FOCUS TOPICS FINANCE • TECHNOLOGY
Your Middle TN Source for Professional Healthcare News ON ROUNDS
Financing the Deal Health Care Council Hosts Annual Panel Discussion At the end of May, the Nashville Health Care Council hosted “Financing the Deal: DealMaking Trends and Strategies for Health Care Companies.”
Lending a Hand Nashville EC Provides Connections, Tools for Real-World Success More than 50 percent of small businesses fail in the first four years – a sobering reality facing entrepreneurs nationwide. Fortunately, one nonprofit is lending a hand to entrepreneurs and transforming Nashville’s healthcare community in the process ... 5
SCALE Conference Goes Virtual July 24-26 Event Expected to Draw Record Attendance The nation’s largest dermatology and cosmetic surgery convention is going virtual this year … but could very well have the greatest impact to date ... 11
ONLINE: NASHVILLE MEDICAL NEWS.COM
June/July 2020 >> $5
COVID-19 – Where We Stand
Healthcare Leaders Reflect on City’s Past, Present & Future Efforts By MELANIE KILGORE-HILL
Editor’s Note: Between the time this article was written and NMN went to press, case counts began to rise in Nashville, and the county moved back to Phase 2 of the reopening plan. On March 8, 2020, days after a tornado devastated portions of Middle Tennessee, Nashville Mayor John Cooper announced the city’s first case of COVID-19. As numbers climbed and “social distancing” became a buzzword in every home, Davidson County soon accounted for more than 4,500 of the state’s 25,000 positive cases and over 40 of 380-plus COVID-related deaths. Today, those numbers have more than doubled, yet Months (seemingly years) later, city leaders are navigating Phase 3 of Metro’s “Roadmap for Reopening Nashville” master plan. After Phase 2 was delayed slightly, the city moved into Phase 3 on June 22 with an expectation of staying in this phase for a minimum of four weeks. As the city emerges, healthcare leaders are cautiously optimistic about the future, while recognizing the fight is far from over.
Alex Jahangir, MD, MMHC, chairman of Metro
(CONTINUED ON PAGE 11)
AMA Issues New Privacy Principles Organization Looks to Restore Trust, Power to Patients By CINDY SANDERS
to provide the best care to my patients, my patients have to trust they can share information with me they From wearables and fitness apps to EHRs and might not want anyone to know,” he said, adding patient portals, an individual’s health data resides in there’s only one opportunity to get it right. “Once a lot of different places. In the wake of rising privacy privacy is lost, you can’t get it back. Privacy has to be concerns, however, the American public has grown fiercely protected.” increasingly worried about how their information is Rock Health and Stanford Center for Digital used and with whom it is shared. Health recently released a white paper outlining In response to this unease, the American Medifindings from the 2019 Consumer Adoption Survey. cal Association released new privacy principles in May In its fifth year, the study highlighted another reason that support an individual’s right to control, access the AMA is well positioned to take the lead in outand delete personal data collected about them. Jesse lining privacy expectations – physicians remain the Dr. Jesse Ehrenfeld Ehrenfeld, MD, MPH, immediate past chair of the most-trusted group when it comes to sharing health AMA Board of Trustees, said it was important for the data. Even physicians, however, have seen consumer organization to take a leadership role on the topic. “Trust is a funconfidence slip a little over the last three years. Yet, nearly threedamental component of the physician-patient relationship. For me (CONTINUED ON PAGE 8)
Inequality in America: A Public Health Crisis Note: We realize some of you might have already read much of what is included below on our website from early June, but we think the message … and our commitment to being active partners in our community … bears repeating. We’re also heartened to add updates, including protections for LGBTQ+ citizens recently affirmed by the Supreme Court. Health doesn’t just happen in the hospital or clinic or doctor’s office. In fact, the overwhelming evidence shows us the vast majority of health happens elsewhere - in our homes and our communities. We unequivocally believe everyone living in this country has a right to expect health and well-being no matter race, ethnicity, religion, age, socioeconomic status, gender identity or sexual orientation. It isn’t political. It’s just a simple human fact ... everyone has the right to breathe ... and in America, that should mean being able to breathe freely. Violence and inequality are a public health crisis. The pain on display across this nation is a public health crisis. The fear that accompanies many of our residents as they go about their daily lives is a public health crisis. Black Lives Matter. LGBTQ+ Lives Matter. Uninsured Lives Matter. And yes, we know that all lives matter, but we also know there remains a large divide between what should be and what actually is. Bridging this gap requires thoughtful attention given to those who are most at risk of failing to receive access and support … both in the clinic and in the community. Just as an ED triages patients based on immediacy of need, it is incumbent upon governmental and industry leaders to make priority decisions to improve the health and well-being of those at greatest risk – doing so not only benefits those lives but improves all lives by creating a stronger community. On a national level, the recent ruling by the U.S. Supreme Court affirms the LGBTQ+ community cannot be discriminated against in the workplace on the basis of gender identity or sexual orientation in accordance with the landmark 1964 Civil Rights Act. Locally, researchers at Vanderbilt University Medical Center have been awarded an NIH grant to explore LGBTQ+ perspectives on a range of issues related to biomedical research (see page 7) and the “All of Us” research program (see page 7) also looks to a more inclusive research model. We recognize how blessed we are to live in a community where so many of you work in large and small ways each day to advocate for your patients. From faith-based initiatives and federally qualified health centers to mission-based organizations like NashvilleHealth, Project Access and the Tennessee Justice Center, many hands are working to level the playing field. Siloam Health has just opened their new clinic in Antioch, which will expand critical outreach to a COVID hotspot in our community. Tech and services companies are innovating care access and delivery. Hospitals run outreach clinics and medical missions. Nashville General Hospital Foundation has a Food Pharmacy to address nutrition as a key component of health. Similarly, Brad Paisley and Kimberly Williams Paisley launched The Store as an option for those who can’t afford groceries, and insurers have boots on the ground in communities of need to identify and address a range of barriers from transportation to prescription costs. We also know how truly blessed we are to have Meharry and Vanderbilt training new generations of providers to deliver culturally competent care. But we also know it will take even more to create the sea change that is needed. For our part, we pledge to share your stories and partner with you however we can to make Middle Tennessee a place where all our citizens know they truly matter. Susan Graham & Cindy Sanders, Nashville Medical News Co-Publishers
thank you To all the
ICU staffers ff
infectious disease specialists
To the doctors, nurses, and other healthcare professionals battling COVID-19—the COVID 19 the employees of ProAssurance and our families are deeply grateful for your leadership, dedication, and sacriﬁces.
respiratory technicians h i i ambulance drivers
To everyone else—please be safe, wash your hands, and most importantly…
microbiologists vaccine research lab technicians
Listen to the doctors.
life sciences engineers pharmacists
nursing homes public health officials p ff
pathologists PPE manufacturers
medical research scientists
Healthcare Professional Liability Insurance
For ProAssurance policyholder information and resources > > >
Paycheck Protection Program Flexibility Act On June 8, 2020, the Paycheck Protection Program Flexibility Act was signed into law. Major provisions of the Act are as follows: • The covered period for loan forgiveness is extended to 24 weeks after the By LUCY CARTER, CPA date of the loan Member, KraftCPAs disbursement (originally 8 weeks). • The requirements for loan proceeds to be used for payroll during the 24-week period was lowered to 60 percent (originally 75 percent). • The repayment period for PPP loan amounts that are not forgiven is extended to 5 years (originally 2-year repayment period). • The requirement to meet the FTE requirement is extended to Dec. 31, 2020. The SBA, in consultation with the Treasury, will issue rules and guidance including a modified loan forgiveness application implementing the legislative amendments to the PPP loan (neither had been issued as of mid-June).
HHS Provider Relief Fund Portal for Eligible Medicaid and CHIP Providers
On June 10, 2020, HHS launched the portal for eligible Medicaid and CHIP providers. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief General Allocation (the $30 billion and $20 billion relief funds based on Medicare revenue). Applicants must meet all the following requirements: • Must not have received payment from the $50 billion General Distribution. • Must have directly billed Medicaid for healthcare related services during the period Jan. 1, 2018 to Dec. 31, 2019 or own an included subsidiary that has billed Medicaid during the same period. • Must have either filed a federal income tax return for 2017, 2018, or 2019 or be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (i.e. a state-owned hospital or healthcare clinic). • Must have provided patient care after Jan. 31, 2020.
