear. The latter benefit is particularly important for practices and businesses with highly compensated individuals. “This eliminates double taxation on FICA and FUTA, and this alone is a victory for our industry and our clients,” said Powlus.
Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. NEW IN JUNE: Richard Wild, MD, FACEP, chief medical officer for the Centers for Medicare and Medicaid Region IV, which includes Tennessee, outlines five ways healthcare providers can prepare for the new Medicare cards that begin rolling out in April 2018 without social security numbers. Ming Wang, MD, PhD, director of the Wang Vision 3D Cataract & LASIK Center and CEO of Aier-USA, discusses the role of advanced ocular imaging in identifying optimal candidates for minimally invasive surgeries, including the newer corneal inlay procedures of Kamra and Raindrop. AcuTarget HD, a double-pass wavefront diagnostic device, objectively measures a patient’s vision to help guide treatment decisions and create ocular landmarks to guide precise inlay placement.
Staying Compliant by Avoiding Complacency Effective Programming, Auditing Required By CINDY SANDERS
For the past few years, the Department of Justice (DOJ) has upped the ante when it comes to cracking down on Stark and False Claims Act violations and assessing monetary penalties for those found at fault. “For a long time, there was a legal debate about whether Stark violations were actionable under the False Claims Act,” said Richard W. Westling, a member with national law firm Epstein Becker Green in the firm’s Health Care & Life Sciences and Litigation practices. With False Claims Act violations, he explained, there is a basic knowledge requirement that parties either know … or should have known … they were out of compliance. Conversely, he continued, “Stark is a strict liability statute. You’re either in compliance or not – intent doesn’t matter.” The 2010 passage of the Affordable Care Act cleared up any debate about the relationship of Stark and the False Claims Act. “The ACA created that connection by statute,” Westling said. “After ACA, Stark violations became predicate offenses under the False Claims Act. Not surprisingly, since the passage of the ACA, we’ve seen an increase in Stark-only false claims cases.” The healthcare community began hearing about large Stark settlements in 2015. In September of that year, Becker’s Hospital Review reported on five settlements to resolve alleged Stark violations over a three-month timeframe ranging from $3 million to nearly $119 million. On the low end, Nashville-based Vanguard Health Systems, which was purchased by Dallas-based Tenet Healthcare in 2013, settled a whistle-blower suit alleging kickbacks for $2.9 million. On the high end, Florida-based Adventist Health System paid a record $118.7 million to settle claims of improper physician compensation. While some infractions are clear, Westling noted, “There are a lot of areas where you can run afoul of Stark.” Reiterating Stark rules don’t require ‘intent’ for an entity to be out of compliance, he said it’s easy to make a mistake and find it quickly compounded. “You can have something that is a fairly minor problem – such as a lease that’s out of compliance because it’s not at fair market value (FMV). If it was out of compliance for three years and you didn’t know it, technically, every claim submitted by a physician during that time can be considered a false claim.” He added false claims don’t have to be proved on a claim-by-claim basis. “If the arrangement is out of compliance, then all the claims submitted during the period of non-compliance, in essence, become ‘false,’” Westling said. Paying an employed physician more than FMV, for example, could impact all of that providnashvillemedicalnews
er’s billings for the duration of the noncompliant arrangement. To avoid missteps and to keep minor infractions from turning into major monetary penalties, Westling said it was often advisable to have an outside valuation expert weigh in on employed physician compensation and benefit packages. Having market comparisons could help defend compensation packages if called into question in the future. Similarly, he said it’s critical to self-audit or have an outside entity complete compliance checks regularly. “The Centers for Medicare and Medicaid Services (CMS) administers a self-disclosure protocol,” he said, adding penalties are reduced substantially for infractions that are self-reported rather than ones uncovered by a whistleblower or the DOJ. “Settling with CMS usually costs a fraction of what you’d face if the Department of Justice gets involved,” Westling noted. While healthcare entities almost universally have some type of compliance program in place, the DOJ has recently signaled that isn’t enough. “The law requires you not just have a compliance program … but you have an effective compliance program,’ Westling stressed. “For a long time,” he continued, “there wasn’t much guidance from the DOJ about what they looked for.” However, Westling noted, the department has produced ‘Evaluation of Corporate Compliance Programs’ that more clearly outlines expectations. “In essence, it has become a rubric for us to use when we advise clients and for compliance officers to use in evaluating their programs.” (A direct link to the downloadable file is available with the online version of this article.) While a lack of intent or awareness might not avoid an investigation into potential Stark violations, the company’s reputation for compliance could have an impact on the financial penalties. Westling said there are numerous examples of the DOJ taking an entity’s track record into account … both good and bad. “The
Department of Justice takes the issue of compliance seriously and promotes selfevaluation,” he said. “Where they see a commitment to that, they have a pretty strong commitment to ensuring you’re not wasting your time by focusing on compliance … that you haven’t gone through this for naught.” Conversely, where there is a poor track record or clear intent to defraud, the government has affirmed its commitment to the principles of the Yates Memorandum, which stresses individual accountability. Westling said identifying responsible individuals and holding them
criminally or civilly liable is an effort to ensure such conduct is punished and the cycle ends rather than just assessing a fine to a company. The idea, he said, “is to cause people to think twice about their actions.” He continued, “Despite the change in administration, there have been statements by various officials at the Department of Justice demonstrating a continuing commitment to the policy expressed in the Yates memo.” While the new administration has made steps to lessen regulatory burden on a number of industries, there is no sign that regulations dissuading fraudulent or non-compliant practices that cost government healthcare programs money will be lessened. Therefore, Westling said, entities should thoughtfully approach decisions that intersect with Stark or FCA statutes and seek appropriate regulatory advice in areas that are outside of their comfort zone. “You need to take issues that bubble up within your company from employees seriously,” he added of another key issue. Westling pointed out these employees are on the frontlines and often see problems that might not be immediately visible to executives. “Pay attention to those people in real time, and you can often avoid them becoming whistleblowers,” he counseled. “Evaluate your program annually, selfreport issues, and make changes as necessary,” Westling concluded.
Westling Establishes EBG Presence in Nashville Richard W. Westling, who was previously a partner with Waller, has become the founding member of Epstein Becker Green’s Nashville office. The national law firm recently opened its first office in Tennessee and 14th location in the United States with space in the Fifth Third Center on Church Street in downtown Nashville. Westling, a healthcare compliance and government enforcement defense lawyer, will be based in Nashville but will also work out of the firm’s Washington, DC office. Certified in Healthcare Compliance by the Health Care Compliance Association, he comes to EBG with almost 30 years of experience in a variety of roles, including as general counsel for a Medicare Advantage organization, federal prosecutor and Richard W. defense attorney. Westling spent more than eight years with Westling the U.S. Department of Justice. He served as First Assistant U.S. Attorney and as an Assistant U.S. Attorney (Health Care Fraud Coordinator and Asset Forfeiture Chief) in the New Orleans U.S. Attorney’s Office and in Washington, DC at DOJ headquarters as Special Assistant to the Assistant Attorney General for the Tax Division and as a Trial Attorney in the Tax Division’s Criminal Section. “We welcome the opportunity to improve the availability of our resources to our many clients in Nashville and throughout the state of Tennessee,” said Mark Lutes, chair of EBG’s Board of Directors. “Rich, and others who will join us as we grow in Nashville, will provide boots on the ground to facilitate the connection between clients in Tennessee with new developments in Washington, DC, and at CMS in Baltimore, two key locations where EBG already has offices.” “Our sophisticated healthcare clients in Nashville will value our depth of experience and national resources delivered with a local touch,” added EBG Board Member Lynn Shapiro Snyder. Founded in 1973, EBG is a national law firm with a primary focus on healthcare and life sciences; employment, labor, and workforce management; and litigation and business disputes.
