FOCUS TOPICS HEALTH TECH • NEURODEGENERATIVE DISEASE • REVENUE CYCLE MANAGEMENT
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PHYSICIAN SPOTLIGHT PAGE 3
Ryan Mire, MD, FACP ON ROUNDS
Key Strategies to Reduce Claim Denials Claim denials can be complicated at most and confusing at best. Conquering the rules and regulations of medical billing and coding is one of the biggest challenges in the fight against denials and clean claim submissions ... 5
June/July 2021 >> $5
Expanding Evidence-Based Care for Dementia
Alzheimer’s Association Creates Training, Certification Program By CINDY SANDERS
The Alzheimer’s Association recently launched a new training program with certification exam to advance the deployment of evidence-based dementia care. Targeted to care professionals in both longterm and community-based settings, Person-Centered Dementia Care Training Program with essentiALZ Exam®, is based on the nationally recognized Dementia Care Practice Recommendations, which were updated in 2018.
Scope of Alzheimer’s
“Today in the United States, there are more than six million age 65 and older living with Alzheimer’s dementia,” said Monica Moreno, senior director of Care and Support for the Alzheimer’s Association. “So many of the general population (CONTINUED ON PAGE 20)
16th Annual SCALE Returns Live to Music City
The Seven Steps of Revenue Cycle for a Healthcare Practice Revenue cycle management tracks patient revenue from the initial encounter with the healthcare system to payment of balance. Getting the seven steps of revenue cycle right helps providers avoid missteps that are costly to the bottom line.
Music City SCALE is returning to Nashville August 18-22, ushering in a new venue and exciting lineup of some of the world’s top skin care experts
Women to Watch Join us in celebrating the honorees who make up the Women to Watch Class of 2021. These impressive leaders showcase the diversity of talent required to transform our complex healthcare system ...
Center Insert (pp. 9-16)
ONLINE: NASHVILLEMEDICAL NEWS.COM
By KATHI CARNEY, LBMC Physician Business Solutions
The first and most vital step in the revenue cycle process, preregistration allows the medical practice to capture demographic information, insurance information and eligibility in real time through a clearing house, often while the patient is still on the phone. Information goes to the patient’s insurance carrier and flows through the provider’s practice management system, then tells the provider the patient’s coverage, deductible, co-insurance, co-payment, and in certain instances, if a referral is needed. During preregistration, the practice can discuss financial expectations of the patient, including time of payment and no-show/cancellation policy. The preregistration process allows a practice to set the financial tone at the beginning and prevents questions about payment. Check your preregistration process to get your revenue cycle process off to a strong start. (CONTINUED ON PAGE 4)
Mark Your Calendar for the Women to Watch Breakfast Event October 14, 2021
Sensory-Friendly Care for Kids
Children’s Hospital at TriStar Centennial redefining ER care for patients with autism Rushing a child to the ER is rarely a positive experience, but for parents with children with Autism Spectrum Disorder, it can be a nightmare. Bright lights, masked strangers, beeping machines and painful prodding can elicit meltdowns from children with sensory disorders, but one Nashville hospital is challenging that process. The Children’s Hospital at TriStar Centennial has adopted groundbreaking protocols to create a sensory-friendly environment, starting in the Pediatric Emergency Room.
A broad spectrum
Leading the way
For years, Perlin heard stories of ER mishaps from parents of autistic children, and wanted something better for her patients. “I watched nurses at Centennial adapt to a six-year-old nonverbal patient and was so proud,” she remembered. “They understood he needed to be standing on the stretcher in mom’s arms for his IV placement, and it got me thinking, ‘why don’t we adapt to these kids since they can’t adapt to us?’” Perlin, who also has a family member on the spectrum, emailed hospital officials in 2018 requesting
“People fail to recognize autism is truly a broad spectrum, with kids ranging from nonverbal to extremely high functioning,” said Donna Perlin, MD, Pediatric Emergency Room physician at The Children’s Hospital. “No matter what their level of function, individuals on the spectrum tend Dr. Donna Perlin Dr. Sheila McMorrow to have difficulty filtering out the permission to make their recently opened overwhelming sensory inputs that most of us Children’s ER more autism friendly. Not can ignore. These sensory issues can make only did they give permission, but asked communication and care very difficult. They often cannot tell us what it’s like to hear every her to lead the effort hospital-wide. Perlin assembled a volunteer committee of staff, ticking of the clock, every water drip, monitor and was surprised by the outpouring of beeps or the sensation of the scratchy gowns interest. “It was amazing to see how many and they cannot focus on anything else.” One people told me, ‘I have a loved one on the in 64 Tennesseans is on the autism spectrum, making need for awareness more crucial than spectrum,’” she said. “None of us knew we shared that in common.” The team partnered ever.
with Autism Tennessee, which provided education and advocacy free-of-charge to support this most needed program. Weekly sessions helped employees better navigate communication, and distinguish between purpose-driven temper tantrums and autistic meltdowns – typically a byproduct of stimulation overload. Fluorescent lights with their constant humming were swapped for dimmable LEDs, while noise cancelling headphones and sunglasses were made available to patients. Parents are now greeted with a sign to let staff know if their child is on the spectrum, and a questionnaire alerts staff to each child’s triggers and calming factors. A specially designed, sensory friendly treatment room is equipped with weighted blankets, calming toys and monitors that alert staff without disturbing the patient.
“When youarrive in an ER you’re sitting with a child who’s 10 but not acting like it and is probably having a meltdown, which can draw attention and judgment from families who don’t understand,” explained Perlin. “Our goal is to get them out of the waiting room, because many of the things parents have to do to calm their child, like certain holds, may look unusual to parents of neurotypical children. We want them to know we understand.” Sheila McMorrow, MD, Pediatric Emergency Department Medical Director, said the hospital’s child life program also has been instrumental. “Our specialists are highly trained, helping us with different techniques to minimize a child’s discomfort,” she said. That means showing a child in the ER a kit with stitches and instruments they can touch, while patients in radiology might receive a tablet with pictures to demonstrate how the machines moves. “Distraction techniques are especially helpful with this population, and our specialists have a toolbox just for them,” she said.
Efforts also are being made to help patients get diagnosed sooner. TriStar Centennial recently partnered with developmental pediatrician James Van Decar, MD, FAAP, at the Siskin Children’s Institute, who also validates autism awareness efforts in the hospital. “It’s a nice partnership, and patients can be seen, access services and start therapy in a couple of weeks now instead of a year,” Perlin said. Their efforts are now being replicated throughout TriStar’s Nashville pediatric clinics and some outlying hospitals. Medical centers nationwide also are taking note, with facilities like Johns Hopkins and San Antonio’s Methodist Hospital both utilizing TriStar’s pediatric blueprint.
Higher quality care
“Our goal is to get this spread to all children’s hospitals, and even adult ERs,“ Perlin said. As one of 10 pediatric ER physicians at TriStar Centennial Children’s Hospital, Perlin is among countless pediatric subspecialists ranging from neurology to radiology to anesthesiology. It’s the reason they’ve earned patient satisfaction scores in the top five percent and rank in the 99th percentile nationally for pediatric ERs. Individualized pain treatment protocols, front door parking, and a recently added pediatric helicopter transport team are also part of the offerings of this pediatric Nashville hospital. “Our team is our biggest asset, because we have a great group of specially trained physicians that continually deliver high quality care,” McMorrow said.
A Natural Leader
Dr. Ryan Mire Named ACP President-Elect By MELANIE KILGORE-HILL
people who make those decisions and advocate for my fellow colleagues everywhere, regardless of their internal medicine subspecialty.”