(CONTINUED ON PAGE 3)
“What’s Up Doc?” Dealing with a Delayed Patient Volume Bounce With COVID-19 restrictions starting to lift nationwide, logic would follow that hospitals and physician practices would gear up for a wave of patients from deferred surgeries and appointments during the shutdown. However, a Commonwealth By CLARE MOYLAN Fund study indi- Principal at Gibbins Advisors cates while some volume has been restored in May 2020, it is still down 30+ percent from precrisis levels. The most significant volume declines have been in surgical/proce- and JEFF BUSHONG Principal at PYA dural specialties and pediatrics, while the drop in adult primary care and behavioral health specialties has been less severe. With this information, it is important to explore why volumes are not returning, what this means for physician practices, and what options may exist to help cope with the issue. Factors Impacting Lower Volumes The impact COVID-19 will ultimately have on the healthcare industry will go beyond the direct impact of the
Paycheck Protection Program Flexibility Act
• Must not have permanently ceased providing patient care directly or indirectly through included subsidiaries. • If the applicant is an individual, must have gross receipts from providing patient care reported on Form 1040, Schedule C, Line 1. The applicant must upload documentation to the portal (income tax returns, payroll tax returns, FTE worksheet provided by HHS). The deadline to submit an application is July 20, 2020. Go online to this article on NashvilleMedicalNews.com for links to instructions and the application. Lucy Carter, CPA, is a member and practice leader for the Healthcare Industry Team at KraftCPAs, PLLC. A well-known industry expert, Carter has more than 35 years of experience working with healthcare providers and executives. For more information, go online to KraftCPAs.com nashvillemedicalnews
number of infections and deaths. Observers believe there has been a psychological shift in the way many patients view healthcare facilities, attempting to avoid them for fear of infection. The potential for a “second wave” of COVID looms large in the mind of the public while also hints at the possibility of resuming mandated closure of certain practices. Part of the problem could simply be convenience, as Professor Thomas Campanella suggests in an interview with Quadax that 25 percent of patients who put off elective procedures may forego surgeries indefinitely instead of rescheduling. But broad macroeconomic trends also present volume headwinds. With U.S. unemployment spiking to nearly 15 percent in April, the number of uninsured Americans rises, as well. Since most patients receive their healthcare insurance through their employer, many now-uninsured people can be expected to defer non-urgent care. Even insured patients may feel insecure in their income and avoid procedures that include significant patient responsibility amounts. Unless carefully managed, practices may also experience collection problems. The practice must carefully weigh the risk of not collecting fees at the point of treatment versus losing a profitable patient encounter. Implications for Medical Practices The reduction in patient volumes will vary based on the type of practice, location and patient demographics, but as we examine healthcare facilities, there are common issues that must be dealt with coming out of COVID-19. For instance, new safety measures may limit volumes and add costs to patient encounters. The initial ramp up coming out of the pandemic may take longer than expected. Physicians surveyed were relatively pessimistic about how long it would take to “recapture” lost patients and procedures. For example, an April Canaccord Genuity survey showed only 8 percent of respondents said it would take 12 months to recapture those lost procedures, but that percentage increased to 25 percent in a more recent survey. A further obstacle to reopening is capital to fuel a ramp-up. Unless cash was carefully husbanded when COVID hit, many practices have burnt liquidity and now have less resources to fund staffing and other costs to recommence the practice. We observe that lenders are skittish about lending to physician groups except under an asset-based formulaic approach (usually based on accounts receivable), or where they have pre-existing relationships. In a trend accelerated by the pandemic, we are expecting to see an increasing shift away from hospital care even as elective surgery procedures are expected
to steadily ramp up over the next six months. In a survey done by Jefferies, 12 percent of current orthopedic procedures are performed in ambulatory surgery centers, but that number is expected to rise to 20 percent over the next six months. While negatively impacting hospitals, this trend will prove beneficial for practices that have their own surgery center. Recommended Next Steps The factors listed above have caused healthcare professionals to reevaluate the economics and strategy for their businesses, as the model for predictable success has changed. If volumes steady at only 70-80 percent of pre-crisis levels, then now is the opportunity to review and reconsider the strategy of your practice to create a stronger, more sustainable model or take other remedial steps. Closely examining the staffing for both physicians and administration is imperative to managing costs during the ramp-up period, as the baseline expense expectations will need to be reset. To manage liquidity, all options need to be explored including relationships with lenders, strategic partnerships with hospitals and competitors, and private
equity funding or negotiating burdensharing with vendors and lessors. If not already undertaken, plans may need to include negotiating temporary relief with landlords and lenders to lower operating expenses and improve short-term cash flows. Perhaps most importantly, providers must start with re-earning the trust of patients. Whether it is reducing the fear of a patient visit or offering more convenient treatment options, the industry must regain the public’s trust before the return of pre-crisis volumes can be expected. Clare Moylan, CFA is principal with Gibbins Advisors, which is focused on C-level healthcare operations and restructuring expertise. Based in Nashville and Syndey, Moylan has a broad base of experience across the healthcare continuum including operations and turnaround management, strategic planning, business analysis, performance improvement and litigation support. For more information, go to gibbinsadvisors.com. Jeff Bushong, MBA is a principal with PYA. Based in Brentwood, he brings more than three decades of expertise serving healthcare providers with a focus on consulting and advisory services in practice operations, performance improvement, business development, revenue cycle, and physician billing. For more information, go to pyapc.com
Your Advocate & Expert For Practice Management
NMGMA keeps you up to date on health industry standards, changes & trends. Meetings held the 2nd Tuesday of the month either by webinar from 12 pm-1 pm or in-person at Saint Thomas West Hospital from 11:30 am-1 pm Please check online at nashvillemgma.org for monthly meeting details. n n
July 14: Interoperability
August 11: Palmetto GBA: Medicare Updates
For more information on joining or attending an upcoming meeting as a guest, please reach out to Laura Watkins at firstname.lastname@example.org.
Financing the Deal
Health Care Council Hosts Annual Panel Discussion By CINDY SANDERS
At the end of May, the Nashville Health Care Council hosted “Financing the Deal: Deal-Making Trends and Strategies for Health Care Companies.” This signature annual event featured experts at the intersection of finance and healthcare for a lively discussion on current and future investment trends, as well as an inside perspective on the state of the market, impact of COVID-19 on deal flow and trending sectors to watch. Moderated by Nashville-based Tom Wylly, a senior partner with Brentwood Capital Advisors, the panel included: Geoffrey G. Clark, senior managing director, Starr Investment Holdings; Bruce Crosby, cofounder and managing partner, Health Tom Wylly Velocity Capital; Annie Lamont, co-founder and managing partner, Oak HC/FT; and Scott Poole, partner, Ridgemont Equity Partners. During introductions, panelists shared information on their specific areas of focus, ranging from early entrepreneurial stages to mature companies, and the amount of investment, which varied from $500,000 to as much as $1.5 billion. Wylly began the discussion with a recap of healthcare deal activity from the last 18 months, He said 2019 was pretty quiet in Nashville after a busy 2018. Wylly added the number and the dollar volume of deals had decreased in 2019 and … in the first quarter of 2020 … healthcare mergers and acquisitions dropped another 10 percent with the dollar value of those deals down 77 percent. “So, you can see the M&A market has been weakening over the last few years and was really put on life support in the first quarter in the wake of the virus,” Wylly said. He then asked the panelists to characterize their deal flow prior to the coronavirus and describe the impact of the pandemic on their portfolio companies. Poole said the impact to his firm’s portfolio companies has varied widely depending on the business, with about half of the companies being largely unaffected, a third down 20-30 percent and the balance seeing a significant downtown. Struggling companies in their portfolio have Scott Poole furloughed staff, cut salaries and postponed planned transactions. “Other businesses have had very different experiences,” Poole continued. “For example, we have two healthcare distribution businesses, one that delivers 4
defibrillators. Historically, defibrillator demand has grown 10 percent per year, but demand is down in this environment. For those customers, we’re now selling personal protective equipment. We created a whole new product portfolio of masks, gloves, gowns, hand sanitizer, wipes and more, which has filled the hole from the defibrillator demand slow-down.” Crosby said digital health was a very robust market in the first quarter of 2020, with $3.1 billion invested in digital health companies, according to Rock Health. “Like most, once COVID19 hit, we retreated and focused on our Bruce Crosby portfolio. Now we’re slowly moving out of it,” he said. “We’re invested in MDLive, one of the largest telehealth platform companies. Like other telehealth companies, they’ve seen a tremendous growth in volume and benefited from the coronavirus. On the other side of the spectrum, we have companies that sell software to health systems, and we expect sales to be slow for three to sixth months until hospitals get back on their feet.” Lamont referred to the coronavirus as “an accelerant” for investment trends such as primary care, home care and digitizing healthcare services. “Right now, you don’t want to be in an institution like a nursing home or hospital unless you have to be. You want to stay home and have Annie Lamont all the support at home. Just like everyone has gotten used to using Zoom, the reality is whether it’s mental or physical health, the coronavirus has changed the dynamic between the clinician and the patient.” She added the pandemic “has created an inflection point in healthcare that’s going to be really powerful.” Clark said his firm’s healthcare portfolio companies took the hardest hit between mid-March and mid-April but are recovering quickly with volumes up 50 percent to 75 percent in the four weeks since then. “We are seeing an aggressive snapback. The question we wrestle with is Geoffrey G. Clark when will this start to level out? What does pandemic recovery look like? At this point no one knows the answer,” he said. Like Lamont, Clark sees a silver lining to the pandemic. “COVID has been
More Council Info For more expert insights on the financial implications of COVID-19 presented by the Nashville Health Care Council, see Katie Schlacter’s article on the following page and online bonus editorial with Premise Health CEO Stu Clark as part of the Council’s Brass Tacks series. And in other news, the Council has a new address: Nashville Health Care Council Capitol View 555 11th Ave. N., Suite 200 Nashville 37203
the single biggest accelerator of change I’ve seen in 25 years of investing,” he said. “For businesses that have good balance sheets, this is an incredible opportunity and incredible time,” he added of changing the delivery dynamic. When the pandemic hit, the focus for all the panelists turned to supporting companies already in their portfolio. Wylly asked what key factors the investors would need to see in order to close new deals going forward. “From a valuation perspective, sometimes it takes time,” said Clark, who is looking for high-quality and high-growth assets and market leaders “Like the real estate market, it will take sellers time to come to terms with reasonable valuations.”
Poole said there was a very different level of confidence when evaluating companies pre-pandemic. For deals to come back, he said rebuilding confidence in forward-looking projections and predictability are key. Crosby concurred, saying, “It’s going to take time for us to get a better handle on what revenue growth is going to be … that just takes time.” He added that while Zoom videoconferencing aids communication, it’s hard to beat face-toface meetings, particularly for new investments with new management teams. While Lamont agreed, she said there are some exceptions. “We just committed to a company where we hadn’t met them live,” she said. “The major investor was a past CEO for one of our companies and the anchor customer was one of our LPs (limited partners),” she added of triangulating around those established relationships. Going forward, Crosby said he was interested in the movement of care outside of hospital walls, including telehealth and behavioral health and substance use disorder spaces. Poole said he also was interested in behavioral health, including combination school-based and homebased therapies for autism and other developmental delays, alongside specialty home infusion services and post-acute care. Clark identified tech-enabled companies and organizations that address the “pain points” of healthcare such as physician staffing. Lamont reiterated her interest in primary care and companies embracing digitization to expand access to care.
Mark Your Calendars Music City SCALE • July 24-26 The premier meeting for cosmetic and medical dermatology is going virtual in 2020. SCALE is using technology to share the latest developments and technological breakthroughs in aesthetic medicine. CME credits available. For more information and to register, go to ScaleMusicCity.com. 14th Annual Healthcare Design & Construction Symposium • Aug. 5-6 Virtual meeting sponsored by the Construction Management Graduate Program, School of Engineering, Vanderbilt University. Keynote presenters include experts from Deloitte Center for Health Solutions, Kaiser Permanente and Thomas Jefferson University. For more information or to register, go online to bit.ly/DesignSymposium. AJMC® Hosts Patient-Centered Oncology Care® 2020 • Sept. 24-25 Omni Nashville Hotel The American Journal of Managed Care® will bring together renowned experts to deliver insights on the future of value-based oncology care during a two-day conference in Nashville this fall. Featured speakers will engage in panel discussions on policy, precision health, chronic care management, biosimilars, the impact of technology and telehealth on value-based medicine, and more. For more information and to register, go to ajmc.com/meetings.
Lending a Hand
Nashville EC Provides Connections, Tools for Real-World Success By MELANIE KILGORE-HILL
More than 50 percent of small businesses fail in the first four years – a sobering reality facing entrepreneurs nationwide. (Throw in a global pandemic, and today’s visionaries are navigating completely unchartered waters.) Fortunately, one non-profit is lending a hand to promising entrepreneurial companies and transforming Nashville’s healthcare community in the process.