NMGMATen Minute Takeaway By CARA SANDERS
The second Tuesday of each month, practice managers and healthcare industry service providers gather at KraftCPA headquarters for the monthly Nashville Medical Group Management Association (NMGMA) meeting. During the June luncheon, George Buck, president emeritus of Frost-Arnett, discussed regulatory compliance issues facing the accounts receivable management (ARM) industry and what providers need to know. Buck spoke of key components making up the regulatory puzzle impacting debt and medGeorge Buck ical bill collection. The majority of the pieces of this ARM puzzle are designed to protect consumers from overly aggressive, strongarm tactics. However, Buck noted that in putting those protections in place, there are now an abundance of restrictions that impact how debt is collected and stiff penalties for missteps in handling those communications. “People just need to be aware of the regulations that are there currently and coming down the pike and how that affects healthcare and their relationship with us,” Buck said of the need for providers to take steps to stay in compliance with collection regulations alongside the ARM industry. In 1977, the Fair Debt Collection Practices Act (FDCPA) was enacted, and its major purpose was to eliminate abusive collection practices. Buck said this law really got the ball rolling in terms of imposing a range of restrictions and disclosure requirements. The law also set out to protect debt collectors who work in a fair, nonabusive manner from being competitively disadvantaged. Since then, there have been a host of other laws and agencies that dictate consumer practices and debt collection. Buck said the Consumer Financial Protection Bureau (CFPB), which was enacted after the 2008 financial crisis and is an outgrowth of the Dodd-Frank Act of 2010, has had one of the biggest impacts on how debt is collected and has increasingly focused on medical debt. However, he noted, DoddFrank rules and specifically the CFPB are in the crosshairs of Republican lawmakers who would like to significantly scale back the regulations and CFPB power. The U.S. House has already passed a measure to do that, but the bill faces a bigger hurdle in the Senate. All of these pieces of legislation and court rulings are especially important today with the healthcare industry facing increased scrutiny. Buck said the CFPB began accepting debt collection complaints in July 2013. By the following December, the CFPB conducted a field hearing on medical debt collection and credit reporting. In June 2015, they took the first major action against a medical debt collection agency, levying a hefty fine and penalties. 4
Of note is that after they finished with the revenue cycle company, they turned to the hospital client. “Reviews allow the agency to follow a trail … they want to get back to the point of origination,” explained Buck. “They do a deep dive in your business.” The Telephone Consumer Protection Act (TCPA) adds yet another layer of regulations. Part of the law monitors the use of an automated telephone dialing system to reach consumers. While there are healthcare exceptions – including appointment reminders, pre-operative instructions, prescription notifications, and several other items – that are exempt from TCPA consumer consent requirements, many communications fall under the regulations. Ultimately, all calls outside of the exemptions either must be manually dialed or the provider must have express consent at every appointment to reach patients or have their vendors do so on their behalf. While Buck said providers are focused on the clinical side of healthcare, as they should be, he also said it was important to understand the restrictions in place that dictate what can and cannot be done in an effort to collect medical debt. For example, he said, the Foti legal case fundamentally changed the way a message could be left on a voicemail. “By leaving a message that discloses you are a debt collector, you violate that person’s privacy,” said Buck of the court decision … but not identifying yourself as a debt collector violates other federal regulations. “It’s to the point that if we leave a message today, it’s about a 45-second message,” he continued. “A lot of us in this industry have quit leaving messages.” In addition to federal regulations, Buck said more restrictions have been imposed by states. Buck noted the FDCPA has advised that where state laws are more restrictive than federal law, the state law prevails. “You’re going to see state attorney generals take a more active role,” he said, adding the National Association of Attorneys General meet regularly to discuss consumer protections. A recent example, he continued, is Utah’s new law that requires a healthcare practitioner trying to collect on a past due bill to send out a certified letter, registered letter or text before the patient could be turned over to collection. Additionally, providers who opt to use text to communicate the required elements of the past due notice must also adhere to the federal TCPA rules. A new proposed rule would require debt collectors to ‘substantiate’ debt before beginning collection activities and to respond to any ‘specific warning signs’ that the account information is inaccurate or incomplete. “We’re only as good as the data you send us,” Buck told the audience. Incorrect addresses and contact information put collection firms at liability of sending a notice to the wrong person. Buck encouraged providers not to be shy about asking questions about specific policies and procedures as part of their vendor oversight due diligence. “I’m not trying to scare anybody, but you need to be aware,” he concluded.
Death Master Crime, continued from page 1 including funeral homes, postal authorities, banks, states and federal agencies. (Note: The DMF doesn’t contain information for every deceased person because many deaths go unreported.) Per the Freedom of Information Act (FOIA), the SSA is required to release death information to the public. However, Section 205(r) of the Social Security Act exempts state information from the FOIA, thus prohibiting the SSA from disclosing death records provided by states (if a state’s record is the sole source of that information) to the public. Therefore, the SSA maintains two versions of the DMF: The full file (shared only with certain federal/state agencies) is made up of all death records from the NUMIDENT, including records received from states. The public file, which is commonly referred to as the Social Security Death Index (SSDI), is provided to the Department of Commerce’s National Technical Information Service (NTIS). The NTIS acts as a clearinghouse that sells access to this information to the public (including healthcare entities, insurance companies, federal and state agencies, banks, credit companies, genealogists, etc. that have been certified). The SSDI comprises information from the NUMIDENT, but not the death records that have been provided solely from a state.
Fighting Crime with the DMF
So how do everyday professionals combat crime with the DMF? In short, they help detect and prevent identity theft. Identity theft often involves the fraudulent use of a SSN because of its status as an authenticator of identification for numerous purposes such as obtaining employment and setting up bank accounts. Decedents’ SSNs are particularly vulnerable and, thus, a frequent target for identity theft. Our compliance heroes meticulously and methodically check information they receive in their respective jobs against the DMF to determine if there is fraudulent activity. Examples include: Healthcare • Verifying that individuals trying to avoid healthcare sanctions and exclusions are not using a false SSN to obtain employment (onboarding professionals). • Performing regular (monthly or quarterly) exclusion screenings to monitor for sanctions (compliance/payer credentialing). • Ensuring that services are not being billed to Medicaid and Medicare under a deceased doctor. • Ensuring that payments are not made to providers or suppliers for services billed for deceased beneficiaries (surveillance and utilization review staff). • Tracking study subjects (medical researchers). • Tracking former patients (hospitals, oncologists). Employers • Verifying that individuals are not using a false SSN to obtain employment. Other Industries • Ensuring that firearms are not being obtained by someone posing as a US citizen (retailers). • Determining whether an individual has filed a fraudulent tax return (govern-
ment). • Verifying identity when setting up bank accounts, issuing loans or extending lines of credit (financial institutions).
In the past, some large genealogy companies were providing free online versions of the SSDI, which allowed dishonest individuals to obtain SSNs in order to commit fraud. In 2011, changes to the information that is included in the SSDI were effected (including the removal of state records), and access restrictions were increased. Then, the Bipartisan Budget Act of 2013 implemented a three-year period (beginning on the date of death) during which only authorized users and recipients who qualify can access a decedent’s DMF record. Deaths are also not incorporated into the SSDI until the three-year period is complete. These changes mean that individuals and genealogists can no longer use the FOIA to request social security records for individuals who have died within the past three years.