Ryan Mire, MD, FACP, is a respected leader in Nashville’s healthcare community, and now he is stepping up to represent physicians on a global level. In May, the Heritage Medical Associates internist was named president-elect of the American College of Physicians, representing internal medicine physicians, related subspecialists and medical students. Mire’s involvement with the ACP has been years in the making, culminating in his formal installation as president of the 163,000-member organization next April.
Lessons from the Pandemic
A Heart for Service
“When I was an intern in residency training, I presented a case abstract to the ACP and received a lot of guidance and constructive feedback from senior leaders who had no motive to invest in me, except to help me grow professionally,” said Mire, now in his 19th year of practice. “I valued that experience, became locally active in the ACP, and gradually climbed to a national leadership role. I’m fortunate to be blessed with the opportunity to do so.” A native of New Orleans, Mire developed an interest in healthcare in high school while serving as a peer counselor at a muscular dystrophy camp. “My camper was hospitalized, and I had to stay with him till his parents arrived two days later,” he explained. “Ultimately he did pass away and that affected me. I became curious about how I could have helped him. That curiosity sparked an interest in medicine, and I’ve never looked back.” Mire received his bachelor’s degree from Rhodes College before attending the University of Tennessee College of Medicine, both in Memphis. He completed his internship and residency at the Medical College of Virginia/Virginia Commonwealth University, serving as chief resident, and soon relocated to Middle Tennessee. In 2005, Mire joined Heritage Medical Associates, an independent, multispecialty physician group with locations throughout Middle Tennessee, and practices at the Ascension Saint Thomas West Office. He has held key leadership positions with both organizations, previously serving as president of Heritage and as vice chief of medicine and chair of the Medical Advisory Committee for Ascension Saint Thomas Hospital West.
Mire has served on the ACP’s Board of Regents since 2017, chairing their Medical Practice and Quality Committee for two consecutive years. He also was the national chair of the ACP Council of Young Physicians and is a nashvillemedicalnews
member of the Tennessee Governor’s Council, served as treasurer and chair of the Finance Committee, and was a recipient of the Laureate Award for the Tennessee ACP Chapter. He will be only the fourth African American to serve as president of the ACP, whose membership across more than 145 countries comprises the largest medical-specialty society in the world.
On a Mission
Mire said his goals as ACP president are two-fold. “I want to help patients by advocating for accessible, equitable and quality healthcare; and also advocate for the ACP membership to reduce administrative burden, assist federal and government stakeholders regarding healthcare policy and advocate for adequate physician reimbursement,” said Mire. “It’s essential to sit down at the table with the
Mire said COVID-19 has been an especially rude awakening for the healthcare system, though outcomes weren’t entirely unexpected. In fact, two months prior to COVID-19 hitting the United States, the ACP organization released four papers outlining needed changes to the healthcare system – all of which were confirmed during the pandemic. “COVID-19 exposed our healthcare system in a variety of ways, most of which were not good,” Mire said. “The ACP published a policy paper January 2020 advocating to change the system from cost and coverage, payment reform, health care delivery, and social determinants of health. It’s a key testament to the value of vision of the ACP and what kind of organization it is.” He continued, “It seemed bold in January, and most stakeholders said it would take a lot of change, but COVID showed us we have many deficiencies in our current system … like primary care physicians receiving fee-for-service who couldn’t get paid because the fee structure is based on volume of patients. That fueled me to say we need to keep pushing forward with a change in healthcare. The status quo is unacceptable, and we need adjustments for improvement – not just for ourselves, but for patients, as well.” While the pandemic highlighted suspected downfalls, Mire said it also showcased the value of internal medicine to the greater healthcare system. “From the
frontline primary care internist to overburdened hospitalists and subspecialists (such as infectious disease and pulmonary/critical care), and other internal medicine subspecialists who dealt with the acute and long-term complications from COVID - these physicians really proved how essential internists are to the healthcare system,” Mire stated.
Mire plans to remain in private practice in Nashville while splitting time between Philadelphia and Washington, D.C. for congressional and regulatory meetings. He’s also focused on helping physicians understand the importance of advocating for themselves and their patients. “For all physicians, advocacy is a very important aspect to impact change,” he stressed. “There are a lot of regulatory policies we don’t agree with, but we’re so focused on our day jobs and duties that we don’t always have time to address issues with our congressmen and senators who make policy. We have to though, because they repeatedly inform me that they just don’t hear enough from physicians. If we don’t take the time to make that phone call, then they don’t know problems exist,” he pointed out. “We must advocate for our own patients with our own legislative representatives. The more physicians get involved with advocacy, the more impact we can make in creating change to improve the field of medicine and healthcare in general. That phone call or email is huge. We have to let them hear our voices and stories, or things will be very slow to change.”
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The Seven Steps of Revenue Cycle for a Healthcare Practice, continued from page 1 2. Registration
to uncover missing charges and identify Registration solidifies the process of miscoded charges. ensuring the patient’s information is accurate from start to finish. During 4. Claim Submission STEP 7 STEP 1 registration, the provider makes The revenue cycle team should Patient Preregistration sure the patient’s address, phone look at the charges, the CPT code, Collections number, date of birth, guaranand the diagnosis code. They will tors, and insurance information ask whether the diagnosis will supare correct, and it is critical port the procedure performed. If STEP 6 STEP 2 they secure this data each time two services are provided, those Insurance Registration a patient is treated. need to be separated and coded Follow-up During registration, the correctly. Claim scrubbing is the provider collects co-payments, process of making sure claims are and if you are a specialist, you clean and going out the door corSTEP 5 STEP 3 will ensure a referral or authorectly. If a claim gets to the insurRemittance Charge rization is in place to treat the ance carrier clean, it will get paid Processing Capture patient. If that step is missed in a lot faster. The process includes STEP 4 a specialist’s office, it is unlikely sending claims from your practice Claim you will get paid in the end. During management system to a clearing Submission registration, financial forms are signed, house, which acts as a mail room, taking and insurance benefits are assigned. In the in the claims and sending them to the difevent these steps are missed, and the pracferent payers. tice is audited, there’s the risk of financial The transmission report shows claims repercussion. sent, claims coming back in and claims vider puts in their documentation – or Often, I recommend a practice hire dropped, while the rejections report done the old-fashioned way with front secret shoppers to help assess the efficacy identifies incorrect codes. Make sure you desk or billing staff manually keying in of the front desk process. This gives the review both reports. The sooner errors are the information. There are advantages practice an independent view of how your identified, the sooner they can be fixed, and disadvantages to both approaches, patients experience your practice and how and the sooner the claims will get paid. as there are charges that can be missed the entire process is functioning. either way. One commonly missed charge 5. Remittance Processing is ancillary services, which results in rev3. Charge Capture Once a practice’s claims have gone enue left on the table. Charge capture can be done a couple out, remittance processing begins. The If you are concerned that you might of different ways. It can be automated explanation of benefits shows the pracnot be accounting for all charges, review – where the information automatically tice what they were paid for the services your charge capture process. As part of a flows into the practice management provided. During this process, allowables revenue cycle audit, an experienced audibilling side based on what the pro– a provider’s contracted prices with the tor can follow a charge from start to finish payer – are determined. One common mistake during the remittance process is “post and go.” As electronic posting has become the norm WE ARE BACK for revenue cycle, a practice can encounter problems when they post remittances and never look at them again. For example, if carrier does not pay or something is set up incorrectly in the practice management system, the error could get missed in the “post and go” scenario. If no one is reviewing the process or the reports, a practice could miss the chance for an appeal and thus an opportunity to correct a mistake. Another element of remittances are fee schedules, which are the amounts providers charge for each service. Providers should review their fee schedules on an annual basis to make sure they are in line with adjusting rates, contracts, and allowables. *5$1'+<$77_1$6+9,//(71 $8*867 Evaluate your fees regularly to make sure you are not leaving money on the table. The final piece of the remittance proIRU3K\VLFLDQ cess includes write-offs, both contractual and non-contractual. Contractual writeIRU1RQ3K\VLFLDQ3URYLGHU offs are unpreventable, as they involve contracted rates with carriers and payers. IRUOﬃce Staﬀ (Manager/Admin) On the other hand, non-contractual write offs are avoidable – they include write-offs for Resident/Fellow that would have not happened with a tight process in place. Avoidable write-offs are IRU*XHVW generally the result of a breakdown in the *XHVWVDUHRQO\HOLJLEOHIRUWKHOLYHHYHQWLQ1DVKYLOOHDQGDUHQRWSHUPLWWHG provider’s revenue cycle process and can WRDWWHQGDQ\RIWKHVHVVLRQV7KH\FDQYLVLWWKH([KLELW+DOO5HJLVWUDWLRQDUHD be identified by looking at reports. Red DQGDQ\PHDOVWKDWDUHOLVWHGRQWKHDJHQGD flags include no authorization, no referral on file, and claims not submitted in a 5(*,67(5$7:::6&$/(086,&&,7<&20 timely manner. These reports are invaluable for a practice to pinpoint opportuni-
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ties in the revenue cycle process and also can assist with financial controls.