Circle of Giving
The Nashville Entrepreneur Center was founded as a vision of the Partnership 2010 initiative of the Nashville Area Chamber of Commerce. Built from a partnership of local and state government support, private interests and the Nashville business community at-large, the EC’s mission was to raise the quality of resources available to Nashville’s entrepreneurial and small business communities. To date, the EC has served more than 10,000 entrepreneurs, with 800-plus businesses supported by EC programs. “Entrepreneurial spirit is the tapestry of this city,” said Jane Allen, CEO of the Nashville Entrepreneur Center. “When this organization first started, the idea was successful business people and entre-
preneurs giving time and money to help the next generation. Our volunteers have given time, wisdom and experience, with the goal that one day these entrepreneurial companies will also be Jane Allen in a position to give back.” That circle of giving is something EC leaders speak about with every new class. “We’re all here because people believe that helping to connect entrepreneurs to critical resources helps them succeed, and it is wonderful to have the ability to work with such innovative and forward thinking people each and every day,” Allen added.
Addressing a Need
From helping to create business plans to growth strategy and connections for important resources, EC staff customize curriculum tailored to the needs of their community. The model has proven very effective. EC’s high-touch programs have an overall 84 percent success rate and have generated more than 1,600 jobs and $233 million in capital … $50 million in healthcare revenue alone. “Our entrepreneurs are solving real-
world problems, and we get to align with them on their entrepreneurial journey,” Allen said. EC programs are designed to meet entrepreneurs where they are. The Advisor Program offers access to a 290-member advisor network that provides coaching and mentorship. Preflight is a 14-week program for early stage start-ups, while Inflight is a yearlong, acceleratorlevel program for early to mid-stage local companies. Project Music is a yearlong, accelerator-level program supporting the growth and development of music technology startups across North America, and Twende is the EC’s yearlong, accelerator-level program driving the growth of Nashville’s founders of color and the city’s minority ecosystem at large. A full one-third of EC clients are participants of Project Healthcare – a yearlong, accelerator-level program supporting the growth and development of healthcare startups across the country.
OMNY founder Mitesh Rao, MD, traveled to the EC from San Francisco after learning of the program from his Nashville attorneys. “I realized I wanted to find the right partners to not just accelerate the company, but help grow and
support us as founders,” said Rao, who completed Project Healthcare in 2019. “We got connected, and that synergy has been nothing but a blessing to us going forward. It’s Dr. Mitesh Rao also helped us think strategically, from hiring and recruiting to fundraising. It’s really hard to figure a lot of this out but having people to support and give guidance is something you can’t put a value on,” Rao continued. During an initial meeting with prospective entrepreneurs, EC team members and advisors determine whether the EC’s high-touch programs are a good fit the applicant or whether other resources might be more beneficial. “We want to make sure we’re selecting companies we really can help, who are really solving problems of the local healthcare community,” Allen said. Those accepted into a program pay a small monthly fee and follow a program schedule. Project Healthcare includes five in-person meetings consisting of immersion visits, mentor meetings, marketing connections, training and pitches. (CONTINUED ON PAGE 10)
Health Care Council Explores the Road to Economic Recovery While the coronavirus pandemic continues to disrupt America’s health and finances, the Nashville Health Care Council hosted two top economists in June to discuss their expectations for the nation’s economy moving forward. Council members heard By KATIE SCHLACTER perspectives from Founder & Principal, Larry Van Horn, Schlacter Consulting associate professor and executive director of Health Affairs at Vanderbilt’s Owen Graduate School of Management and Arthur Laffer, widely known as “the father of supplyside economics.” The pair analyzed the effect of the pandemic on healthcare businesses and emphasized their overall sunny outlook for an improving U.S. economy in the coming months. Van Horn shared data insights revealing that outpatient volumes saw an average decline of 55 percent across the nashvillemedicalnews
country from mid-March through May, while emergency medical care experienced anywhere from 20-50 percent in decline. He emphasized that there is a tremendous amount of variability by state – areas that were hardest-hit by the virus saw the greatest patient volume losses. However, as of early June, office visits had bounced back in many places by 30 percent. If visits continue to increase at the same rate, he says, a normal volume could be seen by the end of summer. The pandemic is also having a dramatic effect on healthcare delivery through telehealth. Utilization of telehealth services skyrocketed from virtually no visits earlier this year to an average of one million telehealth visits per day by mid-April. Since this peak, the numbers have decreased by about 30 percent, and it remains to be seen where it will level off. “This experience was certainly a boost for telehealth, pushing the market to adapt to the model. We expect utilization to continue at a level higher than it was pre-COVID-19,” Van Horn said. “Patients have come to expect it as an option, so we will see persistent demand for telehealth over time.”
Arthur Laffer has decades of experience in studying economic highs and lows, having advised many national and world leaders on economic policy since the 1980s. His take on the country’s current financial position was relatively positive. “The U.S. was well-prepared for COVID-19. We had the right healthcare provisions in place, in addition to a great economic position. The initial hit was less than people thought it was going to be. Hospitals have done great work to tackle the learning curve, and they are much better prepared now to treat coronavirus patients than they were just a few months ago,” Laffer said. Laffer pointed out that the stock market has been creeping up since it crashed in mid-March. While some industries such as cruises, airlines and commercial real estate will take a while to recover, he believes most industries will bounce back quickly. As for the future of the healthcare system, both speakers emphasized pricing transparency as a solution that will drive costs down and make people healthier, which is needed more than ever as 30 million more people are at risk of losing their
health insurance alongside their jobs due to the economic downturn. “There are some benefits to downturns,” Laffer said. “They lead to ‘creative destruction,’ a concept coined by economist Joseph Schumpeter. Basically, it causes the market to do-away with longstanding practices that don’t work anymore to make way for innovation. These events can lead to stronger and more creative companies emerging for an even greater comeback in the years to come.” This virtual event was held as part of a series of in-depth conversations hosted by the Nashville Health Care Council for its members. Like other organizations, the Council is creatively shifting to meet the needs of its members in safe and productive ways. While in-person events are postponed for now due to social distancing guidelines, the Council is offering a variety of new ways for members to learn and engage through virtual opportunities. Katie Schlacter is founder and principal of Schlacter Consulting, a strategic communications company serving the healthcare industry, start-ups and non-profits. Schlacter has more than 15 years of experience working with healthcare CEOs and executives. For more information, go to schlacterconsulting.com. JUNE/JULY 2020
News from Nashville’s Healthcare Technology Partners Alexander Advocates for Permanent Telehealth Policy Changes In June, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) said at least two of the most important temporary changes in federal policy made to ease telehealth access during the COVID19 pandemic should be extended permanently. Senator Lamar “As dark as this Alexander pandemic event has been, it creates an opportunity to learn from and act upon these three months of intensive telehealth experiences, specifically what permanent changes need to be made in federal and state policies,” he said, adding the virus effectively crammed 10 years’ worth of telehealth experience into a few short months. Alexander is advocating for the federal government to: 1) permanently extend policy changes that allowed physicians to be reimbursed for a telehealth appointment wherever the patient is located, including the patient’s home; and 2) permanently extend the policy change that nearly doubled the number of telehealth services that could be reimbursed by Medicare. He said there were 29 other temporary federal policy changes that could also be considered for being made permanent. Alexander said if even 15-20 percent of normal patient volumes transitioned to remote encounters, it would produce massive change in the healthcare system. “Our job should be to ensure that change is done with the goals of better outcomes and better patient experiences at a lower cost,” he stated. Perception Health Puts Predictive Analytics to Work in Pandemic Nashville-based Perception Health, a leading provider of predictive analytics in the healthcare industry, recently released two new data briefs providing insight into COVID-19 patients in each state. In the first brief, State Reported COVID10 Data, company analysts have compiled and tabulated patient data reported by state health agencies since the beginning of April. In the second brief, Prevalence of Chronic Disease in COVID-19 Patients, data analysts have compiled more than 550,000 medical claims records and compared findings to a random sample of 100,000 commercial claims. The analysis found a strong correlation between the CDC’s recommendations and actual claims data that detail the most prevalent comorbidities in COVID-19 patient histories, including higher instances of cancer and diabetes in COVID-19 patients. “Our work is ultimately about saving lives, and we are proud to partner with healthcare organizations in their work to serve their communities,” said Perception 6
Health CEO J. Tod Fetherling. “As we continue to gather and analyze medical claims records, we also work hard to add insights and perspectives on the data, making it a valuable resource for our Tod Fetherling healthcare partners.” For more information on the briefs and other coronavirus insights, go to perceptionhealth.com. Let’s Give Them Something to TECH Talk About! Franklin-based AccuReg, a healthcare technology solutions company offering a full suite of patient access revenue cycle SaaS solutions for hospitals, has been ranked first for the third consecutive time among patient access solutions providers according to the 2020 Black Book Research Survey. Nearly 1,800 hospital and health provider chief financial officers, vice presidents of finance and RCM, controllers, business office managers, analyst staff, consultants and directors were surveyed to determine the topperforming vendors among in-demand financial software systems. “Our goal is to deliver a combination of exceptional customer service and technology solutions that improve our clients’ financial performance and their patient engagement so it’s incredibly rewarding to be recognized as the market leader by Black Book for the third time in a row,” said Paul Shorrosh, AccuReg CEO and founder. Last month, the FCC’s Wireline Competition Bureau approved an additional 53 funding applications for the COVID-19 Telehealth Program. Meharry Medical College was awarded $718,752 for desktop computers, tablets, mobile hotspots, a telehealth platform, and internet access to use for screening low-income and elderly patients with symptoms suggestive of the COVID-19 infection or at a high-risk for complications from infection with the COVID-19 disease. Gartner, Inc., the world’s leading research and advisory company, recently recognized Nashville-based health IT company Bridge Connector on its list of “Cool Vendors in Healthcare Interoperability.” The latest accolade comes on the heels of Bridge Connector receiving the 2020 MedTech Breakthrough Award for Data Interoperability Innovation in early May. Franklin-based MEDHOST®, a market-leading electronic health record (EHR) and healthcare IT solutions provider, is celebrating the end to a legal battle. On June 11, Judge Robert N. Scola, Jr. granted a motion to dismiss a False Claims Act case against MEDHOST and prevented the relators from amending and refiling the case. Judge Scola stated, “The Court dismisses the Relators’ claim on the
merits, without leave to amend and therefore the dismissal is with prejudice.” Wellview Unveils Daily Symptom Monitoring Platform, WellCheck™ Business leaders are seeking returnto-work solutions that protect their employees and their customers by tracking risks related to COVID-19, as well as any future highly communicable illness, within the workplace. WellCheck™ by Nashvillebased Wellview is a quick-to-implement platform prioritizing safety and providing peace of mind by not only identifying a concern but by giving the user easy access to a solution for that concern. Built with the consumer and employer in mind, the WellCheck solution takes just 30 seconds to complete each day. The user receives clear information and action steps to access resources to address many health-related concerns. The application also includes daily reminders to check in prior to entering the workplace or any other public space. For the employer, results are aggregated in a HIPAA compliant database repository, providing real-time analytics for a company’s risk identification and resolution strategies. A key aspect of the WellCheck platform is the ability to vertically integrate wraparound health services, navigating employees from their daily results to resources to address any specific concerns identified by their responses. Patient Create Powered by Bridge Connector Now Available in the Epic App Orchard Bridge Connector, a technology company offering data-driven workflow automation for health IT interoperability, has announced its Patient Create application is now available in the Epic App Orchard. The application streamlines patient creation and reduces duplicate records to help health systems using Epic save time and prevent errors, particularly during the intake and onboarding process. “Adding Patient Create to the App Orchard offers users a new tool to help streamline workflows and automate patient intake,” said Josh Douglas, chief technology officer at Bridge Connector With Patient Create, users can leverage Bridge Connector’s extensive library of pre-existing integrations to automate the exchange and creation of patient health records across disparate data systems, reducing the chance of patient matching errors and streamlining the patient intake process. With this new functionality, users can easily track new leads from call centers and marketing campaigns using a variety of preferred engagement channels, all while reducing the risk of duplicate records often caused by dual manual documentation.