With Great Power Comes Great Responsibility
To further ensure only the good guys are getting their hands on the confidential database, the NTIS established a certification program for those seeking DMF access. This program, under a final rule effective Nov. 28, 2016, limits access to persons or companies that (1) can prove either legitimate fraud prevention interest, or business purpose pursuant to a law, rule, regulation, or fiduciary duty; (2) have network security procedures in place to safeguard the DMF information; and (3) have experience in maintaining the confidentiality, security, and appropriate use of such information. Organizations seeking access now must obtain an attestation from an independent third-party Accredited Conformity Assessment Body (ACAB) stating that their information security systems, facilities and procedures are effective to protect the DMF. A service organization control (SOC 2) report can document whether an organization meets those requirements, as it provides detailed information about the controls relevant to the security, availability, and processing integrity of the systems that process user data, as well as the confidentiality and privacy of that information.
By Your Powers Combined…
If your organization is ready to join the ranks of everyday heroes, contact an ACAB to have a SOC engagement performed. Receiving an “unqualified” SOC 2 report is a critical step in obtaining certification so that you, too, can use the DMF to help fight identity fraud. Moni J. Cook, CPA, CHC, CCSFP, a senior manager in the risk assurance & advisory services practice of KraftCPAs PLLC, has more than 22 years of operational, financial and regulatory experience. KraftCPAs provides clients in the healthcare industry with various services, including audit, tax, accounting, service organization control (SOC), and internal audit. For more information, contact Moni at email@example.com. nashvillemedicalnews
ProviderTrust Helps Employers Keep Compliant by Monitoring Who Isn’t By MELANIE KILGORE-HILL
Background checks are a standard part of the pre-hire process, but who’s looking out for an employer after the contract’s signed? All too often, employers find themselves paying hefty state or federal fines months or even years following a new hire. Medicare fraud, licensure issues, patient abuse and criminal histories often take months to come to light, costing employers an average of $105,000 in fines for a single employee. That realization was the fuel behind ProviderTrust, a Nashville-based healthcare compliance technology company whose solutions help clients across the nation stay compliant with the OIG exclusion list. ProviderTrust was one of the first in the compliance space to offer an inhouse, full-service, employee monitoring package.
Fulfilling a Need
“We’re a combination business that does both compliance monitoring and making more efficient software to track and notify employers about license status,” said Michael Rosen, who started ProviderTrust with business partner Chris Redhage in 2010. “These seemed to be the least funded and least attractive parts of healthcare, and no one was paying attention to them.” According to the company’s Compliance Healthcare Index Report, which was released in June, federal fines for employing or contracting with an excluded person or entity nearly doubled from $4.47 million in 2015 to $8.13 million in 2016.
A former attorney, Rosen left his legal practice in 1995 to launch his first entrepreneurial venture, Background America. “I really wanted to do something where I could go to sleep knowing I was helping to make the world safer,” Rosen said. Although the company was sold to a New York-based intelligence firm in 2009, Rosen still heard complaints from clients who had no way to track employees after a hire. Employer liability began on the hire date, but licensing boards only reported changes monthly. During this period, Rosen was introduced to Redhage, an expert in the medical staffing and technology fields. The duo soon launched ProviderTrust and immediately received funds to develop software and begin testing. “The test hospitals thought it was awesome because they knew when nurse licenses were coming due, and we alerted staff on their behalf,” Rosen said. “We took a lot of inefficiencies and labor off their hands because we were monitoring nashvillemedicalnews
ProviderTrust Co-founder Michael Rosen
all state license boards and the OIG exclusion list on an ongoing basis.”
A Lot to Manage
While data used by ProviderTrust is publicly available and free, managing a large employee database is nearly impossible for employers with multiple locations in multiple states. That’s because there’s more than 42 state and federal lists of people or companies that have been excluded. “Even if a company has a way to hit 42 of those, how would a company with 200,000 employees know which John Smith or Maria Garcia was theirs?” questioned Rosen, who noted many traditional services simply provide an aggregate list of similar names to be weeded through by
the employer. “What we do each evening is update those public lists to capture and scrub it to run against all names and provide results through a secure, easy-to-use webpage each morning.” ProviderTrust currently monitors over 2 million people for more than 350 companies, including six of the nation’s 10 largest nursing home chains. Another piece in the growing compliance puzzle is the Nurse Compact Act, a new piece of legislation being implemented in various states. The Act allows providers to cross certain state lines as a traveling healthcare professional without obtaining a license in each state. “Our technology was built to follow a provider wherever he goes,” Rosen said of meeting that challenge.
ers. “If it’s been two years and someone’s progressed through your company, he’s not going to tell you: ‘Oregon just excluded me,’ or that his license got suspended somewhere else,” he said. “The 95 percent of people in healthcare follow the law and aren’t stealing drugs, but the five percent that cause problems will cost you huge fines, because they won’t volunteer that information,” Rosen pointed out. Once questionable activity is suspected, the reporting and discipline process can be notoriously slow, giving an employee ample time to find a new job elsewhere. Rosen said employees typically have four to six months before being disciplined through the state. And since disciplinary boards often meet quarterly with results published one month later, employees have plenty of time to secure a new job in another state and pass a background check while still under investigation. That’s bad news for the new employer, since every billable item related to that employee, right down to surgical tray preparation, can be rejected and result in fines of up to $10,000 per patient per day. “There’s a lot of opportunity to commit fraud, waste and abuse in healthcare, and some people just want to get lost in the system,” Rosen said. “We provide a really important service that makes those penalties 100 percent avoidable for employers.”
making a move?
Looking Back & Forward
While today’s healthcare employers understand the need to ensure employees and vendors stay off lists that would prohibit reimbursement from Medicare or Medicaid, Rosen said that wasn’t the case in pre-ACA 2010. “Back then it was discussed as a good idea and if it passed would be dealt with,” he explained. “Our company bet on the right trajectory of what would be on the minds of compliance officers in healthcare companies.” Rosen said post-hire monitoring is imperative for today’s healthcare employ-
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monitor the frequency of antibiotic-resistant bacteria in a population. The scientific possibilities get very exciting very quickly.” SHERLOCK utilizes Cas13a, a different CRISPR-associated protein than the gene-editing tool. Working together the Zhang and Collins teams found a way to amplify Cas13a sensitivity utilizing body heat to boost the levels of DNA or RNA in their test samples, according to materials provided by the Broad Institute. After increasing those levels, the team then applied another amplification step to convert the DNA to RNA, thereby enabling them to increase the sensitivity of the RNA-targeting CRISPR by a millionfold in a manner that can be used in almost any setting. The new tool is so sensitive that it can detect the presence of as little as a single molecule of a target RNA or DNA. Reaching out to colleagues at Broad studying Zika, researchers in Zhang’s lab were able to take the raw serum, or urine samples, and input it into their SHERLOCK reaction. In a matter of a few hours, they were able to detect very low levels of Zika, which is critical since there often is only a very small amount of the virus in the body even in patients who are quite sick. The new tool can be designed for use as a paper-based test that doesn’t require refrigeration, which also makes it very exciting as a diagnostic tool in remote settings with little access to advanced equipment. “Diagnostics in the infectious disease field is actually very unique from diagnosing any
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other disease and that is that time is of the essence. People die even with each passing hour if we can’t make the correct diagnosis,” said Deborah Hung, MD, PhD, one of the coauthors and co-director of the Broad’s Infectious Disease and Microbiome Program. Rapid results from SHERLOCK could provide needed information to guide patient management Dr. Deborah Hung in a much shorter timespan. “There is still much work to be done, but if SHERLOCK can be developed to its full potential, it could fundamentally change the diagnosis of common and emerging infectious diseases,” she stated. “If SHERLOCK can help to diagnose and prevent spread of disease, then I think that would be really impactful,” concluded Zhang.