6. Insurance Follow-up
In this stage, practices look at not only what has been paid, but also what has not been paid. What happens to the items that don’t get paid? The accounts receivable (A/R) report shows everything that’s sitting in the insurance and/or patient buckets for a period of time. This report will show if insurance follow-up is broken and why it is taking so long to get it paid. An important piece of insurance follow-up is determining the structure. Questions to ask include: • Are people assigned certain carriers? • Is your billing team cross-trained? • Do you have more than one billing person who can work on a particular insurance carrier? • Are you seeing any noticeable changes on the aging monthly? • Are claims being appealed or are they just being resubmitted? • Have your adjustments increased, or are you seeing “suspicious” write offs such as the full charge is adjusted?
7. Patient Collections
The most difficult part of the revenue cycle process is patient collections. The best time to get money from a patient is when they are in your office. For that reason, it’s recommended front desk staff are trained to collect at the time of service. To prevent the collections backlog from snowballing, make sure you have a standard policy for collecting copayments and deductibles that sets the financial expectations for the practice. Just has important is making sure routine patient statements go out. Best practice is a daily statement cycle – your patients will get one statement every 30 days, but statements to go out more quickly, allowing you to move your revenue cycle better and accelerate your cash flow. Cleaning up your patient collections helps reduce the need to bring in a bill collector.
Invest in the Process
Automation can certainly assist with the revenue cycle process. However, many practice management systems have numerous reports that can be cumbersome and ultimately don’t provide the exact information required. Working with an outside source can help create a custom “dashboard” to keep your revenue cycle on track. A custom dashboard will incorporate all the reports you need into one place where you can view in real time. If you are struggling with any part of your revenue cycle, consult with an expert to review the steps. Taking time to clean up your processes now will pay off in the long run. Kathi Carney, CPC, CPMA, CPC-I, CHC, is director of LBMC Physician Business Solutions. A certified professional coder with more than 20 years of healthcare experience across multiple medical specialties, she currently serves as president of the Nashville Medical Group Management Association. Kathi can be reached at firstname.lastname@example.org.
Key Strategies to Reduce Claim Denials Claim denials can be complicated at most and confusing at best. Conquering the rules and regulations of medical billing and coding is one of the biggest challenges in By STACEY the fight against STUHRENBERG, Kraft denials and clean Healthcare Consulting claim submissions. It’s extremely important that medical practices ensure claims are filed appropriately the first time. A denial management action plan is critical for practice success. Inaccurate claim submissions result in claim denials, which in turn causes delayed payments and extra work for staff. According to published statistics from MGMA and Change Healthcare, the approximate cost of reworking a claim is $25.20. This cost can turn into a huge expense for the practice. The Change Healthcare’s 2020 Revenue Cycle Denials index indicates that 11 percent of claims are denied upon initial submission. The report further contends that 86 percent of all denials are potentially avoidable, while 14 percent are unavoidable. Why are denials increasing? Many industry professionals believe COVID-19 slowed the release of many payer policy
updates and changes that were in the works prior to the public health emergency. Those changes and updates are now being released. Other contributing factors include insufficient staff training, staff turnover, lack of adequate resources, and an absence of effective denial management policy. Denials can typically be placed into a few different categories, including: Front-End Demographic and Eligibility Denials: This includes denials for claims with incomplete and/ or inaccurate patient demographic and/ or insurance information. The Change Healthcare index states that approximately 27 percent of the denials are related to registration and eligibility, which is consistent with 2017 report. • It’s critical that front office staff know and understand the types of healthcare coverage and different insurance network requirements. • Staff should always ask about additional coverage. If the patient has more than one insurance policy, staff should understand the importance of sequencing primary and secondary coverage. • Patient registration data should be reviewed for completeness and accuracy. • Eligibility should always be confirmed prior to claim submission. Changes and/or differences in coverage can’t and shouldn’t be left up to the patient to disclose.
Preauthorization/Precertification/Medical Necessity Denials: This includes claims that were denied due to preauthorization not being obtained or preauthorization being obtained for an incorrect procedure. It also includes claims that were denied for medical necessity or non-covered services. Payers have expanded the number of services that require prior authorization and can sometimes change the rules unexpectedly. • It is critical that staff ensure the correct CPT code is being preauthorized. If there is a possibility of an additional procedure or multiple procedures being performed, obtain prior authorization for all CPT codes when possible. • Make sure the preauthorization number is included on the claim form. • Patient’s charts should include documentation reflecting date and time prior authorization was obtained, as well as method used (i.e. automated phone line, website, telephone, etc.). • If the prior authorization is obtained via telephone, always document the name of the representative or employee identified on the call, the date and time, and a reference number for the call. • Language used by many insurance companies can be vague or unclear. Medical necessity is one of the most common reasons given for denial. Staff should famil-
iarize themselves with payer policy exclusions and limits. Coding Denials: This includes claim denials with Local Coverage Determination (LCDs) requirements not being met, bundling issues, or coding errors. • Accurate and specific clinical documentation is essential to show relevance, support treatment and level of care on the procedure. • Ensure coding staff is skilled in your specialty and current on all updates and/or coding changes. • Educate providers on LCDs, payer specific requirements, and bundling issues that could affect your practice. • Many practices have seen an increase in the number of medical records requests from payers. Staff should look for trends in the type of requests, as well as make sure they are sent in a timely manner. Billing Denials: This includes claims that were submitted past filing limits, claims with missing or incomplete claim data, duplicate claims, and claims in which payer specific guidelines were not followed. • Staff should be aware of payer specific guidelines for timely filing limits. • Remark codes on remittance advice can be helpful when trying to identify the missing information. (CONTINUED ON PAGE 18)
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Concert Genetics Releases Comprehensive Genetic Test ID System Coding Key to Order Accuracy, Reimbursement Concert Genetics has released its comprehensive genetic test identification system for use in the market, enabling a level of automation in test ordering, coverage, payment and clinical decision support that wasn’t previously possible, Concert’s Genetic Testing Units (GTUs) are the first and only system that uniquely identifies all 160,000 genetic testing products, organizes them into a multilevel taxonomy, and incorporates new tests as they enter the market, which is currently happening at a rate of more than 30 per day. Initially developed as an internal test tracking system, Concert’s GTUs have powered the company’s widely used, endto-end genetic test management solutions, becoming essential infrastructure for precision medicine in the process. Now they are available to the market at a time when the need for reliable test identification is critical for accuracy and reimbursement. Ambiguity in test identification has created burdens for healthcare stakehold-
ers. The company cited disagreements between health plans and laboratories about test reimbursement arising from the codes used to bill the test. Genetic tests are billed using an average of 6.9 codes per claim. in one study Concert found panel tests for hereditary cancer were billed with more than 2,100 different code combinations during a 36-month period. The inevitable confusion has led to a protracted series of denials and appeals that take away time and money. “At Concert, we believe in the promise of precision medicine, and we recognize this promise will not become a reality until unnecessary friction is eliminated,” said Rob Metcalf, CEO of Concert Genetics. “Today, every system of record in healthcare, from electronic medical records Rob Metcalf and lab information sys-
tems to billing and claims payment systems, operates with a different or incomplete language to identify tests. Without a common language, automated digital communication has been impossible, and manual work has been the only option. As of today, that is no longer the case.” Concert’s GTU system assigns a fivedigit alphanumeric code to each specific, orderable test from a specific lab. The system links to Concert’s master test catalog and covers a wide range of clinical areas, including prenatal, pediatric, rare disease, pharmacogenomic, hereditary cancer, and somatic oncology tests. The system is organized into Concert’s multi-level taxonomy, which groups the 160,000 individual testing products into almost 45,000 categories, which roll up into 34 domains and 8 clinical areas. In the context of Concert’s data platform, the test identification system also ties with other key data assets, including billing codes, lab quality information, and health plan medical coverage policies, enabling
automation where manual work is otherwise required. This system builds on Concert’s recently announced patent US10,896,405, for capabilities that support real-time, automated coverage determination and accurate reimbursement of genetic tests. “The reason this system is transformative is that it eliminates manual work and potential for error at every step in the value chain,” said Metcalf. “A test can be selected, authorized, ordered, resulted, billed, adjudicated, and correctly paid through a seamless exchange of information between systems that requires few if any manual stops, all because of unanimous agreement about the test in question.” From the homepage (ConcertGenetics. com), click on “Customer Login” and create a free account to access and view Concert GTUs, which are available on a royaltyfree basis under the terms and conditions for many uses. Licenses for additional uses, including derivative works, can be obtained from Concert.