Nashville-Based Startups Launch New Charity Initiatives Charity-tech brands GeekCause, Generous, Givful and Kindful have jointly announced a range of new initiatives to support the important work of nonprofits during the COVID-19 pandemic. “Tennessee is ‘The Volunteer State,’ so it’s not surprising that Nashville has become a hub for charity-tech companies,” said Brian Moyer, president and CEO of Greater Nashville Technology Council, the leading advocate for Middle Tennessee’s $8-billion tech sector. “I’m proud of how these member organizations are offering their technology and their time to assist nonprofits, whose work is now more important than ever.” Generous (joingenerous.com) is a national platform that makes it easier for individuals to give to charities they care about. Locally, the startup has partnered with NewsChannel5 on an emergency response fund that had already raised more than $15,000 by early June. Givful (givful.com) provides a solution that simplifies workplace giving and volunteering. The company is offering to businesses and individuals the free use of its platform for the remainder of 2020. Kindful (kindful. com) – a fundraising and donor management platform – is offering its product pay-as-you-go, with no minimum contracts and free access to enhanced features to enable nonprofits to use it on an as-needed basis without a long-term commitment. While the first three efforts are nationwide, Hands On Nashville’s GeekCause (hon.org/geekcause) – a platform that connects Nashville nonprofits with skilled tech volunteers – is focused on assisting nonprofits in Music City. GeekCause has partnered with the Frist Foundation and the Center for Nonprofit Management to implement the Remote Working program, supporting Nashville organizations as they navigate the challenges of shifting major facets of their work online.
Follow us on Twitter @NashMedNews
All of Us Looks to Improve Care for Each of Us NIH Precision Medicine Project is Changing the Research Landscape By CINDY SANDERS
Historically, medicine has been a ‘one size fits all’ proposition. It’s only been in the last few decades, as researchers have begun to uncover specific mutations and mechanisms driving disease, that the concept of precision medicine has really begun to take root and flourish. While the field is still in its infancy, a bold initiative from the National Institutes of Health – the All of Us Research Program – is working to move the science forward dramatically. “Our goal is to improve health and medical breakthroughs for everyone,” stated All of Us CEO Joshua Denny, MD, MS. Dr. Joshua Denny The ambitious initiative looks to enroll one million individuals in the United States across the full spectrum of age, gender identity, race, ethnicity, sexual orientation, socioeconomic status, education, geography, health status and other factors influencing health. Denny noted many segments of the population have been underrepresented or left out of research projects in the past. “We specifically said we wanted this population to be reflective of the diversity of the United States,” he explained. By capturing this huge amount of deidentified data, the hope is to build one of the most comprehensive precision medicine platforms in the world, allowing researchers to speed discovery by tapping into a breadth and depth of information that is not currently available. Moreover, Denny said the goal is to make this rich dataset easily accessible. “We really believe that the best science is done in a broad, open fashion,” he noted. Denny has been involved with the initiative from the very beginning. He was part of the NIH’s Precision Medicine Initiative Working Group while serving in his previous role as director of the Center for Precision Medicine and vice president for Personalized Medicine at Vanderbilt University Medical Center. The work group released a detailed report in September 2015 that became the framework to create the All of Us research platform. At the end of last year, Denny was tapped to lead the NIH effort.
Participation was purposefully made easy. Anyone aged 18 or older who lives in the United States is eligible to become part of the large study by simply logging onto JoinAllofUs.org. Participants answer health surveys, share electronic health records and might be asked to provide key physical measurements and biospecimens of blood and urine. Some will also be asked nashvillemedicalnews
to provide saliva for lab and DNA tests. Those asked to share biosamples are able to visit a convenient partner site. However, participants decide how much data they are willing to share. Those who opt not to share their EHR can still participate in health surveys but wouldn’t be included in other aspects of the program. Denny noted active engagement among participants sets the program apart. “We’re not a typical research study that just collects information and does research …
we engage participants,” he said of actively seeking input and sharing information.
At the heart of All of Us is the desire to move science forward in a safe, effective, efficient manner by building one of the world’s largest and most comprehensive databases. “It is really to drive medical care, treatment and prevention,” Denny said of the massive undertaking. “It is both about population research and precision
medicine research.” He pointed to cystic fibrosis research that led to the 2013 debut of the first drug targeting a specific CF mutation. “It only worked in 5 percent of the population, but it was almost curative,” he said of the breakthrough. Building off that genetic knowledge led to further discovery. By 2019, novel treatments were available to improve function and quality of life for 90 percent of CF patients.
(CONTINUED ON PAGE 10)
VUMC Faculty Receives Grant to Explore LGBTQ+ Perspectives on Biomedical Research Researchers at Vanderbilt University Medical Center’s (VUMC) Center for Biomedical Ethics & Society were recently awarded a grant from the National Human Genome Research Institute (NHGRI) of the National Institutes for Health (NIH) to explore LGBTQ+ perspectives on a range of issues related to biomedical research. With the focus of medical treatment and research on precision medicine, Vanderbilt University School of Medicine and VUMC researchers have joined partner organizations in Nashville and surrounding areas to collect input on this topic from individuals who are LGBTQ+. Past research has shown that sexual and gender minorities experience significant disparities in health and healthcare. These inequities result from complex interactions among social, political, environmental and genomic factors. In this study, investigators explore what these minorities think about research that combines genetic data, sexual orientation and gender identity with other health and demographic information, a strategy that can bring better understanding and resolution of these disparities. The “GetPrISM study, short for Genetic Privacy and Identity in Sexual and Gender Minorities, is a project of VUMC’s GetPreCiSe Center (Genetic Privacy and Identity in Community Settings). The GetPreCiSe Center is an NIH Center of Excellence in Ethics Research. “In order for precision medicine research to be effective, it is important that the participants broadly reflect the diversity of the general population, including LGBTQ+ people,” said Ellen W. Clayton, MD, JD, the Craig-Weaver Professor of Pediatrics, the study’s principal investigator and director of the GetPreCiSe Center. “Including LGBTQ+ individuals requires identifying and responding to their opinions about research.” Historically, the voices of LGBTQ+ individuals have been only a fraction of those included in surveys and focus groups, and this population has not been specifically highlighted. Through the grant, investigators have already conducted 31 in-depth telephone interviews. In-person interviews were planned originally, but the Dr. Ellen W. COVID-19 pandemic required a change. Clayton “We are particularly grateful for the LGBTQ+ community’s trust in our research team and their thoughtful engagement on these important issues,” said Clayton. “As we strive toward a more inclusive society, we are excited to amplify LGBTQ+ voices in genomics research.”
WE UNDERSTAND YOUR CHALLENGES Let LBMC bring the strength of an experienced healthcare team, deep resources, and reputation as an expert advisor to your business.
lbmc.com/industries/healthcare JUNE/JULY 2020
AMA Issues New Privacy Principles, continued from page 1 quarters of respondents still were willing to share information with physicians and more than half with insurance companies compared to 23 percent willing to share with health tech companies, 12 percent with the government, and only 10 percent
with general tech companies. Confidence has been shaken by a number of tech sector breaches and scandals over the last few years, said Ehrenfeld, a public health policy expert who serves as director of the Advancing a Healthier
Highlights of AMA Privacy Principles The American Medical Association detailed expectations and rights for data exchange and privacy derived primarily from policy approved by the AMA House of Delegates. In a release, AMA leadership said the goal is to create a national framework of transparency and guardrails to guide data collection, direct privacy legislation and build public trust. The privacy principles are available online at NashvilleMedicalNews.com. Individual Rights: Recognition that individuals have the right to know who is collecting their data, why it’s being collected, how it will be used, and what is in the information. Furthermore, the AMA calls for individuals to have control over their info unless privacy rights have been waived “in a meaningful way,” the data has been appropriately de-identified, or in rare instances when a public health or safety issue warrant “limited invasions of privacy or breaches of confidentiality.” Equity: Commitment to adopting privacy protections promoting equity and justice to ensure individuals are safeguarded from discrimination, stigmatization, profiling or exploitation in the collection, processing or sharing of data. Entity Responsibility: Expectation that all entities that maintain an individual’s health information “should have an obligation or ‘duty of loyalty’ to the individual.” With that expectation, the entity should disclose exactly what data is collected and for what purpose. Applicability: Understanding that privacy legislation applies to all entities that “access, use, transmit and disclose data,” including entities not traditionally associated with healthcare that might be outside current HIPAA regulation. Enforcement: Recognition that individuals shouldn’t be responsible for the cost of enforcement except when exercising their private right of action. Furthermore, federal privacy legislation should serve as a “floor, not a ceiling” and shouldn’t weaken any state laws or regulations.
that final rule to promote transparency.” Ehrenfeld added, “HIPAA is a law that predates almost all modern digital technology. HIPAA does not cover data that is created or managed by a patient or third party app.” Without appropriate privacy controls, he said health information collected by apps or wearable fitness trackers could be shared with an employer or added to a credit score. “Once health information goes out the door and goes to a broker, you have the perfect recipe for harmful profiling and discrimination,” he pointed out. Yet, he continued, data collection is both ubiquitous and important to optimizing care. Trackers and apps can improve activity levels, diet, hydration and disease management. Data collection can highlight risk factors, identify at-risk populations or help clarify symptoms and spread of an infectious disease like COVID-19. “The more assurances people have about how entities will use that data, the more willing society will be to use technologies – whether it’s telehealth or contact tracing,” he said. “We think that having guardrails and transparency is key to building trust and not inhibiting data exchange. We want to restore confidence in data privacy, and that’s what our principles are all about,” Ehrenfeld concluded.
Nashville Medical News Modified Schedule
The Music City SCALE Meeting is for all physicians and clinicians interested in enhancing their practice and learning more about the latest procedures in aesthetic medicine, medical dermatology and much more.