Nashville-based specialty diagnostic company IQuity leverages machine learning as a core part of a breakthrough RNA analytics process that hones in on a number of autoimmune disorders, which have traditionally been difficult to pinpoint with speed and accuracy. Chase Spurlock, PhD, co-founder and CEO of IQuity, said the technology originated at Vanderbilt University Medical Center. He and IQuity co-founder Thomas Aune, PhD, both worked on the RNA platform before licensing the technology from the university, where they both remain on faculty. The pair has continued to enhance the analytics process and expand its appli- Dr. Chase Spurlock cation across neurology, gastroenterology and rheumatology through a robust R&D program. “The underlying question is can we look inside cells, look at RNA, and identify an RNA fingerprint that is indicative of a certain disease?” Spurlock said of the company’s foundational question. “The answer is ‘yes.’” Spurlock noted IQuity is built on almost 15 years of research. He added the last couple of years have been focused on finalizing the technology and preparing a go-to-market strategy. The company is in the process of a national rollout of their first IQIsolate platform focused on diagnosing multiple sclerosis. A gastro panel is scheduled to launch later this summer to distinguish inflammatory bowel diseases including Crohn’s and colitis from irritable bowel syndrome (IBS), which is not an autoimmune disease. In the fall, the neurology platform is slated to roll out to help providers identify fibromyalgia versus rheumatic disease including rheumatoid arthritis and lupus. He explained the proprietary IQIsolate process analyzes RNA expression data from a blood sample to look for the presence or absence of disease at the cellular level. The test panels ‘rule in/rule out’ a suspected autoimmune disorder and can be ordered from
PHOTO: MARIA NEMCHUK
Building off their respective bodies of work, Feng Zhang, PhD, from the MIT Broad Institute; James Collins, PhD, of Harvard’s Wyss Institute who is also affiliated with Broad; along with several other colleagues co-authored a paper in Science this past April describing the adaptation of a CRISPR protein to target RNA to create a highly sensitive, inexpensive, rapid diagnostic tool. Hailed as having the potential to transform Dr. Feng Zhang research and global public health, the technology has been dubbed SHERLOCK – Specific Highsensitivity Enzymatic Reporter unLOCKing. “SHERLOCK is a different application of a CRISPR system – using Dr. James Collins CRISPR not for editing the genome but to detect and diagnose biological material,” said Zhang. “We can now effectively and readily make sensors for any nucleic acid, which is incredibly powerful when you think of diagnostics and research applications,” said Collins. “This tool offers the sensitivity that could detect an extremely small amount of cancer DNA in a patient’s blood sample, for example, which would help researchers understand how cancer mutates over time. For public health, it could help researchers
PHOTO: MARIA NEMCHUK
Rapid RNA Testing Dials Up Quicker Diagnostics, continued from page 1 the earliest onset of symptoms with results being sent to providers in as little as a week. Prior to this new technology, Spurlock continued, clinicians have been vexed with trying to reach a definitive early diagnosis for autoimmune diseases, which often have similar symptoms and typically fluctuate between periods of active disease and remission. “It’s not until the disease gets to the point where it’s clear it is MS and not something else that we have absolute clarity of diagnosis – and this involves time,” Spurlock said, noting physicians have typically had to take a ‘treatment to diagnosis’ approach. “Now, in the era of personalized medicine, the shift has been more toward correct diagnosis/early diagnosis and then treating the patient based on this information.” Spurlock said a move to the latter approach has been made possible by access to large data sets and improved computational capabilities. “For us, that centers on machine learning and being able to create computer models that are capable of determining presence or absence of disease based on data you provide … in our case, that’s RNA.” Scientists at the lab generate RNA data from the blood sample and then run that information through the customized computer system. “The backbone of our MS test is an algorithm that was developed using a thousand patients during the course of our research,” he said of the MS platform. “It’s similar for other diseases,” Spurlock continued. “We looked at the molecular portrait and built a computer program to identify them.” He added, “What we’ve developed is a platform technology for RNA analysis and diagnosis of disease. RNA is dynamic. It’s a real-time measurement of the activity of living cells.” While current panels are focused on diagnosis, the next steps are to look at RNA patterns in patients to assess disease progression and effectiveness of treatment options. Last month, IQuity was awarded a $1 million grant from the National Institutes of Health’s Small Business Innovation Research (SBIR) program. This SBIR grant – the company’s third – has been earmarked to further the ongoing analysis of long non-coding RNAs (lncRNAs) in multiple sclerosis, with a particular focus on developing tests to help physicians monitor disease progression. “The best way for patients living with debilitating autoimmune diseases to lead happier, healthier lives is to receive an early, accurate diagnosis,” said Spurlock. “Evidence shows relapses are often not as severe or frequent when a definitive diagnosis is made early in the disease process and tailored treatment options are started sooner.” For patients who have waited months … or years … for a diagnosis, this new technology offers great hope for faster, more accurate treatment. “Doctors need actionable tools, actionable information,” noted Spurlock. “The faster we can right the ship, the better off the patient is in the long-term.” He concluded, “One day, if we can identify disease at the earliest point, then perhaps we can hold the deleterious effects of the disease at bay more than we can today. That’s the whole goal.” nashvillemedicalnews
Track & Follow Up on Your Tests By JEREMY WALE Missed or delayed diagnosis is one of the most often litigated allegations in medical malpractice.1 These claims often result from tracking and follow-up procedure failures. Lab testing is one of three key areas (the others are referrals to specialists and missed/canceled appointments) where tracking and follow-up are vitally important. A retrospective study researched the frequency of patients not being informed of test results, concluding there was a 7.1 percent failure rate.2 Tracking and follow-up procedural safeguards can be implemented and have a large impact on potential liability claims. A reliable test tracking and follow-up system ensures the following steps occur: 1. The test is performed. 2. The results are reported to the practice. 3. The results are made available to the ordering physician for review and signoff. 4. The results are communicated to the patient. 5. The results are properly filed in the patient’s chart. 6. The results are acted upon when necessary. Here are some suggestions for improving your process: • Route all test results to the ordering physician for review. Procedures to ensure the ordering physician receives each and every test result can help lessen the risk of a result “falling through the cracks.” Something as simple as a log book or email notification can help facilitate physician review. • Ask the ordering physician to review and sign off on each ordered test result. Physicians order lab tests for specific reasons; physicians are encouraged to sign or initial each test result following review. • Notify your patients. Several practices notify patients only when there is an abnormal result. Some practices choose to send a letter for normal results and call the patient for abnormal results. Others call patients with all results. In today’s technology-driven world, an email may be appropriate for normal results, or an email directing patients to a portal where results can be reviewed. Patient notification of all test results is advised however your practice chooses to do so. Ensuring all tests ordered by your physicians are handled a consistent manner will help avoid tracking and follow-up errors. Develop a system, which works within the context of your practice, and follow these protocols with every patient – helping to effectively and efficiently stay on top of test results. PIAA Closed Claims Comparative: A comprehensive analysis of medical professional liability data reported to the PIAA Data Sharing Project,” 2015 Edition. 2 Casalino, L.P., et al., “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results.” Archives of Internal Medicine 169 (2009): 1123-9. 1
Attorney Jeremy Wale works as a risk resource advisor for ProAssurance. He has authored numerous articles about mitigating medical professional liability risk and also conducts loss prevention seminars to educate physicians about new and emerging risks. www. ProAssurance.com.