Revenue Cycle Rounds HST Pathways, Waystar Enhance Partnership for Improved Revenue Cycle Management
This spring, HST Pathways, a leader in cloud-based software systems for surgical centers, announced a partnership with Waystar, a leading provider of healthcare payments software, that will further simplify the revenue cycle management process for outpatient surgery, improve ease-of use for ambulatory surgery center (ASC) staff, and expedite the turnaround time for payments. As part of the partnership, HST Pathways and Waystar are developing a series of enhancements to automate tedious tasks, remove inefficient touches, and drive HST workflows with actionable data and intelligence to minimize manual data entry and risk of human error. End users clients will gain improved revenue cycle technology integration, with enhancements to critical processes for eligibility, estimation, payer and patient payments. “We have been working together with Waystar for nearly a decade with proven success. This enhanced partnership will allow us to further align our technology offerings by improving integration, user experience, and automation” said Tom Hui, CEO and founder of HST Pathways, which currently provides practice management software for over 1,300 ASCs across the country and recently moved its headquarters from California to Nashville. “Getting payments processed quickly is critical at this point in time, as surgery centers and clinics bounce back from the challenges they faced with COVID-19 elective procedure shutdowns. These new 6
points of integration between Waystar and HST Pathways will further streamline workflows to make revenue collection simpler and faster,” added Ric Sinclair, Waystar’s Chief Commercial Officer.
AccuReg EngageCare™ Earns Top Spot in Patient Access Solutions
AccuReg, a leader in front-end revenue cycle intelligence, has been ranked first for the fourth consecutive year among patient access solutions providers according to the influential 2021 Black Book Research Survey. Black Book Research surveyed nearly 2,300 hospital and health provider chief financial officers, vice presidents of finance and RCM, controllers, business office managers, analyst staff, consultants and directors and physician practices to determine the topperforming vendors among in-demand financial software systems. This spring, AccuReg launched EngageCare™ – a single platform that integrates and automates patient access with digital intake and engagement. Developed by listening to what both patients and providers said they needed, EngageCare is an intuitive experience that helps deliver safe, personalized patient visits while optimizing the front-end of the revenue cycle to prevent denials, increase net revenue and decrease costs.
From appointment reminders, online self-pre-registration, digital check-in and virtual waiting rooms to automated registration auditing, benefit-level eligibility validations and accurate price estimates and payment capture, EngageCare utilizes one platform for patient access, digital patient intake and engagement. Providers report EngageCare has been critical to improving patient and staff collaboration, safety and satisfaction, while increasing net revenue, delivering accurate cost estimates and convenient payment options, improving the financial experience for patients and helping hospitals, health systems and clinics fully collect revenue they have earned. “This has been a pivotal year for our company as we launched EngageCare to provide our customers the digital experience patients expect while championing the benefits of shifting focus to the front-end of the revenue cycle,” said Paul Shorrosh, AccuReg CEO and Founder. “EngageCare stands out by consolidating multiple vital functions and disparate vendor systems into one integrated solution that complements EHRs by ensuring data integrity and revenue capture from both patients and payers.” Earlier this year, AccuReg was named 2021 ‘Best in KLAS®’ for patient access. The company has offices in Nashville, Orlando and Mobile, Ala.