Like everyone else, COVID-19 has turned ‘normal’ upside down for Nashville Medical News and forced us to rethink processes, business model, scheduling and events. It’s also allowed us to think about our vision for the paper and our ability to share news. As a monthly, a long-held frustration has been that we aren’t as nimble as a daily paper. On the flip side, though, not being a daily has given us the luxury of space and time to drill down on important topics and share expert insights. While there’s not much positive to say about a pandemic, one personal ‘pro’ has been that we’ve become more responsive to quick changes and breaking news by relying more heavily on our website NashvilleMedicalNews. com. One of the ‘cons’ is that revenue has taken a hit as advertisers have been a wee bit busy with other things like rethinking their own business models in the wake of the coronavirus. A mixed ‘pro/con’ has been an evaluation of work/life balance during the last few months. Putting together each issue takes a village, and we’re so grateful for the help of outstanding contributing writers, sales representatives and our terrific print shop. Yet, the majority of the work falls on our shoulders as owners and publishers, as it should. We share all of this to say we’ve made the decision to move forward with bimonthly issues for the balance of the year: June/July, August/September and October/November before the annual “InCharge Healthcare” special edition at year’s end. We’re going to use this time to evaluate how the new schedule works both professionally and personally before making a decision about next year’s frequency. We want to reiterate that the website is updated daily (and sometimes hourly), so there’s always a way to access the latest news. Some of you receive both the digital edition and print edition, while others prefer one option over the other. We’d like to encourage those of you who want to receive our eNewsletters (no more than four per month), to go online to the website and add a digital subscription … or simply email editor@nashvillemedicalnews. com with a subject line of ‘Digital Subscription,’ and we’ll get you added to the list. There’s no charge to receive the eNewsletters. While this is a time of change for everyone, we know that many positives come from ‘rethinking the routine.’ We’re excited to be able to bring you more news faster online, while continuing to feature in depth topics in print … all while enjoying dinner with our families on a more regular basis! Thank you for your continued readership and support.
R E GG II SS TT EERR AATT WWWWW. U SUISCICCICT IY. W.S SC CA AL LE M EM T CY.OCMO!M !
Susan Graham & Cindy Sanders, Nashville Medical News Co-Publishers
THE PREMIER MEETING FOR COSMETIC & MEDICAL DERMATOLOGY
15T H A N N I V E R S A R Y Presented by TSLMS
Music City Symposium for Cosmetic Advances & Laser Education
JULY 24-26, 2020 COURSE DIRECTORS: BRIAN S. BIESMAN, MD AND MICHAEL H. GOLD, MD
C M E C R E D I T S A R E AVA I L A B L E T O M E D I C A L P R A C T I T I O N E R S !
SCALE IS GOING VIRTUAL IN 2020!
T HE PREM IER MEETING O F TH E YEA R WILL NOW BE VIRTUAL LEA R N FR O M TH E EXPERTS...
Wisconsin Endowment and maintains a faculty appointment at Vanderbilt University School of Medicine. Additionally, there is growing recognition and frustration over the tech business model that quietly collects personal data, often without consumer knowledge or consent and without the strictures that accompany HIPAA. “We fully support the right of patients to be able to access, download and share their data,” Ehrenfeld stated, adding that control belongs with the individual not an entity. To address these concerns and issues, he said the AMA Privacy Principles outline transparency expectations across five main categories – individual rights, equity, entity responsibility, applicability and enforcement. Ehrenfeld noted part of the impetus for AMA publishing these new principles stems from the spring release of final rules on data sharing and patient control from the U.S. Department of Health and Human Services in connection to the 21st Century Cures Act and the MyHealthEData initiative. “We advocated strongly and regularly to HHS to include controls in those final rules that would promote how apps use health data and how patients can prevent an app from using their information without consent,” he said. “Unfortunately, HHS didn’t take any action in
NMN SCALE Virtual ad.indd 1
6/5/20 12:45 PM nashvillemedicalnews
Risk Aversion: Status, Avoidance & Action in the Age of COVID-19 Medical centers and nursing care around the world have shifted from acute and post-acute intervention to crisis responsiveness. The U.S. Department of Health and Human Services (HHS), the Corp of Engineers, the American Hospital Association, architects, engineers, and building planners have By JAMES G. EASTER, JR. responded to Principal & Founder, Ehc COVID-19 service demands by developing new, mass response centers for testing, triage, diagnosis, isolation and nursing care. The places where this traditional care was provided have moved to a variety of retrofitted locations. For example, converted parking structures, athletic stadiums, convention centers and older facilities previously closed have been re-opened or restructured to respond to this emergency need. The type of rooms required for a highly contagious disease are not readily available to meet increased demand. In a typical planning environment, one could trendline the needs, project what the number of beds/rooms might be, and then design a facility to meet those projections based on the appropriate number of observation stations, isolation rooms, nursing support and recovery areas. The preplanning, under normal circumstances, could also determine the infection control measures, staffing requirements and codecomplying environmental features required to meet the safety needs of the patient, family, physicians and nursing care. Process & Responsiveness Before COVID-19, listing hospital risk concerns was straight forward. However, this pandemic has created an infection and space management challenge. In today’s healthcare environment, the networking and merging of healthcare programs compounds all risk factors and makes them more complex. For example, additional consideration must be given to: • Multiple hospitals with numerous access points, • Extensive information management challenges, • Regional clinical and nursing service challenges, • Asset management and life/safety considerations, • Accessibility, safety and wayfinding challenges, and • Infection control and risk assessment (ICRA). The proactive responses of facility managers and engineers working in partnership with infection control has been effective pre-COVID-19. The current status is not manageable. Collaboration with nashvillemedicalnews
lic awareness and make the information available via a website, which has been and should continue to be updated every three years following the 2014 program implementation.
Samaritan’s Purse set up an emergency field hospital in New York City’s famed Central Park.
the regional and statewide agencies having jurisdiction over healthcare providers have helped with crisis intervention by providing variances to rules and regulations. Another source of leadership support and guidance has come from professional associations including the American Hospital Association/American Society of Healthcare Engineers and the American Institute of Architects (AHA/ASHE/AIA). Regulatory Compliance and CHNA Value It is timely for providers to begin a focused “community planning effort” to address pandemic responses in a collaborative manner. This could be conducted as a part of the Community Health Needs Assessment (CHNA), which is currently required for 501(c)(3) public providers. Investor-owned providers have also joined in since they do receive federal funding and CMS support. This law requires the CHNA master plan be developed and be updated every three years. The regulations that were effective at the program’s implementation in 2014 should be slated for update in 2021, considering: • The community served by the provider or system, the geographic area and the target populations being served, including the medically underserved, low-income and minority populations (which also would certainly apply to high-risk populations as noted in COVID-19). • Prioritization of the significant health needs of that community and target population. • Soliciting community input to the healthcare provider, or system, within the service area and seeking out persons with specific healthcare expertise in public health, disease awareness and prevention and defining proactive measures for emergency responsiveness. • Providing individual or group documentation in the report, such as: definition of the community served, process
and methods used to conduct the CHNA, community input received or ongoing feedback, significant health needs of the community that are prioritized by cycle, and a description of resources available to address the significant health needs identified Ideally, every hospital facility or system would document its CHNA for pub-
Master Plan & Future Action From this planner’s point of view, the CHNA efforts in tandem with an appropriate facility and environmental response would be the preferred approach. The primary objective should be a virtual road map or master plan for the future. This would be based on current events, lessons learned and “regionally collaborative” responses to service gaps, new trends and crisis intervention. The approach would include the following: Assemble a Regional Team. The team should include the agency-In-charge, healthcare architect(s) and engineer(s), epidemiologist, systems representative (telehealth), product representative (biomedical and technology), provider representation (facility/risk management), scientist (from a specialty deemed appropriate), psychologist (behavioral health authority), government (CMS, HHS, other local, state or national agency representation) and financial/insurance representative. (CONTINUED ON PAGE 10)
HEALTHCARE HELPINGS SERIES
Changes to evaluation and management codes Join us as we review the rationale for the changes, the new code selection process, and the medical decision making (MDM) guidelines.
Tuesday, August 18 10:00 am - 11:30 am CST kraftcpas.com/events
All of Us Looks to Improve Care for Each of Us, continued from page 7 From a population health standpoint, Denny said researchers discovered a small population of African-Americans in Dallas had a rare mutation that corelated with significantly lower cholesterol and was protective of heart disease. That discovery by geneticists at UT Southwestern ultimately led to a new class of drugs for lowering LDL cholesterol in the broad population. “Those two stories highlight the power of genomics and how data can impact specific populations and everyone,” Denny said. Having easy access to rich data allows researchers to move more quickly and with greater assurance, he said of the repository of millions of pieces of information All of Us will contain that can be easily sorted by population characteristics, disease characteristics, geography, age, exposures, medication regimens, genetic signatures and more. “You don’t have to recruit a new population of participants,” he pointed out. “Once you have a research database that’s large and has dense disease data and molecular information like genetics, it’s almost a look up.” Denny added the cur-
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. Here are the latest additions to the blog: Adam Hicks, vice president-account manager Skanska USA, looks at the accelerated evolution of medical facility design and building with a focus on how the current pandemic has underscored the need to create flexible, adaptive spaces. Greg James, MD, chief clinical officer for Ascension Saint Thomas, shares his thoughts on public responsibility in ensuring community safety as the city continues to reopen. The consumerdirected blog is a good resource and reminder for patients … and healthcare industry professionals, too. Sandra Martin Parham, executive director of the Meharry Medical College Library (MMCL), provides a historical review of the work of Meharry’s physicians and researchers in the face of pandemics and medical crises throughout the venerable institution’s nearly 150-year history. Additionally, the article delves into why MMCL was designated ‘essential’ and the role the library has played in supporting the community during COVID-19. Chris Sabis, member with Sherrard Roe Voigt Harbison, discusses the exponential expansion of telehealth usage in the wake of COVID-19 and looks at where the technology … and regulations … go from here.
rent COVID-19 pandemic underscores the need for this type of information that could provide scalable insights into who is protected and affected by the virus. “We’re trying to rethink the whole process of doing research,” he said, adding the goal is to allow broad access for both public and private researchers following beta testing, which launched at the end of May. Once researchers have registered and gone through the onboarding process, All of Us uses a ‘data passport’ model that pro-
vides wide access to explore data rather than having to be granted permission for each study on a project-by-project basis. As part of beta testing the All of Us Researcher Workbench, participating researchers have begun using the study’s initial dataset and tools and have been asked to provide feedback. “We really welcome any U.S. academic researcher at this beta phase,” Denny added. Go to ResearchAllofUs.org for more information on applying for access.
To date, All of Us has more than 349,00 individuals who have taken the first steps of enrolling. Of that group, over 271,000 have completed the initial stages of the program, which include completing the in-person visit for measurements and biospecimens, offering consent for EHR access, and finishing the initial surveys. Denny noted progress has been slowed over
Lending a Hand, continued from page 5
“Our community spends a lot of time working with these entrepreneurs, and we want to make sure it’s a good fit for all involved,” she added.