The Future of Precision Medicine
Concert Genetics Bringing Leaders Together to Maximize Potential By MELANIE KILGORE-HILL The field of precision medicine is growing at an astronomical pace, with nearly a dozen new tests hitting the market daily. Tracking what’s out there … and how effective it is … is a big task, and it’s one being tackled by Nashville-based Concert Genetics. In June, the precision medicine specialists released a white paper called “Connecting the Genetic Health Information Network: Critical Steps to Realizing the Potential of Precision Medicine.” Their goal, said company founder Mark Harris, PhD, is to Dr. Mark Harris start a conversation among stakeholders in the personalized medicine marketplace.
“We are in a unique position in the personalized medicine space, since our clients are labs, hospitals and health plans,” Harris said. Concert Genetics clients include seven of the nation’s top 10 children’s hospitals, while the company also provides analytics management and consultative services to health plans, helping them understand what they’re paying for. “As we dug into the problems facing these stakeholders and thought about our own position in the market, we quickly realized there wasn’t one simple solution,” Harris said. “We see things being brought to the market that will benefit one stakeholder or another, but no one is talking about systematic problems facing the industry.” Harris, who earned his doctorate in Cancer Biology from Vanderbilt University, said the absence of a systematic approach to industry challenges is likely to hinder big picture progress within the precision medicine space. “We felt compelled to tell the story from multiple stakeholder angles, bring to light some of the problems and try to find solutions with stakeholders engaged, as well,” said Harris.
appropriately, and the health plan side is seeing a bunch of different codes for the same test and are wondering if they’re paying a fair price or if the lab’s making a mistake,” said Harris. “Both sides are worried about the other’s intention because there’s a lack of transparency.” The ongoing coding war between providers and health plans is an ugly industry struggle, with both groups trying to figure out how to maximize reimbursement. Harris believes consistent coding could help resolve conflict from both sides. Another industry roadblock is the lack of clinical utility data and patient outcomes available on many of these tests. “The data is held in silos, meaning some is in the providers’ hands, while other pieces are with labs and health plans,” he said. “Nobody is combining the data so that we, as an industry, can see which tests are working.” How was the patient before the test occurred, and what happened to the patient afterward are two important questions each industry player needs answered. “We need to know if they had surgery or a medication change following the test, and we need access to claims data and lab results, as well as EHR data,” Harris said. “We envision a stage where there’s a consortium of providers and labs willing to submit a subset of data into a common reposi-
More Dialogue Needed
Discussions between Concert Genetics and their clients have led to positive conversations and a mutual desire to sit down with other industry leaders to brainstorm possible solutions for some very big problems. “Each stakeholder is very familiar with his own set of problems but generally isn’t as familiar with problems from the other perspective,” Harris said. “When you lay it out for them they say ‘this makes sense,’ and by working together, we’ve identified a few core issues causing problems across the board.” In September, Concert Genetics will host an invitation-only industry summit for the 100 top genetics leaders with the simple goal of starting that conversation on a larger scale. The meeting could be the first steps in changing the trajectory of personalized medicine. “ We’re seeing a lot of interest from all parties to come together and solve this,” Harris said. “It will take time to put these pieces together, but we’re excited about the positive feedback so far.” A link to download the full white paper is available in the ‘Resources’ section of the company’s website and also included with the online version of this article at NashvilleMedicalNews.com.
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Problems in Precision Medicine
So, what exactly are the problems hindering precision medicine? For starters, a tremendous lack of standardization and nomenclatures in coding. “Today’s IT systems weren’t built with genetics in mind and aren’t nearly as granular as they need to be,” Harris said. In an industry with more than 70,000 genetic tests on the market, only 200 genetic CPT codes exist with a mere four to five added quarterly. “There’s no good translation tool between claims and tests being ordered,” said Harris, noting that data regularly gets lost in the information transfer between lab orders and reported outcomes. More times than not, genetic tests fall into the “miscellaneous” category, resulting in a general loss of efficiency across the board. “There’s frustration from the lab’s perspective because they want to get paid
tory leveraged by researchers,” he continued.
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Taking Telemedicine to the Next Level Access, Convenience Driving Factors of Growth
dermatologic issues and sexual health. “We’re not setting broken bones or suturing a laceration remotely,” Gorevic said with a smile. However, he continued, “For the issues we see, 92 percent of our users get their medical issue resolved the first time without having to have a followup.” While telemedicine has long been looked at as an access solution, particularly for those living in rural areas, Gorevic said it also offers access in terms of convenience and off-hours care even in large metro-
Health Care Council Unveils New Purpose Statement Last month, officials with the Nashville Health Care Council announced the Board of Directors has updated the organization’s purpose statement to better reflect the Council’s scope and impact. The new purpose statement is: “To inspire global collaboration to improve healthcare by serving as a catalyst for leadership and innovation.” “The Nashville Health Care Council was founded with the purpose of bringing together healthcare leaders to position Nashville as our nation’s healthcare capital,” said Board Chair C. Wright Pinson, MBA, MD, who is CEO and chief health system officer for Vanderbilt University Medical Center. “Given the amount Dr. Wright of change the Council, our industry, and Nashville have undergone Pinson in the 20 years since, we felt the time was right to evolve this purpose statement to more accurately reflect the role the Council plays today.” “I’m pleased our Board recognized that an important piece of the Council’s current and future work involves facilitating conversations among leaders from around the country and the world who wish to work together toward a common goal – improving health care,” said Hayley Hovious, president of the Council. “As the Council grows and evolves to meet health care’s increasing need for collaboration, we’re excited to build upon our unmatched legacy and unique position in the industry. For our nearly 300 corporate members, the Council’s new purpose statement reflects a commitment to further growing the programs and initiatives we already offer, Hayley Hovious such as Fellows, Leadership Health Care and international study missions, while developing new opportunities to connect members with colleagues around the country and the world.”