HFMA Installs New Board
In June, the Healthcare Financial Management Association (HFMA) Tennessee Chapter announced the induction
of new executives into office for its 2021 - 2022 term. “We are in a pivotal moment in healthcare and I am confident with the strategic direction of our leadership, we will meet the ever-changing needs of our industry’s landscape,” said HFMA President Rodney Adams, associate administrator of Finance at Williamson Medical Center. “By equipping our members with education and practical tools, we can help them lead their organizations, and in turn, move healthcare forward.” Buffy Loveday, vice president of Strategic Development at CarePayment, was elected chairperson. Nashville’s Katie Tarr, shareholder in the Healthcare Valuation Division at LBMC, is president-elect. Other elected officers from Middle Tennessee include Kathryn Topper, consulting contract analyst at HCA Healthcare, who is serving as the organization’s treasurer; Franklin-based Clint Jones, vice president for Business Development at AccuReg, who is serving as west district vice president; and Scott Mertie, president of Kraft Healthcare Consulting, who is the middle district vice president for HFMA. “The Tennessee Chapter is uniquely positioned in the heart of our nation’s health services ecosystem to prepare for the immediate and long-term implications of COVID-19,” said Buffy Loveday. “I am grateful for these new additions and their guidance in furthering our mission to lead the financial management of healthcare through this unprecedented time.” nashvillemedicalnews
HFMA Offers Best Practices for Fair Debt Resolution By CINDY SANDERS
It’s a subject no one really wants to discuss, but communication is key when it comes to addressing a patient’s financial responsibility for medical bills. To help with those uncomfortable conversations, the Healthcare Financial Management Association (HFMA) recently released “Best Practices for the Fair Resolution of Patients’ Medical Bills.” Designed to be used by providers, their business affiliates and credit bureaus, the best practices were jointly published with the Association for Credit Collection Professionals. The 28-page report, published last fall, updates guidance originally released in 2014. The HFMA Medical Debt Collection Task Force – which includes diverse representation of providers, consumer advocates, collections agencies and credit bureaus – reconvened in 2020 to update and add best practices, particularly financial assistance response to COVID-19 and future health emergencies. HFMA Senior Vice President for Content & Professional Practice Guidance Richard Gundling, FHFMA, CMA, said strains from the pandemic, changes in collection laws, increased transparency expectations and available tools made it the right time to update the guidance. “Let’s make sure these are fresh, up to date and top of mind,” he Richard Gundling said of reviewing the accounts receivable process. The release coincided with the upheaval surrounding the pandemic. “We saw a big spike in unemployment and loss of insurance. Hospitals were backing away from collection policies because communities were hurting,” said Gundling. Yet, he added, that’s the time to have solid processes in place. Gundling noted a job loss should serve as a trigger for provider enti-
ties to discuss options the patient might not know are available, including Medicaid eligibility, ACA Marketplace plans and financial assistance programs. The updated guidance provides detailed information on each step in the accounts receivable process from recommendations for pre-service financial communications and best practices for resolution of medical debt post-discharge to working with account resolution business affiliates and accounts sent to a collection agency. Gundling said the best opportunity to avoid difficult conversations down the line is to clearly outline financial responsibility and collection procedures up front in the pre-service time frame whenever possible. “It’s all about communication. Everybody has such variable coverage and costs,” he explained. “You should be able to get a good estimate of what your cost will be. Can you afford that? If the answer is ‘no,’ then ask why.” He continued, “It’s not a matter of just giving them a laundry list of prices, you have to explain the costs.” Gundling added, this pre-service conversation provides a natural opportunity to discuss other coverage options, interest free medical financing, and financial assistance programs from pharmaceutical companies, manufacturers and provider entities. Even with coverage in place, provider participation changes over time, so it might warrant a discussion about finding an in-network provider. Timing for elective procedures or the course of treatment are also topics to be considered. Do two drugs work equally well with one being less expensive or covered on the patient’s plan? Those are options that can be explored on the front end. Even when there isn’t much opportunity to reduce pricing, Gundling said setting expectations is valuable. “It’s better to know up front than to get home and have a bill you didn’t anticipate,” he pointed out. Of course, he added, emergency situations often don’t allow for pre-service conversa-
Bonus Editorial Go online to NashvilleMedicalNews.com for expanded editorial content. Recent online-only content includes: Monroe Carell Jr. Children’s Hospital Patient First to Receive Investigational Gene Editing Therapy: A nine-year-old patient at the Children’s Hospital has become the first in the world to receive an investigational gene editing therapy for Methylmalonic Acidemia. Nashville Health Care Council Event on Transformation: In June the Council brought together four industry experts to discuss transformational healthcare in an era of uncertainty.
tions. In those cases, discussing financial responsibility has to come later. “You want (the conversation) as soon as possible in the course of treatment, but if the patient is not ready, then follow up when they are. Again, its communicating.” To that end, Gundling said provider entities should review their bills to ensure they are as clear and concise as possible without a lot of medical jargon. That said, bills should provide necessary information on treatment costs, patient’s financial responsibility and a contact number to call for clarification. “A patient is much more likely to pay a bill they understand and were expecting,” Gundling pointed out. The HFMA best practices report notes all account resolution efforts should follow the formally documented provider collection policies that have been approved by the board or other authorizing body. This is also true for all business affiliates under contract with providers. Additionally, affiliates need timely and accurate information to service accounts, making regular reconciliations between the provider’s system and affiliate’s system critical to ensure balances are accurate and in sync. For accounts deemed a bad debt risk, those outstanding balances are often turned over to a collections agency after other steps have failed. “Work with collection agencies
to make sure those agencies are also following best practices and the mission of the hospital,” Gundling said. Providers should have a formal policy established regarding the use of extraordinary collection actions (ECAs) as defined by the IRS. These ECAs could include a lien on property, wage garnishment or lawsuits. However, HFMA’s best practice document notes using ECAs is optional and must be weighed in light of potential negative impacts. The report includes a checklist of internal controls to consider before moving to this step. “There’s always a balance with collections,” said Gundling. Providers, he continued, need resources to run but also want to make sure patients receive the care they need. “Providers need to have people who are empathetic and compassionate explain financial policies to people up front. I think they get tripped up by not being clear and trying to avoid an uncomfortable conversation.” “Best Practices for Resolution of Medical Accounts” is freely accessible on the HFMA website. From the hfma.org homepage, click on the Industry Initiatives tab and then select Healthcare Dollars and Sense for the report and additional resources. A direct link to the page is also available in the online version of this article on our site at NashvilleMedicalNews.com.
HEALTHCARE HELPINGS SERIES
Healthcare Provider Relief Funds: Countdown to Reporting We will take a deep dive into these new reporting requirements including Single Audits, what are the eligible uses of Provider Relief Funds and whether your business may have an extended timeline to use these funds.
Tech Talk: Roundup of recent health tech news and announcements. Tennessee Health Care Hall of Fame Class of 2020 & 2021: The Hall of Fame has unveiled two classes of honorees after last year’s event was cancelled. Go online to read about the 10 healthcare leaders to be inducted in the Hall of Fame this fall. VUMC Joins National Effort to Improve Disease Prediction in Diverse Populations: Vanderbilt will participate in a new federal initiative to improve usage of polygenic risk scores (PRS) to predict complex diseases in diverse populations.
Tuesday, July 27 10 am - 11 am CST kraftcpas.com/events
16th Annual SCALE Returns Live to Music City
Nation’s Largest Aesthetic Medicine & Dermatology Convention Scheduled for August 18-22 By MELANIE KILGORE-HILL
Music City SCALE is returning to Nashville August 18-22, ushering in a new venue and exciting lineup of some of the world’s top skin care experts. Organizers say the 16th annual convention, which typically draws more than 1,000 dermatology and cosmetic surgery professionals, is a welcome change of pace from last year’s virtual event – one of the first international conventions to go online in 2020. “The amount of education participants received last year was incredible because they could actually sit and listen to all the talks without the distractions normally associated with live meetings,” said Brian Biesman, MD, SCALE co-founder and Nashville-based cosmetic and reconstructive surgeon. “Ours was one of the Dr. Brian Biesman first large-scale virtual events, and we learned a lot.”
While last year’s event drew an impressive 500-plus online attendees, organizers are grateful to bring one of the nation’s largest industry events back to Middle Tennessee. In fact, the Symposium for Cosmetic Advances and Laser Surgery has notably found a new home for 2021 - The Grand Hyatt Nashville. A newcomer to Nashville’s luxury hotel scene, the Hyatt is walking distance of the Gulch, Lower Broadway and Midtown. The hotel offers enough space to house SCALE attendees, along with ample meeting space to encourage social distancing. The symposium represents the first in a five-year commitment to the Broadway hotel. “These meetings really work best when you can have everyone in the same place, and we’re taking up 90 percent of the hotel,” said SCALE co-founder Michael Gold, MD, FAAD, dermatologist and cosmetic surgeon at Gold Skin Care Center. “It’s spectacular inside, and we’re excited to showcase Nashville in a new venue.”
The August event is expanding its
highly popular cadaver facial dissection anatomy course, now offered for a full day. Led by Biesman and world-renowned anatomist Sebastian Cotofana, MD, PhD, the course consists of four 90-minute modules focusing on toxins and fillers in the upper, middle and lower face. A two-hour SCALE hair workshop also has been added to this year’s lineup, featuring the latest in hair loss research and restoration treatment options. Gold said the workshop, and many others, are a response to patient demand. “We’re really expanding the scope of program because a lot of surgeons are now doing more surgical and nonsurgical treatments,” Biesman added. “This started as a laser meeting but has expanded into different areas outside energy-based devices from injectables to medical dermatology, aesthetic surgery and topicals.”