EC Program Manager Jeremy Raley said the center was founded on the idea of mentorship, which continues to be their emphasis. “At the end of the day we’re about creating opportunities, because surviving entrepreneurship is a tough go and can be lonely … like you’re on an island every sinJeremy Raley gle day,” he said. “We try to surround them with the most critical
resources we can.” Project Healthcare includes 70-plus mentors armed with real-world legal, financial and business insight. Entrepreneurs also use their own experience to help pull each other along. “Our entrepreneurs didn’t just walk in off the street with an idea,” Raley said. “Many have tons of experience, and some have launched other successful ventures in the past. Our team helps connect those dots in the human game and creates special opportunities for conversations to help push a business forward.” Many of those opportunities stem from the EC’s growing relationships with the Nashville Health Care Council, which provides mentorship with the industry’s most respected leaders. “That’s the magic that Nashville has and that the EC has
the past few months during shelter-in-place orders that accompanied COVID-19. He added genetic testing was slated to begin just as the pandemic hit. “We’ve actually paused our in-person recruiting right now,” he explained, adding the team is assessing safety and timing to restart visits to partner facilities. Despite that pause, Denny encouraged anyone interested in being part of this seminal study to begin the enrollment process now. In addition to providing important information online that could be immediately useful, it also puts participants in a ready position when in-person visits start back. While Denny said it is crucial for physicians to share the importance of All of Us with patients to increase representative enrollment, he encouraged providers to become part of the cohort, as well. “The program is only as powerful as the participants who join us on this journey,” Denny concluded. “We want to make sure everyone is represented here at the table.”
an opportunity to leverage,” Raley said. “The Health Care Council has become so woven into big institutions here and has really helped bridged a gap for the EC, becoming the missing piece that allows the right folks to come to the table.”
Connecting the Dots
Despite its success, the Nashville Entrepreneur Center remains one of the best-kept secrets in Nashville’s business community – something Allen hopes to change as the organization continues to grow and thrive. “If you’re an entrepreneur, it doesn’t matter where you are,” she said. “If you have questions, come talk to us. We’re really a place where entrepreneurs, investors and the business community can connect and help everyone achieve their goals.”
Risk Aversion, continued from page 9 Assess the Situation, Goals and Objectives. Determine the facts associated with COVID-19, including current CHNA status, size of acute care facility, trend analysis on cases, attributes of community, statistical projections, staffing, functionality, environmental/infection rates and preparedness of building. Benchmark issues and outcomes, including trendlines, staffing implications, qualified A/E/C direction, funding and continuity, leadership, vision, risk assessment measures and continuity of CHNA findings. Determine responsiveness measures for the next crisis or threat, develop a workplan and assemble a team. Activate the work plan within the CHNA context for operations and staffing, policy and process, patient care implications, transition and transformational strategies (particularly in rural areas), budget and schedule, approval authority, supportive resources, assessment of progress within a three year window, and sustainability. Finally, take remedia-
A Deeper Dive Check out more information on smart healthcare construction at NashvilleMedicalNews.Blog where Adam Hicks, vice president and account manager for Skanska USA, discusses the accelerated evolution of medical facility design and building.
tion efforts where required and look at environmental and operational changes from the standpoint of assignments, staffing outcomes, statistical progress and priority, capital access by phase, human resource and budgetary requirements, and the approvals process. Integrate Crisis Intervention with the Master Plan. Assess status of the facility or system master plan (MP), gather electronic data for all sites and
buildings, assess available space and inpatient/ED/holding areas, assess staging/ phasing and patient handling and movement options, seek state and AHJ regulatory variances and ST/LT intervention measures, quantify impact factors and associated data, outline ICRA compliance plan and pandemic guidelines at all government levels, and benchmark similar programs for a quick, comparative check. Putting processes in place will help mitigate risk and accelerate action in the face of the current pandemic and in preparation to address future threats. Jim Easter, MArch, ACHE is principal and founder of Nashville-based Easter Healthcare Consulting (Ehc), which specializes in facility planning within the healthcare continuum. Easter has more than 2,000 healthcare master plans and functional programs to his credit. For more information, go online to easterhealthcare.com.
SCALE Conference Goes Virtual July 24-26 Event Expected to Draw Record Attendance By MELANIE KILGORE-HILL
The nation’s largest dermatology and cosmetic surgery convention is going virtual this year … but could very well have the greatest impact to date. From July 24-26, the 15th Annual Music City Symposium for Cosmetic Advances and Laser Education (SCALE) conference will offer more than 800 attendees world-class training and CME credit from the comfort of their home or office.
Adapting to Change
“Once COVID-19 hit, we had to be realistic,” said Michael Gold, MD, SCALE co-founder and owner of Gold Skin Care Center in Nashville. “Conventions around the world were being cancelled, so we made the decision early to go virtual. The nice thing about Nashville is that we have the AV teams and engineers who know what they’re Dr. Michael Gold doing and can come to our offices to professionally film it.”
While panel and Q&A discussions will be hosted live, 90 percent of the convention will be pre-recorded, allowing for higher quality production than available through live feed. Despite the unexpected new format, going virtual has allowed organizers to promote SCALE on a global front and provide more healthcare professionals more opportunities for CME. “Like many other innovations we’ve experienced over the past several months, virtual education will continue to play an important role in medical education moving forward,” said oculofacial plastic surgeon and SCALE co-founder Brian Biesman, MD. “Advantages of the virtual format include the ability for attendees to both participate in the program as it is preDr. Brian Biesman sented and to review it later should they wish to do so.”
access to SCALE presentations for four months following the event. “As several lectures are sometimes presented concurrently, if an attendee is present at a meeting in person, they will miss some of the content presented,” Biesman said. “With a virtual format, they can tune into one of the sessions and then watch the other sessions presented simultaneously at a time of their choosing, expanding learning opportunities.” The virtual event will include 80 exhibitors and more than 80 world-renowned instructors. “Our faculty are on top of the food chain in dermatology and plastic and cosmetic surgery,” Gold said. “The teaching will be high quality, and attendees will have the opportunity to come back and do it again or see what they missed.” A highlight of every SCALE conference, the six-hour cadaver head facial dissection workshop will be prerecorded and reformatted into a video course attendees can continue online after participating in the first session during the conference.
Less Cost, More Training
The event also will retain its Nashville vibe – a strong draw each year for visitors worldwide. “We really want to showcase
Registration fees are less than half of previous years, and attendees will have full
COVID-19 – Where We Stand, continued from page 1
Nashville’s Board of Health, has been pleased with the responsiveness from city and healthcare industry leaders and residents. “When this broke out we knew it would require a differDr. Alex Jahanigir ent response than anything we’ve ever done,” he stated. Three days after Mayor Cooper’s announcement, Jahangir assembled leaders from Nashville’s largest healthcare players including Ascension Health, Vanderbilt, Meharry Medical College, HCA, the Tennessee Hospital Association, American Red Cross, and state and city officials. “The caliber of being able to host a meeting like that last minute demonstrated the urgency everyone recognized it was,” said Jahangir, who was appointed to lead Nashville’s COVID Task Force the following day. “The Mayor was still dealing with the tornado but recognized the importance of having someone looking at this, not just from the health perspective but how it would affect every aspect of our city. Not many cities were doing what Mayor Cooper did,” said Jahangir, noting many other major cities were weeks later in establishing their own COVID task forces. “He was really ahead of his time, and I commend him for his leadership.”
On March 23, Nashville became the first city in the Southeast to enact at Safer at Home order, which Jahangir credits with nashvillemedicalnews
mitigating widespread disaster. Leaders also recognized the need to build public health infrastructures for testing, leading to the establishment of three no-cost assessment centers staffed by local hospitals. While others across the country struggled to get tested, Nashvillians had easily accessible options at the assessment centers. At press time, those centers accounted for nearly 35,000 of the city’s 87,000 tests performed – two-thirds of those from minorities. James Hildreth, PhD, MD, president of Meharry Medical College, credits increased efforts for lower-thanaverage COVID rates among Nashville’s African American communities. Nationwide, black Americans experience a death rate of 3 percent compared to Tennessee’s 1.5 percent. “The disease Dr. James Hildreth burden and number of deaths among African American communities here has been much better,” he said. Jahangir also credits local business owners for the city’s relatively stable transmission and hospitalization rates. “People are taking it seriously … but are also tired,” he said. “Even with fatigue, Nashville is resilient, and people are still using science and evidence to reopen. That ‘Nashville Strong’ mentality has really been seen in this.”
continue social distancing and taking the threat seriously. That’s because vaccine discovery doesn’t ensure rapid production or distribution. In fact, he doesn’t anticipate a vaccine being available to the public until 2021 due to the lack of biological bioreactors required to produce hundreds of millions of doses, as well as inefficiencies in distribution. “We want a vaccine that’s at least 80 to 90 percent effective,” said Hildreth, who was recently appointed to Operation Warp Speed, the national program to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics and diagnostics (medical countermeasures). “Anything less for a pandemic would be helpful but not solve the problem.” Still, he said it’s encouraging to know that all possible vaccine approaches are being tested, from inactivated viruses to genetic material. “I’m feeling excited about the fact that any idea you might think of is being tested somewhere on the planet right now,” Hildreth said. In the meantime, protective measures are crucial in preventing herd immunity. “When a herd or species achieves 60 percent resistance or immunity to an organism or microbe, it can no longer spread quickly, so the chances of an infected person traveling to someone who’s not immune is low,” he said. “For the U.S., that would mean 200 million-plus infected and 10 million dead. Clearly we don’t want to take that route.”
Vaccines & Herd Immunity As vaccine development moves forward, Hildreth has urged the public to
Nashville has already seen case numbers rise and key metrics fluctuate as
Registration Still Open Online registration will be open until July 24. The event is offered free of charge to residents and fellows, with separate price points for office staff, non-physician providers and physicians. To learn more, or to register, visit scalemusiccity.com.