politan areas. “Fifty percent of our visits are nights, weekends or holidays when the doctor’s office is closed,” he said. Gorevic added after hours access to physicians through Teladoc and other virtual providers rather than through an Emergency Department also represents a significant cost savings for both the patient and the healthcare system. One of the early criticisms, Gorevic noted, was a concern that telemedicine providers would get in the way of the continuity of care. However, he countered, “Being an integral part of the overall healthcare system is important to us. Increasingly, we’re working with health systems to create an integrated experience.” One of the company’s largest clinical areas is behavioral health. “At the beginning of 2015, we acquired a company doing direct telebehavioral health. It’s one of our fastest growing areas of the company,” said Gorevic, adding telebehavioral health addresses a number of barriers to receiving care. He shared an anecdote from Teladoc’s medical director for behavioral health. A board certified psychiatrist, she lived in a small town with a high suicide rate and other mental health issues. Yet, she recalled, no one wanted to park their car in front of her office where it might be recognized by neighbors. Additionally, Gorevic said there are other patients, such as those suffering from PTSD, who have a difficult time even leaving their house. Accessing care remotely, he said, offers a viable, nonthreatening solution. He sees continued growth in telemedicine as a cost effective piece of the overall continuum of care. Certainly, Teladoc has experienced significant increases over the company’s history both in revenue and virtual office visits. The company almost doubled the number of visits from 575,000 in 2015 to 950,000 last year. Gorevic said
PHOTO © 2017, DONN JONES
At the intersection of healthcare and technology, telemedicine continues to change the delivery landscape and is expected to attract 7 million patient users by 2018. Last month, Jason Gorevic, president and CEO of Teladoc, sat down with Sen. Bill Frist, MD, as part of a Nashville Health Care Council program to discuss the continued growth of this technologyenabled healthcare platform. Launched with a mission to create a new kind of healthcare experience connecting patients and physicians, Gorevic said the value proposition is to shift the mindset from ‘I’m sick. I need to go to the doctor’ to ‘I’m sick. What’s the best way to get care?” Today, Teladoc commands nearly 75 percent of the telemedicine market share and serves roughly 7,500 payer, provider and employer clients representing more than 20 million members. The healthcare team includes 3,100 boardcertified, state-licensed physicians and therapists who handle medical consults around the clock in general medicine and behavioral health. Gorevic noted that in addition to dealing with routine upper respiratory issues and skin rashes, patients are increasingly able to tap into assistance for more complex issues including counseling needs,
the company expects to see 1.5 million individuals in 2017. “That’s pretty staggering growth in any industry,” he pointed out. In response to a question from Frist regarding the challenges of taking a startup to a publicly traded company, Gorevic offered a few pieces of advice. “Beware of the technology in search of a business model,” he warned, adding that just because technology exists doesn’t mean anyone wants it. “Make sure there’s a value proposition and a real business model before you launch.” Second, he noted, “You have to be super comfortable with ambiguity. There’s rarely a right or wrong answer.” Finally, expect challenges. No one said it would be easy. “We’ve had some challenges along the way. The regulatory environment was probably the biggest challenge,” he said. Gorevic noted Teladoc had highly publicized dispute with the Texas Medical Association. After spending millions over the course of six years on court cases and working to get legislation passed to allow the virtual visits, the company prevailed. “You hate to spend that kind of money, especially as a cash-strapped startup, but I always knew we were right,” he stated. PHOTO © 2017, DONN JONES
By CINDY SANDERS
Teladoc CEO Jason Gorevic shared insights with 200 Council members on the future of telemedicine and growing a startup into a dominant industry player.
As of Sept. 1, Teladoc will be in all 50 states when the company enters the Arkansas market. Gorevic believes the growth the company has already experienced is just scratching the surface of the overall telehealth potential. “It’s about improving access to care and enabling patients to interact with healthcare systems remotely – just as everyone does everything today. We live in an on-demand society, and we believe healthcare access should be on-demand, as well,” Gorevic stated. nashvillemedicalnews
Reforming Healthcare Reform By CINDY SANDERS
As the July issue of Nashville Medical News was going to press, the U.S. Senate had just decided to defer a vote on their Obamacare ‘repeal and replace’ strategy amid dissension in the ranks. The Senate version came in the wake of national outcry following the U.S. House of Representatives narrow passage of the American Health Care Act (AHCA). If Mitch McConnell is successful in moving “The Better Care Reconciliation Act of 2017” forward, he will have to find a way to simultaneously appease conservative senators who believe BCRA doesn’t go far enough and moderates who believe it goes too far in replacing the Affordable Care Act. Adding to the difficult balancing act is a Congressional Budget Office score that estimates BCRA would result in millions of Americans losing coverage over the coming years, which should make the holiday recess with constituents fun. With no Democrats expected to support the bill, McConnell cannot afford to lose more than two GOP votes. If McConnell rallies the troops through ongoing negotiations to the legislation, the bill must then go back to the House. Differences in strategy between the Senate and House versions of healthcare, coupled with deep ideological differences among Republican lawmakers, likely signals an uphill climb to find consensus. Key points to the Senate draft (as of press time) included: • Tax credits based on income will continue to help individuals purchase insurance as with ACA. Currently, credits are available for Americans making up to 400 percent of the federal poverty level. In the Senate bill, that cap would be at 350 percent of FPL after 2020. In the House AHCA bill, credits were tied to age. The Senate version still has an age factor, but income is weighted more heavily. • The Senate bill rolls back the significantly higher federal match rate that was part of the ACA Medicaid expansion program for those making 100-138 percent of FPL. No one would be allowed to join expansion beginning in 2020, and the federal funding of the expanded rolls would be phased out over four years beginning in 2020. By 2023, the additional federal funding would be eliminated, which could lead states to contract Medicaid rolls. • Those who fell in the ‘donut hole’ after the Supreme Court ruled states couldn’t be forced to expand Medicaid coverage would be eligible for tax credits. • While the tax credit for individuals is more generous in BCRA than the AHCA, Medicaid spending growth down the line would be more severely impacted by the Senate version. Both bills have a per capita Medicaid spending limit, but the Senate bill shifts the calculation from the consumer price index for medical care, which is more generous, to the lower general CPI rate after 2025. • States won’t be allowed to ‘opt out’ of covering pre-existing conditions but can
request a waiver for covering the 10 essential health benefits under ACA. • The bill allows for funding of a federal reinsurance program to stabilize the individual insurance market on a temporary basis. • Most ACA taxes would be rolled back, and the bill eliminates the individual mandate to buy coverage. A link to the bill text as it was released on June 22 is available online at NashvilleMedicalNews.com under the ‘Breaking News’ section on the right, which is being updated as more information becomes available.
What’s at Stake?
Last month icitizen released poll results gauging reaction to the proposed AHCA legislation. Nearly 65 percent of American
adults polled said they would be less likely to reelect their U.S. Senator or Congress member if he or she votes to enact the AHCA. The online survey of 1,290 U.S. adults found more than 6 in 10 Americans believe the AHCA would have a negative effect on their household. “Interestingly, a quarter (25 percent) of Republicans believe that AHCA will have a negative effect on their household, along with 85 percent of Democrats. Only 45 percent of Republicans believe the AHCA will have a positive effect on their household, a full 19 percent drop from last month’s icitizen poll,” said Cynthia Villacis, icitizen’s director of Polling. Pessimism over healthcare reform measures is more pronounced among several groups. Belief in the negative effect of
AHCA is especially strong among women under 50 (75 percent), racial minorities (68 percent) and Independents (70 percent). “This poll demonstrates that one month since the House’s passage of the AHCA, the public remains pessimistic about the new healthcare legislation. Republicans’ opinion remains mixed, suggesting that advocates of the AHCA should consider reforms to the bill that would unify the party,” noted Villacis. With the 2018 midterm elections looming, members of Congress from both sides of the aisle must be prepared for Americans to hold them accountable for their vote on the AHCA.” Whether or not the Senate version is received more warmly outside of the Beltway remains to be seen. Information on AHCA, the Senate bill, and reaction from a variety of stakeholders are available online.