The Zoom Effect
Now a popular component of SCALE, medical dermatology is rolling out new therapies for acne, psoriasis and other common conditions. “Research endeavors didn’t stop during the pandemic,” Gold said. “On the cosmetic side a lot of innovation took place behind the
scenes with a lot of new approvals, and we’re the first meting to showcase much of that.” Gold noted cosmetology practices are booked solid in 2021 – a post-pandemic reaction that caught providers off guard. “We call it the ‘Zoom boom’ or ‘Zoom effect,’ because people were forced to look at themselves all day online,” he said. “Using minimally invasive aesthetic Dr. Michael Gold treatments, we’re able to help people feel good about themselves.” The infamous “quarantine weight gain” has opened an additional unexpected market for injectables in the face and neck, as well. Many of the latest innovations with these treatments will be highlighted. SCALE will be among the first meetings to showcase a recently approved injectable for cellulite.
Bringing the Best to Nashville
The meeting’s 80-plus faculty mem-
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By CINDY SANDERS The impressive honorees who make up our 16th anniversary edition of Women to Watch showcase the diversity of talent required to transform our complex healthcare system. Physicians, scientists, CEOs, entrepreneurs, strategists, advocates, subject matter experts – the 12 women selected for the Class of 2021 display the vision, passion and leadership necessary to innovate and integrate approaches to health and well-being for all. Launched in 2006 to shine a spotlight on women making a difference in healthcare, this annual recognition has grown over the years from a feature article to a special section and accompanying awards event. Perhaps the most important growth, though, has been in the number of nominations submitted each year. Breaking all previous records, the number of women nominated in 2021 highlights an exciting expansion of female voices impacting every sector of the healthcare ecosystem. We believe Middle Tennessee is all the richer for welcoming the viewpoints and insights of this year’s honorees and all the nominees.
Presenting Sponsor: Gold Sponsors:
Kraft is proud to sponsor the
WOMEN TO WATCH
class of 2021
CONGRATULATIONS TO THE 2021 WOMEN TO WATCH HONOREES!
We honor this year’s winners as well as our own past recipients who continue to serve & support Nashville’s healthcare community. class of 2017
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Lucinda (Cindy) Baier
Shindana L. Feagins, MD
President, Chief Executive Officer & Board Member | Brookdale Senior Living, Inc.
Medical Director | Feagins Medical Group, PLLC
rowing up on a small farm in Central Illinois, Cindy Baier probably didn’t imagine she would one day take the reins of a publicly traded company leading the way in senior living, home health and hospice care. Yet, it’s a position she has been preparing for since middle school. Following a terrible accident, Baier’s mother was bedridden for months, and the preteen stepped in to become her caregiver. It’s a role she repeated in college for her grandfather when he lost his sight. “I learned firsthand the special needs that come with aging,” she said of living with her grandparents while attending Illinois State University. “These experiences helped me to see how difficult caregiving is and the importance of this work in providing meaningful support to those who need it,” Baier stated. “I still hear my mother’s voice telling me, ‘You need to take care of those who cannot take care of themselves.’” Today, Baier is doing just that as she oversees Brookdale Senior Living, with the ability to provide residential and community care for about 60,000 individuals. In addition to the sheer scope of running a $3.5 billion company with around 42,000 employees, Baier said senior living – which combines healthcare, hospitality and real estate – is a complex industry sector. Yet, the biggest challenge each day is making sure every decision, every interaction is undertaken with the end user in mind. “At Brookdale, we are providing care and services for people 24 hours a day, seven days a week, 52 weeks a year,” pointed out Baier. “It’s a tremendous responsibility, and the pandemic highlighted the life-anddeath aspect of this.” Passionate about doing the right thing for residents, patients and associates, Baier continued, “I always remember this is a people business. The filter I have for making decisions is to keep their health and well-being as the top priority.” To put those intentions into action, Baier said it’s important to have boots on the ground. “One of the things we’ve done as part of our culture is we created community learning visits,” she explained. “I’ve done the job of a housekeeper, cook, server and walked side by side with clinicians.” Baier noted the best part of the day is any opportunity to visit residents and associates in Brookdale communities. “There is no substitute for that personal connection,” she said. “It helps me understand the business better but, more importantly, visiting in communities helps keep the focus on our mission of enriching the lives of those we serve. Relationships are the most important thing.” One of the career relationships she cherishes is with former Brookdale CEO Bill Sheriff. Baier, a certified public accountant whose career has spanned multiple industries, first arrived in Nashville to take the chief financial officer’s role at Brookdale. Although Sheriff had retired from the company before she started, Baier reached out to him when she was named CEO. “I had to lean heavily on him to agree to advise me. I am glad he did,” she said with a laugh, adding Sherriff is a legend in the industry. Happy to learn from the best, Baier is also unafraid to shake up the status quo. “Eighty percent of healthcare decisions are made by women. Most caregivers are women,” she said. Knowing representation matters, she has sought to make sure the board and executive team are reflective of the community Brookdale serves. “I think the only way you get the best results for your company is if everyone has an opportunity to participate, and their voice is heard.” Baier’s most important relationship, both professionally and personally, is at home. “My husband Dave is my biggest mentor and supporter and has provided important advice for many, many years,” she said. “Family is important. I value the time I get with them,” she added of her crew, which includes three stepchildren and five grandchildren ranging in age from six months to four years. She also relishes any time she can get with her sister. Despite her public-facing work life, Baier said she’s really an introvert who is perfectly content to be at home cooking, baking and spending time with family. Being able to recharge has been especially important over the past year as work days became fraught with challenges to the safety and well-being of residents, staff and patients. Despite the rough going, Baier stressed, “If it matters enough, you find a way!” Not only did Baier and Brookdale find a way, but they are taking those hard-won lessons to fuel future success.
Chairwoman | Hospital Authority Board of Metropolitan Nashville & Davidson County
hindana Feagins always wanted to be in healthcare, although she laughingly admits the first attraction to medicine was purely selfish. “I wanted to have access to all the lollipops,” she said of the sweet treat offered at the pediatrician’s office. As she got older, a love of math and science, along with a desire to help others, kept her early dream alive. “In high school, I had the opportunity to volunteer in a cardiologist’s office, and that strengthened and confirmed my desire to go into healthcare,” Feagins recalled. Graduating from the University of Southern California, she enrolled in dental school, noting her father had always dreamed of being a dentist. Despite excelling in her coursework, Feagins’ heart simply wasn’t in it. When the school called to see why she hadn’t signed up for the next year’s classes, she couldn’t bring herself to register. After teaching for several years, she realized her dream was medical school. Early in the process, she interviewed at Meharry and fell in love with the school. “I went on my second interview and said, “If I get in, I’m cancelling all my other visits.’” Not only was Meharry the right fit professionally, but it also turned out to be a perfect personal match. Edwin Feagins, a handsome young architectural engineer working at Meharry soon took notice. “He would see me walking by his office every day,” she said with a smile. Following graduation, Feagins matched in obstetrics and gynecology at Charles Drew Medical Center back home in Los Angles. Now engaged, she wanted to return to Nashville, but Meharry didn’t offer an OB/GYN program. The late Pamela Williams, MD, who was dean of Academic Affairs at Meharry at the time, was an early mentor to Feagins and had long encouraged her to consider internal medicine. “After speaking with Dr. Williams, everything came full circle,” said Feagins. “I switched to internal medicine, and I am very happy that I made the decision to do so, as it has been a true blessing to be able to help patients improve their health and get better.” She loves the space internal medicine provides to think outside the box with a more holistic view of health and wellness. “In 2013, I started the Walk With Your Doctor weight loss program that allowed me to help thousands of patients lose weight and become healthier,” Feagins said. “From the WWYD program, I started an annual 5K walk where I invited healthcare providers and their patients to walk together in an effort to improve the doctor-patient relationship.” Although the pandemic cancelled the 2020 walk, she plans to revive the event in 2022 and hopes to take the 5K national over the next decade. “I think it’s important for patients to know that their doctors genuinely care about their health and well-being,” she explained. “When my patients feel better, and I help them improve their hypertension or their diabetes for example, it makes me feel like I am serving the purpose that God put me on this earth to do.” Giving back is a core principle in Feagins’ life. In addition to her thriving practice in Madison, she has written two books for children using poetry and illustrations to foster conversations on diversity and inclusion. She is also the first Black woman to chair the Metro Hospital Authority governing Nashville General Hospital. “I felt like it was my job to give back to someone who helped me become the doctor I am,” Feagins said of her involvement. “I graduated from Meharry and did my internship and residency at Nashville General Hospital. I have a love for both institutions, and I want to see them succeed.” She’s equally dedicated to helping friends and family thrive. Feagins is mother to Sabria, a rising senior planning to follow Mom into medicine; Edgerin, a rising eighth-grader; and bonus son Edwin Feagins, Jr., a Nashville firefighter who will soon graduate from Tennessee State University. She and Edwin Sr., who now manages her medical practice, also adore their role as grandparents to Olivia, two, and Elaina, nine months. While her days are busy, Feagins said they are also extremely fulfilling. “If I could pass on any advice to someone entering the healthcare field, I would tell them not to worry so much about the money … that will come. Instead, really choose a field where they will enjoy waking up and going to work every day. When one enjoys their job, it makes doing it a lot easier and more rewarding.”