Nashville,” Gold said. “It’s our home, so we’ve been working hard on a design and layout to reflect that.” In fact, Gold and Biesman hope more local providers will check out the conference that brings hundreds to their hometown each year. “Nashville has seen a huge increase in the number of cosmetic and aesthetic procedures being performed,” Gold said. “If you’re going to do them, make sure you learn them … and this is an opportunity you’d rarely get online, especially from the medical dermatology side while earning CMEs, ” he said. “Hopefully if they like what they see, they’ll come back in 2021.”
the city has begun moving through the reopening phases. “The battle with this pandemic is not over. While as a city we have been able to do well in keeping mortality rates and hospitalization rates low, we are starting to see an increase in cases,” said Jahangir. “Part of why this is happening is that people are letting down their guard with the most basic, yet proven concepts – wearing a mask, social distancing and hand hygiene.” In late June, the Metro Board of Health unanimously adopted a measure to make wearing masks mandatory in public in an effort to slow the spread of COVID-19. As summer fades into fall, the reality of a second wave – mixed with traditional flu season – has many fearful, as well. “Until there is a second wave, we have to be in a new reality,” Jahangir said. “Everyone is worried about it. As providers we have to know, ‘is it flu or not?’” He said patients should be extra diligent about receiving the flu shot and getting tested when symptoms develop. “The difference between now and March is that we are more aware of the fact that COVID is in the community,” he said. “We can mitigate flu with vaccines, and COVID testing is easier to get now.” He also encouraged government and public health leaders to continue advocating for social distancing, wearing masks and leading by example. “Even if there’s a second wave, it will be more controllable,” Jahangir said. “As healthcare leaders, we must continue to encourage vigilance in these concepts to prevent our city’s success from being eroded.” JUNE/JULY 2020
The Impact of Diabetes on Stroke Research Points to Worsened Brain Function, Increased Severity By CINDY SANDERS
Diabetes is well established as a risk factor for stroke. For diabetics, the chance of having a stroke is 1.5 times higher than in people who do not have the condition, according to the American Diabetes Association. However, the burden of diabetes is likely even higher. Recent studies find diabetes might impact post-stroke outcomes, as well.
Jorge Plutzky, MD, chair of the Diabetes Committee of the American Heart Association, said the systemic disease of diabetes accelerates atherosclerosis, increases risk for atrial fibrillation and is often accompanied by high blood pressure. All three of those conditions can lead to heart Dr. Jorge Plutzky attack and stroke. “We’ve always known we need to pay attention to people who have had a heart attack or stroke for another one,” Plutzky said. “People who had a history of diabetes but no heart attack had the same risk as someone who had previously survived a heart attack,” he continued, adding the same is true for stroke. Plutzky, who is also director of preventive cardiology at Brigham and Women’s Hospital and on faculty at Harvard Medical School, said diabetes intersects with stroke risks at several points – from the link between type 2 diabetes and obesity, which is often accompanied by high blood pressure and high cholesterol, to peripheral artery disease and microvascular disease, which have been linked to dementia and Alzheimer’s. Less clear is the role of prediabetes as a risk factor for stroke and heart attack. “The absence of association between prediabetes and stroke does not inform us of the relationship of diabetes and stroke,” said Plutzky. “The complexity of the disease means it can be difficult to draw a circle around prediabetes – how you are defining it,” he pointed out. “We know that people with prediabetes do have a higher risk for diabetes, but not all will go on to diabetes.” However, he cautioned, it doesn’t mean someone with prediabetes won’t have a stroke. Nor does it mean those with prediabeties can bank on being in the group that doesn’t develop diabetes.
In May, the American Heart Association published a new analysis of seven international studies looking at poststroke progress three to six months after the event. The analysis found study participants with diabetes functioned worse than those without on measures for memory, attention, mental flexibility, process12
ing speed, language and other tests of cognitive function. Looking at 1,600 stroke patients in Australia, France, Korea, the Netherlands, Singapore and the United States – almost all of whom had ischemic strokes – researchers also considered whether there was a difference in outcomes between those with type 2 diabetes and those classified as being prediabetic. It should be noted, the classification was determined by a single measurement of fasting blood sugar levels at hospital admission and medical history without follow-up measurements or additional information on severity or duration of disease. With that limitation, and after adjusting for age, gender and education, researchers found that diabetic stroke survivors had “significantly poorer” function than others, including those with prediabetes. Even after adjusting for additional factors including high blood pressure, smoking, body mass index, previous stroke history and ethnicity, the results held up with prediabetic stroke survivors not experiencing the severity of cognitive decline as seen in those with diabetes. According to the researchers, led by Perminder Sachdev, AM, MBBS, MD, PhD at UNSW Sydney, key takeaways include: • A call to focus on early, more aggressive treatment for prediabetes to prevent the progression to type 2 diabetes; and • The need to assess the capacity for self-care in diabetic stroke survivors to ensure patients have the ability to fulfill the complex tasks required to measure and manage diabetes.
Adding Alzheimer’s to the Equation
Diabetes has also been linked to an increased risk for vascular dementia and Alzheimer’s disease. A separate study released earlier this year found the combination of diabetes and Alzheimer’s disease compounded severity for those with hemorrhagic stroke. Analyzing more than 2,000 adults in the Kentucky Appalachian Stroke Registry, researchers found 75 percent with both diabetes and Alzheimer’s either died or required hospice or long-term care post-stroke compared to 62 percent with Alzheimer’s alone, 42 percent with diabetes alone, and 39 percent with neither condition. Researchers did not have each patient’s specific blood pressure measurement at the time of stroke … but if high blood pressure, a common cause of hemorrhagic stroke, had been previously diagnosed, the research team did control for that factor. Even with that limitation, the study’s authors stressed the need to effectively manage diabetes in light of the significantly worse outcomes that accompanied diabetes and Alzheimer’s, particularly in combination.
With prediabetes, Plutzky said it is essential to address lifestyle modifications to try to slow or halt the progression to diabetes. For those who already have diabetes, he said there has been a “sea change” in the management of the disease with the addition of two newer classes of therapies. Whereas older treatments didn’t reduce the risk of heart attack and stroke, sodium-glucose cotransporter inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 agonists (GLP-1 receptor agonists) do. “We do want physicians to be aware of these newer drugs because they are underuti-
lized,” he noted. “The presence of diabetes increases one’s risk for heart attack and stroke,” summed up Plutzky. “Not only does it increase the risk for having a stroke but for not doing as well after having a stroke, and it may be linked to cognitive function, in general.” However, he added, early intervention and improved management through both drug therapy and lifestyle modification can change the trajectory for a patient. “Paying attention to all the red flags – both in prediabetes and diabetes – can make a difference in how patient’s ultimately do,” Pltuzky concluded.
Let’s Give Them Something to Talk About!
Awards, Honors, Achievements
Nashville-headquartered HCA Healthcare has been recognized by The Joint Commission and the National Quality Forum (NQF) with the prestigious John M. Eisenberg Patient Safety and Quality Award for its pioneering work using artificial intelligence to help reduce sepsis mortality. Sepsis Prediction and Optimization of Therapy, known as SPOT, received the award for Innovation in Patient Safety and Quality at the national level. SPOT goes by the popular dog name because it sniffs out sepsis in a way humans cannot. Its algorithm continuously monitors vital signs, lab results, nursing reports and other data to detect often subtle changes in a patient’s condition and alerts clinicians to signs of sepsis in patients, as much as six hours earlier than previously, so they can take appropriate action. “The current public health climate of COVID-19 has emphasized now more than ever the importance of early detection of life-threatening illnesses,” said Jonathan Perlin, MD, PhD, HCA Healthcare’s chief medical officer and president, clinical services group. “We are honored to receive this respected award for our technology that helps Dr. Jonathan Perlin clinicians detect sepsis earlier, accelerates treatment, improves the care provided to patients, and helps save lives.” Belmont University’s Occupational Therapy Master’s Program recently received full accreditation from the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA). The status was granted for a period of 10 years. Ascend Federal Credit Union, the largest federal credit union in Middle Tennessee, has been named to Training magazine’s Top 125 list for the sixth consecutive year. It is also the fifth con-
secutive year that Ascend has placed in the top 40 on the list. The Top 125 showcases the 125 world class companies that excel at employee training and development.
GuideWell Appoints McConnell to Lead Consumer Engagement Business GuideWell Mutual Holding Corporation (GuideWell), parent to a family of companies focused on transforming healthcare, has appointed Brentwood-based Onlife Health CEO Mark McConnell as CEO for GuideWell’s portfolio of consumer-engagement Mark McConnell businesses, including GuideWell Connect, Onlife Health and PopHealthCare. McConnell has over 30 years of healthcare industry experience leading employee health initiatives, building mobile and digital assets for remote monitoring, and integrating numerous consumer tools, focused on health, wellness and disease-management. In this new role, McConnell will identify innovative ways to leverage product and infrastructure integration, while creating opportunities to engage with members to improve overall health outcomes. “I am honored to lead this incredible suite of companies,” said Mark McConnell, CEO of GuideWell Connect, Onlife Health and PopHealthCare. “Leveraging the shared capabilities of these three consumer-engagement businesses will allow us to deliver even more value to our clients and members, as well as further enhance the customer experience for health plan members throughout their continuum of care.” McConnell joined Onlife Health in 2015 as chief revenue officer and was later promoted to president and CEO. Previously, he served in senior roles at AMC Health, Healthways and HealthFitness.
Ascension Midtown Announces Major Campus Enhancements Having developed a 10-year Master Facility Plan (MFP) for the midtown campus over the last several years, Ascension Saint Thomas has announced the multi-phased project launch is set to begin this year. The Saint Thomas Midtown MFP is designed to enhance access through the reconfiguration of the campus and simplification of parking and pedestrian access with dedicated parking, valet, patient welcome/registration and family spaces in a quieter, hotel-style environment The plan will also increase community integration with a unique approach to urban design that incorporates nature into the campus landscape, as well as an enhanced experience for patients, clinicians and associates with a “hospital within a hospital” model, offering an innovative boutique experience. In the era of COVID-19, the ambitious plan includes enhancing features like facility air flow and dedicated entry points to enable easier screening and stop the spread of infections inside the hospital. The timeline of the clinical program development and enhancements includes a new OB emergency department, new surgery center for women and expansions to the cancer center in 2020. Next year is slated for the previously announced new rehabilitation hospital and Spine Institute. Coming in 2022, surgery and critical care tower and the Cancer Center ‘hospital within a hospital,’ and a new entrance to the Women’s Hospital and new medical office building are slated for 2023. Gresham Smith will be the architectural design firm for the Surgery and Critical Care Tower, new entrance for the Women’s Hospital and the new Medical Office Building. Turner Construction Company will provide general management and construction.
Meharry Medical Group Alum Rejoins Practice Meharry Medical Group alum Carlton Z. Adams Jr., MD, has rejoined the active medical. Adams is a board-certified general surgeon whose practice emphasizes endovascular, wound care and general surgery procedures. He was recently recruited back Dr. Carlton Adams Jr. to the Department of Surgery as chairman of the department after a brief departure last year. A native of California, Adams received his medical degree from Howard University, College of Medicine and completed his residency at Meharry Medical College. Adams was the very first Vascular Fellow at the State University of New York at Buffalo. “Working to create opportunities and reconstruct mission values in the surgery department is an invigorating challenge,” said Adams. “I love apnashvillemedicalnews
proachable challenges, especially in surgical healthcare and education. To be privileged to engage that challenge along with the entire Meharry family exceeds all the professional victories that have blessed my career.”