Study Disputes Link between Uterine Fibroids, Miscarriage Risk A 10-year study, led by Vanderbilt University Medical Center professor of Obstetrics and Gynecology Katherine Hartmann, MD, PhD, disrupts conventional wisdom that uterine fibroids cause miscarriages. The results of study appeared June 7 in the American Journal of Dr. Katherine Epidemiology. Hartmann “We find women with fibroids are not at increased risk of miscarriage,” said Hartmann. “Women with fibroids had identical risk of miscarriage as women without fibroids when taking into account other risks for pregnancy loss. We were stunned.” Changes in uterine architecture and other local effects of fibroids have been implicated in prior research as a risk factor for miscarriage, said Hartmann. “This is great news for women. Our results challenge the existing paradigm and have potential to reduce unnecessary surgical intervention,” she said. Investigators from Vanderbilt, University of North Carolina-Chapel Hill and
the National Institutes of Health (NIH) National Institute of Environmental Health Sciences, accrued the largest prospective cohort to date to investigate the association of fibroids with miscarriage, said Hartmann, the study’s principal investigator. The study, “Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk,” included women from eight urban and suburban communities in three states to achieve a racially diverse cohort of women planning pregnancies or in the early weeks of pregnancy. Each woman in the Right from the Start study had a standardized ultrasound for fibroids to determine presence, number, size and location in the uterus. Of the more than 5,500 women enrolled, ultrasound detected uterine fibroids in 11 percent, while 89 percent of the study participants did not have fibroids. The chance for miscarriage in both groups was 11 percent. Hartmann noted the initial goal of the study was to understand which fibroids confer the highest risk of miscarriage in order to determine who might benefit most from surgery or myomectomy to remove the fibroids before a future pregnancy. How-
ever, the results led investigators in a different direction. “The key message is that fibroids don’t seem to be linked to miscarriage,” said Hartmann. The authors explain their analysis likely reached different conclusions than other studies for several reasons: few earlier studies conducted ultrasounds for all participants to document fibroid status; no prior prospective cohorts took into account the influence of age and race. Age and African-American race/ethnicity are both associated with having miscarriages; and prior conclusions did not untangle these confounding factors, and fibroids were incorrectly blamed. Hartmann said when all factors are taken into account, the surprising results of the study should give both women and care providers reassurance. “More than 1 million miscarriages occur in the U.S. each year,” she said. “Loss is remarkably common, but we know very little about the causes. When something bad happens in a pregnancy, the first thing women look at is themselves, asking why it happened and what they could have done differently. Now women with fibroids have one less thing to worry about.” JULY 2017
Finding a Healthcare Home
Safety Net Consortium Initiative Links Community to Primary Care By CINDY SANDERS
While the debate over access to healthcare rages on nationally, a collaborative partnership in the Nashville area is fostering increased awareness and utilization of area resources and services to promote a healthier community. My HealthCare Home, a joint effort of more than 50 area clinics through the Safety Net Consortium of Middle Tennessee, looks to connect some of the community’s most vulnerable members to a primary care home for improved health and wellbeing. My HealthCare Home is a project that came about as part of the Collaboration College, an opportunity for nonprofit organizations alongside public and private partners to align expertise for the greater community good. The new website – myhchtn.org – connects people to participating clinics and providers to establish primary care relationships. “As a consortium, we talk a lot about need and how to let people know what exists and how to access the safety net so
people aren’t just accessing care in the ED,” said Carol Westlake, chair of the Safety Net Consortium and executive director of the Tennessee Disability Coalition. “We want to build mediCarol Westlake cal homes for folks so they have access to well care to build good health, as opposed to only episodic care
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when things go wrong.” Mike Kessen, project consultant on behalf of the Safety Net Consortium, added, “It’s helping people connect to a regular source of care so that they can live healthier lives overall.” Centerstone, Faith Family, Interfaith Dental Mike Kessen Clinic, Matthew Walker, Meharry Medical Group, Mental Health Cooperative, Mercy, Nashville General, Neighborhood Health, Primary Care and Hope Clinic, Saint Thomas, Salvus, ShadeTree, Siloam, The Clinic at Mercury Courts, and UCHA are all among the participating clinics. Additionally, Westlake said the Metro Nashville Department of Health has been a key partner throughout the process. “The Health Department has a Community Health Improvement Plan (CHIP). There is a particular goal in there about system navigation and getting people to services. My HealthCare Home is a piece of the commitment we made to the CHIP on improving navigation, especially for the underserved.” The partners, however, have long recognized people cannot access what they don’t know exists. Through research with focus groups, the Safety Net Consortium has found nearly half (48 percent) of uninsured individuals in the area aren’t fully aware of services available within the community. “We have developed a number of strategies over the years to connect people to the safety net,” Westlake said, adding the new My HealthCare Home platform is another way to engage the community in the mobile manner in
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which many people now expect to link to information and resources. Kessen said the first phase of the project was building a database with a comprehensive list of resources. “The website is absolutely vital to having information available,” he noted. Kessen added that as the site was being developed, a patient advisory committee helped test usability and provide feedback on how to build awareness. Now the group has moved to the next phase. “Given the launch was April 20, we’re really working on the marketing plan and getting the word out,” noted Elisa Friedman, director of Planning and Community Engagement for the MeharryVanderbilt Alliance. She added the awareness message is important for both community Elisa Friedman members who would benefit from services and for healthcare providers and discharge planners so they know this new resource exists. “It would be a great tool to get people to the right care, at the right place, and right time when they are discharged from the hospital,” Friedman pointed out. Westlake said, “Many years ago when we started the Bridges to Care program, we actually had case managers embedded in EDs that would help direct people to the appropriate level of care.” Now, discharge planners and hospital case managers can use My HealthCare Home in a similar manner to help patients access needed care within the community. Friedman agreed, noting the website is a ‘onestop shop medical home.’ Westlake added it’s important for consumers and providers to know the clinics all use a sliding fee scale based on income and family size. She stressed My HealthCare Home isn’t just for the uninsured as the clinics also accept TennCare and other payment sources. Kessen added additional enhancements are being made to the site. “As we move into the next phase, we are going to be able to translate the website into eight languages in addition to English,” he said, noting that was one of the suggestions made by the patient advisory committee. “Long term,” Friedman said, “we’re looking at those high level measures in terms of reducing cost and impact to the healthcare system. Ultimately, this is really about population health … raising the health of the community.” Westlake concurred, “If we can get the population healthier, the entire healthcare system will be more efficient and effective … everybody benefits.” nashvillemedicalnews
GRAND ROUNDS Mark Your Calendars
Health:Further • Aug. 22-25 More than 2,000 healthcare innovators and entrepreneurs are expected to descend on the Music City Center Aug. 22-25 for the annual Health:Further Festival. Organizers recently announced a technology partnership with Nashvillebased Lucro, a digital platform that helps healthcare organizations make better purchasing decisions. Lucro is providing its platform to Festival attendees, allowing vendors and purchasers to accelerate the buying cycle by connecting prior to and post event based on strategic initiatives and relevant offerings, in an effort to enhance the live experience. Other recent announcements
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include the addition of Brookdale Senior Living as a sponsor and Innovation Partner, a partnership with Brain+Trust Partners, and the addition of noted healthcare exec and investor Charlie Martin and renowned economist and policy advisor Dr. Arthur Laffer who is known as the ‘father of supply-side economics’ as keynote speakers. For previous announcement and info, go online to NashvilleMedicalNews.com or healthfurther.com.
MMC Welcomes New CFO
Murfreesboro Medical Clinic & SurgiCenter recently announced the addition of Matthew C. Stearns as the chief financial officer of the clinic and its associated operations. The Shelbyville native earned his undergraduate degree in economics from Matthew C. Harvard University and Stearns both his MBA in finance and law degree from Vanderbilt Owen and Law School, respectively. Previously, he worked in the telecommunications industry where he managed the development of more than $300 million worth of critical infrastructure projects across the United States.