Erika Hamilton, MD Director, Breast Cancer & Gynecologic Cancer Research | Sarah Cannon Research Institute Partner | Tennessee Oncology
he most influential individuals in my life are those who ignite curiosity and refrain from using the word ‘no,’” said Erika Hamilton. For someone who has spent her life pushing past the norms in a quest for improved cancer outcomes, it’s important to be surrounded by ‘can do’ people. “It is vital to think outside the box and not take the current answer or statistic as the final word,” she said of oncology care. “If we just become comfortable with the status quo, we will never advance care or propel new drug therapies forward.” Growing up in Charlotte, N.C., Hamilton said she knew from the age of five that she wanted to be a doctor and was fortunate to have family and teachers who said ‘yes’ to her interests. “Throughout school, I was lucky to have teachers who allowed me to pursue my curiosity in nontraditional ways – like dissecting frog brains in elementary school when it wasn’t on the curriculum or helping me explore my passion for science … even if that meant taking AP Biology a little ahead of my peers.” After completing her undergraduate studies at Washington and Lee University, Hamilton returned to her home state for medical school, internship and residency at the University of North Carolina Chapel Hill, followed by a fellowship at Duke University in nearby Durham. While she never wavered about her decision to be a doctor, Hamilton said she originally thought she might work in a pediatric field. “But I quickly realized that I enjoyed working with adults and helping them discover the empowerment that comes from understanding their situation and treatment options and finding a personalized plan that was right for them,” she explained. “When patients find the correct therapy, it’s such a joy to watch their progress wildly exceed our expectations,” Hamilton continued. “I also love celebrating the important milestones with them, whether that’s their children getting married or even starting kindergarten.” Her responsibilities with Sarah Cannon Research Institute and Tennessee Oncology allow Hamilton to enjoy the best of both worlds by taking an active role in research while still engaging directly with patients two days a week. She’s most passionate about the intersection of those two roles – clinical trials. “No advance in cancer has been made without a clinical trial,” she stated unequivocally. Hamilton said a misconception persists that clinical trials are for those who are out of options … that it’s a last line of therapy. Instead, she hopes people will think of it as a starting point. “That’s something a patient should ask their doctor at diagnosis,” she said. “I often tell my patients a clinical trial is a way to access the drugs we may be using five or 10 years from now.” She’s equally passionate about the Sarah Cannon mission to bring those cutting-edge clinical trials to patients in their own communities. “Patients shouldn’t have to hop on a plane to get the latest care,” she noted. Hamilton is deeply appreciative of all who participate in trials without knowing all the answers ahead of time. “The bravery of the patients that come and participate in clinical trials, even with the uncertainty of the outcomes, is inspiring,” she said. “It’s incredibly special when that bravery is rewarded with clinical success, much like running into the end zone and scoring a touchdown!” While the pandemic was undeniably disruptive, Hamilton said a silver lining was the increased time she and husband Justin, an Air Force pilot and squadron commander, had to spend with daughters Patten and Ellis, ages seven and four. Whether playing games in the park, backyard scavenger hunts or just doodling with sidewalk chalk in the drive, Hamilton said it was important to remember little things can be big fun. “This year has been a good reminder of the value of finding childhood joy and contentment in life’s simplicities,” Hamilton noted. It’s a perspective she plans to carry forward in her work. “Every single improvement is one additional stair on the staircase,” she pointed out. New drugs, precision medicine, improved tolerance, fewer side effects – Hamilton said each advancement allows physicians to better care for patients and give them more simple moments with friends and family. “If we look back decade to decade, this type of progress is astounding from where we have come. Every step we take brings us closer to improving patients’ quantity and quality of life.”
Christi Throneberry Henry, PharmD Founder and Chief Executive Officer | Clinical Solutions Pharmacy
ee a need and fill it. That simple mantra led Christi Throneberry Henry to launch a unique business in 2004 to provide mail order pharmacy and consulting services to correctional facilities. She began by providing medications to one small county jail. Today, Clinical Solutions Pharmacy works with more than 370 correctional facilities in 24 states. “I absolutely love fixing problems and a really good challenge,” she said. “If you think about it, it is the genesis of how most entrepreneurs start their companies.” Her first introduction to healthcare came from her father, Larry Throneberry, who spent his entire career as a hospital administrator. “He would constantly encourage me to consider healthcare as a profession. I am so glad he did!” Henry said. She traces her desire to become a pharmacist back to Cullman High School in Alabama. “I have always loved math and chemistry,” Henry explained. “I was encouraged early on in high school by an amazing math and chemistry teacher to take college courses at a local community college for calculus and inorganic chemistry. That decision changed the entire projection of my career as it allowed me to start pharmacy school earlier, and I was able to obtain a head start in starting my business.” She completed her undergraduate degree at Samford University in Birmingham before earning her PharmD from Samford’s McWhorter School of Pharmacy. Her training continued with a year of residency at Ascension Saint Thomas Health, which brought her to Nashville. Henry said she really loves the intersection between clinical care and healthcare business where she resides. Like many in the industry, her work is made more meaningful by knowing that it helps others – whether that is the end user who gets much needed medications, a client trying to find effective solutions or those carving out careers at Clinical Solutions. “I enjoy watching my employees go from an entry level position to one of our top levels within the company. That is what gets me up in the morning,” she said. Finding the right people is always a challenge, but Henry recognizes the need to follow the business axiom of “hire good people and get out of the way.” Currently, Clinical Solutions has about 150 employees. After landing two exciting new contracts, she said the company anticipates adding another 20 to the staff. Like many entrepreneurs who nurture a business from idea to expansion, she said it can be difficult to let go of tasks. “When you start the business, everything does have to be an emergency because one little thing can put you out of business,” Henry noted. Now that staff has grown alongside of the company, she’s trying to put day-to-day issues into perspective. “Everything is not an emergency,” she stated, before adding, “I say that … but living it is a little different. I still operate in this mode, which can be so exhausting,” she said with a wry smile. Still, Henry is making strides with identifying which items demand her undivided attention. “I have learned to always prioritize what is important,” she said. “If you are always taking care of the patients first and foremost, everything else just falls into place.” Refreshingly, she admits to struggling with work/life balance, noting it can set up unrealistic expectations for women to think they should be able to do it all flawlessly. “My business is my life’s work,” Henry said. “I try to figure out how to make that work around everything else. There are choices you have to make, but my husband is so supportive.” She and husband Todd hike every weekend rain or shine, often with their seven-year-old rescue pup, Sophie. “We enjoy all the wonderful parks in Nashville and surrounding areas and being in nature helps clear my head and decompress,” she said. With long hours during the work week, Henry noted weekends tend to be very low key. “We both work long hours, so we like to just hang out.” Henry enjoys painting, and when the opportunity arises to travel, the couple enjoys trying new foods and unique dishes. “We’re definitely foodies,” she said with a laugh. Taking weekends to recharge prepares her for whatever new challenges land on her desk during the week. “I truly believe 99 percent of staying in business and staying relevant is just showing up and not giving up – just pure perseverance,” Henry concluded.