Sisk Named CNE for TriStar Health Bryan Sisk, DNP, MPH, RN, NE-BC, CENP has joined the HCA Healthcare TriStar Division as chief nursing executive. In the CNE role, Sisk will establish the overall strategic direction for the practice of nursing operations across the Bryan Sisk TriStar division, working collaboratively with facility chief nursing officers and other nurse leaders. Most recently, Sisk worked at the HCA Healthcare corporate office where he served as AVP of Nursing Leadership and Organizations. In this role he provided subject matter expertise to all lines of business on clinical, operational and technology-driven initiatives in support of the HCA Healthcare nursing strategy. Prior to joining HCA Healthcare, Sisk was CNO at Central Texas Veterans Health Care System in Temple, Texas. Sisk is a veteran with 20 years in the United States Army where he held multiple leadership, academic and clinical roles as a nurse leader. He earned his undergraduate nursing degree from Arkansas Tech University, his Master of Public Health from Texas A&M University’s School of Rural Public Health and his DNP at Northern Kentucky. He is a board certified Nursing Executive (NEBC) by the American Nurse Credentialing Center and Certified in Executive Nursing Practice (CENP) by the American Organization of Nurse Executives. Sisk replaces Velinda Block, who is retiring, as CNE.
White Named COO of TriStar Southern Hills TriStar Southern Hills Medical Center has named Joe White as the hospital’s new chief operating officer. He comes to Middle Tennessee from Riverside Community Hospital, a 373-bed facility in Riverside, Calif., where he was vice president of operations and interim Joe White COO. White earned his undergraduate degree in Healthcare Administration from the University of Nevada Las Vegas and his Master of Health Administration from the University of Minnesota. He is a 2019 graduate of the HCA Chief Operating Officer Development Program and a member of the American College of Healthcare Executives.
Siloam Health Expands with New Antioch Location Siloam Health has expanded access to high-quality healthcare for Nashville’s underserved and medically vulnerable populations through a new clinic in Antioch. The organization’s second facility opened in late June at 2717 Murfreesboro Pike and offers acute care for minor illnesses and injuries, behavioral health consultations, and vital community health services. Care is available at the clinic primarily through walk-in or same day appointments.
“We are thrilled for the opportunity to expand services to this important community where so many of our patients live,” said Morgan Wills, MD, president & CEO of Siloam Health. “Siloam Health Antioch is strategically designed to overcome barriers to access and capacity by moving closer to where Dr. Morgan Willis the patients are.” Siloam Health, a faith-based, notfor-profit health care organization based in the Melrose area, has served Nashville’s culturally marginalized immigrant and refugee populations for nearly 30 years. Antioch, which boasts the city’s highest concentration of immigrant residents, has grown significantly in recent years, but nonprofit services have not kept pace with the need. It has also been hit particularly hard by the COVID-19 pandemic, which has exposed and exacerbated underlying challenges related to transportation, housing, language barriers, and access to services. Siloam Health Antioch will also serve as a base for the organization’s community health worker program, which serves patients from over 80 homelands and more than 70 language groups.
Ryan Promoted to VP Healthcare Integration at Centerstone Centerstone, a national leader in behavioral healthcare, has promoted Mandi Ryan to vice president of Healthcare Integration. Ryan joined Centerstone in 2014 as program manager of Integrated Care and then Mandy Ryan advanced to director of Healthcare Innovation. In her new role she will oversee Centerstone’s Health Link services, Continuous Treatment Teams, Safety Net case management, hospital liaisons, and several grants from the Substance Abuse and Mental Health Services Administration. Ryan, a past Nashville Medical News Women to Watch honoree, holds a Master of Science in Nursing degree for Leadership and Management.
Ascension Saint Thomas, USPI, TOA Get CON Green Light Through a long-standing clinical partnership with United Surgical Partners International (USPI) and Tennessee Orthopedic Alliance (TOA), Ascension Saint Thomas is moving ahead with investment in Rutherford County by developing a joint-venture Ambulatory Surgery Center (ASC) in Murfreesboro’s Westlawn community. Certificate of Need approval for the project was granted unanimously on June 24 by the Tennessee Health Services and Development Agency. The new Westlawn ASC will offer two specialties: orthopedics and pain management. It will be situated inside TOA’s new medical office building, currently under development at the west corner of Veterans Parkway and Shores Road. The 13,000-square foot ASC will provide patients with a single location for all outpatient orthopedic needs, including: physician office visits, orthopedic-specific urgent care, imaging studies, surgery and rehabilitation. This project is the first of its kind in Rutherford County. “By strategically shifting a variety of procedures from a hospital setting to an ambulatory surgery center, TOA, USPI and Ascension Saint Thomas are creating lower-cost options for the community we are privileged to serve,” said Gordon Ferguson, president and CEO, Ascension Saint Thomas Rutherford. Facility development will begin this year and is expected to take approximately 14 months. The project is estimated at $13 million. JUNE/JULY 2020
Meharry, Wharton Team Up Meharry Medical College and University of Pennsylvania’s Wharton School Health Care Management (HCM) Department recently announced a joined MD/PhD program to foster more diversity in healthcare that will launch in 2021. This partnership represents the first of its kind for both institutions and will create new opportunities for students interested in clinical practice and policy administration. Nashville Medical News is taking a deeper dive on the new program in the August/September issue.
TriStar StoneCrest Debuts Scar-Free Transoral Thyroidectomy The surgical team at TriStar StoneCrest Medical Center, under the direction of general surgeon, Joshua Taylor, MD, FACS, with The Surgical Clinic, has become the first in Tennessee to remove thyroid glands using an approach that leaves no visible scar. Dr. Joshua Taylor Rather than performing the surgery through an incision in the neck, which leaves a visible scar, this new scar-free minimally invasive approach was performed using very small incisions inside the mouth, between the gums and lower lip. An endoscopic camera and instruments are inserted through the hidden incisions underneath the lower lip. The endoscopic camera provides a magnified view of the operative field to permit safe removal of the thyroid gland. With this approach, there is no incision or scar on the neck and the incisions in the oral cavity heal very quickly and are not
visible within 7-10 days of surgery. “We want to offer patients an opportunity to undergo surgery on the thyroid and parathyroid without the visible scar as they can be potentially disfiguring or serve as reminders of a disease process,” said Taylor. “Studies have shown that a thyroid scar is one of the biggest concerns patients have regarding their surgery.”
Wold, HFR Design Complete Merger Wold Architects and Engineers has expanded services and expertise through a merger with Brentwoodbased HFR Design. Wold Architects and Engineers is a national firm focused on sustainable architecture and engineering for healthcare, senior living, government and education facilities. “We are proud of our legacy and see this merger as the next progression of HFR. Our long-term vision is to leave a positive impact on the communities we serve by bringing our clients’ goals forward in meaningful projects. The partnership with Wold helps us accomplish this with additional resources and knowledge,” said Jim Gilliam, president of HFR Design. The HFR leadership team of Jim Gillian, Ron Franks, Martin Franks, Steven Griffin, Brian Crump, Mike Williams, Beth Meadows and Marjorie Moody, along with the entire dedicated HFR team, will continue to serve their clients under one shared entity, Wold | HFR Design.
Wishes Granted On June 16, two Vanderbilt University Medical Center physician scientists were each awarded a $220,000 grant to
TriStar Centennial Opens New Inpatient Neurosciences Floor TriStar Centennial Medical Center has completed the 10th floor of its inpatient tower, adding 30 patient rooms dedicated to treating neurology patients. The project was the final phase of a four-floor expansion at the 741-bed medical center. The floor features three different levels of care for neurosciences patients including an eight-bed neuro-intensive care unit (ICU), eight-bed step-down unit and 14-bed medical/surgical unit. The unit is staffed by physicians, nurses and rehabilitation therapists specifically trained to treat neurology and neurosurgical patients including stroke, TIA, brain hemorrhage, aneurysms and seizures, among other conditions. The floor was designed with the patient’s experience in mind and includes the latest monitoring capabilities to quickly detect warning signs of a potential emergency.
fund separate clinical research efforts to study diabetes. Only six fellows were selected nationally for the highly competitive grant competition to win 2020 Doris Duke Physician Scientist Fellowships … and two hailed from VUMC. Jeeyeon M. Cha, MD, PhD, won for the project “A Role for the MAFA S64F Mutation in Sex-dependent Diabetes by Accelerating Beta Cell Aging and Senescence.” Jordan J. Wright, MD, PhD, was Dr. Jeeyeon Cha granted funding for his project, “Role of Pancreatic Macrophages in the Progression of Type II Diabetes.” Vanderbilt had two honorees out of only six fellows nationally selected for Dr. Jordan Wright this highly competitive grant competition to win 2020 Doris Duke Physician Scientist Fellowships. In June, the Patient-Centered Outcomes Research Institute (PCORI) announced new funding across several disciplines including $25 million to fund 10 new studies comparing the most effective ways to treat a range of health conditions that impose high burdens on patients, their families and the health care system. Meharry Medical College received support for a $1.4 million project that compares the addition of a culturally tailored counseling strategy known as motivational interviewing to medical nutritional therapy to see if it is more effective than medical nutritional therapy alone in improving diabetesrelated outcomes among African-American women in the southeastern United States. Belmont University’s School of Nursing received a $285,000 Nurse Faculty Loan Program (NFLP) grant from the Health Resources and Services Administration (HRSA) to address the national shortage of nurse educators who are committed to educating the next generation of nurses and family nurse practitioners. In addition to the traditional Doctor of Nursing Practice (DNP) education in the family nurse practitioner (FNP) role, students will obtain coursework specific to the role of a nursing educator. Students in the Belmont NFLP will benefit from mentorship and strong nurse educator preparation, as well as monetary support to pursue doctoral education and loan forgiveness. Easing the financial barrier to doctoral education will improve the supply of nurse educators and nurse practitioner preceptors. The program will provide loan forgiveness of up to 85 percent of Belmont tuition, fees and associated costs if graduates are employed full time as family nurse practitioner preceptors or faculty in any school of nursing in the United States for four years following graduation. Students will have one year after graduation to secure appropriate employment.
Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S
PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Ford Sanders Pam Harris MANAGING EDITOR Cindy Sanders email@example.com CREATIVE DIRECTOR Susan Graham firstname.lastname@example.org CONTRIBUTING WRITERS Jeff Bushong, Lucy Carter, Jim Easter Melanie Kilgore-Hill, Clare Moylan Cindy Sanders, Katie Schlacter CIRCULATION email@example.com —— All editorial submissions and press releases should be emailed to: firstname.lastname@example.org —— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 (FAX) 615.673.8819 or e-mailed to: email@example.com
Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials. All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.
NashvilleMedicalNews.blog NashvilleMedicalNews.com @NashMedNews
More Grand Rounds Online NashvilleMedicalNews.com
your primary source for professional healthcare news