Correct Care Solutions Names Perez CFO
Nashville-based Correct Care Solutions (CCS) has named Juan C. Perez to serve as the company’s chief financial officer, according to the company’s CEO Jorge Dominicis. CCS is a leader in public healthcare with nearly 12,000 professionals working in 38 states Juan C. Perez plus Australia. Previously, Perez was a director with Warbird Consulting Partners in Atlanta. Prior to that, he held key financial roles for two Denver firms, serving as senior vice president, corporate controller and treasurer with Intrawest Resorts Holdings and as CFO, treasurer and corporate secretary for Accruit, LLC. Perez earned his degree in business from the University of Colorado at Boulder and is a CPA in Colorado.
TMA Builds Physician Leaders The Tennessee Medical Association recently announced a new partnership with the University of Tennessee, Knoxville’s Haslam College of Business Physician Executive MBA program, reaffirming the organization’s commitment to providing leadership training opportunities for its members and fostering a new generation of physician leaders. The UTK Physician Executive MBA is a one-year program exclusively for physicians with a curriculum that emphasizes applied assignments, innovation, and financial acumen. More information is available at haslam.utk.edu/pemba. Additionally, TMA recently announced the latest participants in
the Physician Leadership Immersion Program, part of the John Ingram Institute for Physician Leadership. The 2017 class is made up of 12 physicians from across the state, including six from Middle Tennessee: Ranjan Chanda, MD, Natalie Dickson, MD, Karie McLevain-Wells, MD, Seenu Reddy, MD, MBA, Betsy Triggs, MD, and Laura
Zeigler, MD. The program launches on July 28 and concludes with a September meeting in Nashville. Participants in the program will take part in both inperson and webinar group meetings to cover course material and will earn 30 hours of continuing medical education and a certificate in Physician Leadership.
VUSN Breaks Ground
In late June, Vanderbilt University School of Nursing (VUSN) hosted a groundbreaking ceremony officially starting construction of the nursing school’s new $26.3 million expansion. The five-floor structure will be built on land where Godchaux and Patricia Champion Frist Hall intersect at 461 21st Ave. S. The new 29,947-square-foot building, which is expected to open in August 2018, will house technologically advanced classrooms, conference and seminar rooms, student services offices, faculty offices and a state-of-the-art simulation teaching lab that will allow complex skills development and real-time feedback on students’ clinical nursing skills. With nearly 900 students, VUSN is one of the largest graduate nursing programs in the country. Officials gathered in late June to join School of Nursing Dean Linda “In the past 10 years, our Norman and Vanderbilt University Chancellor Nicholas Zeppos to break student enrollment has ground on VUSN’s $26.3 million expansion. increased by nearly 50 percent. Applications to the school have shot up by 110 percent,” said Dean Linda Norman, DSN, RN, FAAN “The new building will accommodate the increased number of students, faculty and staff, and ensure the school continues to attract and recruit the best students and faculty.”
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www.krafthealthcare.com JULY 2017
GRAND ROUNDS Let’s Give Them Something to Talk About! Scott Mertie, president of Kraft Healthcare Consulting, an affiliate of KraftCPAS, has joined the Saint Thomas Health Foundation’s board of directors where he will serve on the investment committee. Saint Thomas Health Foundation is focused on providing access to essential health services to everyone in the Middle Tennessee community, particularly uninsured and underinsured. Healthcare communications firm Jarrard Phillips Cate & Hancock recently announced the promotion of Kim Fox to partner. Fox, who Scott Mertie joined the firm in 2006, previously served as a senior vice president. An organizing session by the recently formed Enhanced Recovery After Cardiac Surgery (ERACS), titled ERACS: Best Practices, Cost-Effective Initiative took place in Boston and featured a consortium of forward-thinking leaders in cardiac surgery. The select group – which included TriStar Centennial Heart and Vascular Institute cardiovascular surgeon Seenu Reddy, MD – joined together to address the need to standardize best practices in cardiac surgery as other specialties have done through their ERAS® (Enhanced Recovery After Surgery) programs. Last month, the Robert F. Kennedy Children’s Action Corps presented Tivity CEO Donato Tramuto with the “Embracing the Legacy” award, which recognizes leaders who help improve the lives of children and their families. The award was presented to Tramuto for his body of philanthropic work, including founding Health eVillages, a company that brings healthcare to underserved populations in seven countries. Vanderbilt University’s Robert J. Coffey Jr., MD, has received an Outstanding Investigator Award from the National CanDonato Tramuto cer Institute (NCI) – more than $6.6 million over seven years – to support studies aimed at advancing the diagnosis and treatment of colorectal cancer. He is one of 27 researchers nationwide to receive one of the awards in the second round of the NCI program. Last month, local anesthesiologist Jesse M. Ehrenfeld, MD, MPH, was introduced as an executive officer for the American Medi- Dr. Robert J. Coffey, Jr. cal Association’s 2017-2018 Board of Trustees in the office of secretary. Additionally, Kevin W. Williams, a former senior executive at General Motors from Nashville returns as the public member on the AMA Board. Frost-Arnett was recently awarded the 2017 Torch Award for Ethical Commerce by the Better Business Bureau (BBB) of Middle Tennessee, in the 175+ employee category. Middle Tennessee companies made a good showing on the 2017 Healthcare Informatics 100 list. The recognition program ranks the top 100 healthcare IT companies in the United States based on HIT revenues from the most recent fiscal year. Area honorees were: Change Healthcare ranked 11th, M*Modal 43rd, Experian Health 45th, HealthStream 51st, MEDHOST 67th, and Cumberland Consulting Group 95th. Interfaith Dental Clinic was presented with the Henry Schein Cares Silver Medal for excellence in expanding access to care as part of last month’s Henry Schein, Inc. humanitarian awards. TriStar Centennial Medical Center CMO Divya Shroff, MD, a University of Missouri – Kansas City alumna, received the School of Medicine 2017 Take Wing Award. She was honored for her nationally recognized leadership in improving the quality and safety of patient care by merging medicine and technology. BlueCross BlueShield of Tennessee’s Medicare Advantage Quality Rewards Program recently recognized primary care physiDr. Divya Shroff cians across the state for achieving exceptional patient care outcomes. Among those recognized, 52 physicians statewide earned a 5 out of 5 star rating, including 11 in Middle Tennessee: Indumeet B. Bal, Ayrika L. Bell, Nageswara R. Chunduru, Wayne E. Moore, Christopher E. Ingraham, Gibran B. Naddy, John D. Rudd, Pamela J. Sanders, Moses A. Swaucy, Charles R. Tessier IV, and James C. Wallwork. Lipscomb University’s graduate program in healthcare informatics has been ranked No. 11 in the nation by Healthcare Administration Degree Programs. Additionally, the university’s College of Pharmacy became the first academic organization to join Nashville-based Hashed Health, which is leveraging blockchain and distributed ledger technologies to transform the healthcare industry. In other news from Lipscomb University, Dale Alden, assistant professor of Psychology, was recently named to the Tennessee State Board of Examiners in Psychology by Governor Bill Haslam.
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PHOTO COURTESY OF THE UNIVERSITY OF MISSOURI – KANSAS CITY SCHOOL OF MEDICINE
Awards, Honors, Achievements
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