Gretchen Purcell Jackson, MD, PhD Vice President & Chief Health and Science Officer | IBM Watson Health Associate Professor | Vanderbilt University Medical Center
lifelong commitment to healthcare and a love of science led Gretchen Purcell Jackson to carve out a successful career that perfectly joins her diverse interests. “I was exposed to the cold end of the stethoscope early in life, and I was always going to be a surgeon to give back to the profession that extended my life,” she said of being diagnosed with congenital heart disease as an infant and successfully undergoing corrective surgery at age 10 years. During high school in Maine, she developed a deep interest in science and computer programming. Heading to Stanford for undergrad, Jackson majored in both biology and electrical engineering with an emphasis on software engineering. “I paid for school by programming and building databases as a consultant and teaching computer science,” she recalled. “I discovered what is now called biomedical informatics, an interdisciplinary field at the intersection of medicine and computer science, and I earned a PhD in this field during medical school.” After completing her advanced degrees at Stanford, Jackson moved to North Carolina for residency at Duke University Health System, followed by a fellowship at Pittsburgh Children’s Hospital. “I had always thought I would be a cardiac surgeon when I began medical school,” Jackson said, “but I literally fell in love with pediatric surgery.” She relocated to Nashville in 2006 and joined the faculty at Vanderbilt University Medical Center where she continues part-time as an associate professor of Surgery, Pediatrics and Biomedical Informatics. One piece of advice she often shares with the next-gen workforce is the value of flexibility. “I tell aspiring medical students that the job you sign up for when you begin medical training is going to be very different when you are done. Be prepared for change and to embrace it.” Recruited to IBM in 2018, Jackson followed her own advice and pursued an exciting new opportunity to help the healthcare industry make the best use of artificial intelligence and big data. However, she felt very strongly that she also keep practicing medicine. She noted, “I felt like it was really important to keep my finger on the pulse of medical practice.” With her dual role, Jackson is keenly aware of the power of actionable insights on outcomes. “Delivering effective advanced analytics and artificial intelligence for all stakeholders in the healthcare ecosystem is a multidisciplinary team sport,” she said of the dedicated group of clinicians and scientists who provide clinical, scientific, informatics and public health expertise for health-related business activities at Watson Health and across IBM. “We do together what none of us could do individually. I’m humbled by the energy and skill of my teammates each day.” Having found her dream job, Jackson relishes the opportunity to help develop career pathways for her team members that marry their talents and interests. A physician-scientist to her core, Jackson truly loves science. “In healthcare, scientific evidence is the language of trust,” she pointed out. “Technologies,” she continued, “are evolving very rapidly, but high quality science often takes time. It is a challenge to conduct science at the pace of health information technology evolution.” Yet, Jackson said, such science is critical. “I believe it is a professional and ethical responsibility for all developers of artificial intelligence solutions in healthcare – both in academics and industry – to commit to doing the scientific studies to ensure these tools are safe and effective.” Leading by example at work, she is sharing her expertise on a national level, as well. Jackson currently serves as chair-elect of the American Medical Informatics Association Board of Directors and will step into the role of president and board chair in January 2022. While work is spent in a fast-paced, ever-evolving environment, Jackson’s downtime is decidedly more low-key. “I love spending time with my family and enjoying the outdoors,” she said. The family of four includes husband Heath, Olivia, 18, and Brynn, 10. While home base is Kingston Springs, they also have a farm in the rural countryside. “We’re working on learning to farm,” Jackson said with a laugh. “We have cows and soon will have goats.” The active family also enjoys sports – the girls play lacrosse, and Heath played football at Mississippi State. “We enjoy games for all our colleges,” added the Stanford alum from deep inside SEC territory.
Sharon W. Reynolds President & Chief Executive Officer | DevMar Products, LLC | DevMar Global Healthcare Solutions, LLC
fifth generation Nashvillian, Sharon Reynolds is proud of her hometown and the role her family has played in making it better for all. Her maternal grandfather and great grandfather were soughtafter stone masons who worked on several of the city’s beautiful churches. Her father was one of the first African American firefighters in the city. And she has carved out a space in a typically male-dominated field to create safer, healthier environments across hospitality, corrections, industrial, educational and healthcare spaces. Reynolds laughingly notes her career path is a bit eclectic as she pursued different interests, including stints in mortgage banking and real estate. Along the way, she also gained more than two decades of experience in the chemical disinfecting industry through her husband DeMarco’s facility management company. “I have always been fascinated by how certain chemistries eradicate pathogens, keeping surfaces and spaces free from harming people,” she explained. “At the height of the 2007 downturn, I launched DevMar Products, named after our two sons – DeMarco II and Devin,” Reynolds continued. While DevMar began as a sanitary supply distribution company, she wanted to differentiate her young company. “I engaged the Morehouse School of Medicine’s research team and a partner to develop unique and innovative products with environmentally sustainable components that stood out from the typical ‘me too’ products. From that effort, we developed new technologies to include a five-patented biohazard absorbent called Clean Up, currently undergoing the EPA’s Emergency Exemption Authorization process,” she explained. Always curious, Reynolds returned to school as an adult to earn an undergraduate degree in business with a focus on green and sustainable enterprise before going on to earn an executive MBA at Tennessee State University. She uses both her education and background to make DevMar products highly effective but kinder to the earth. She noted the company’s biohazard and antimicrobial products are created with sustainability in mind but with the power to eradicate more than 80 pathogens, including norovirus and C. difficile. “I am energized each day to think of new ways to become a part of the solution for our customers. When we bring ideas that cure pain points in supply chains and product development, it keeps us relevant, and we become value-added partners,” she said. “One of the most challenging aspects is identifying the science behind technologies a lot sooner that will quickly impact situations such as the current pandemic.” With a growing focus on the medical field, Reynolds founded DevMar Global Healthcare Solutions. The company has teamed up with Oregonbased NI-Q in the development and distribution of safe, shelf-stable human donor breast milk for at-risk infants in NICUs across the country. “It’s Mom’s milk that is commercially sterilized but doesn’t degrade nutrients,” explained Reynolds. “While the two companies are opposites, both outcomes are geared toward health, wellness and safety of our population.” Involved with NI-Q three years before the birth of her granddaughter, the business affiliation would become incredibly personal. “My daughter-in-law had preeclampsia and my granddaughter was born prematurely. We almost lost them both,” she recalled of that frightening time. Bryla J, now threeand-a-half, used NI-Q for the first six months of her life and is thriving. In celebration, Reynolds, who loves fashion, launched Bryla J Couture Clothing featuring elegant designs for professional women. A portion of every sale is donated to March of Dimes and St. Jude’s. Although the clothing line has been on the back burner while Reynolds has been focused on helping clients address heightened disinfecting concerns in the midst of the pandemic, she hopes to relaunch with a new line for 2022. Just as her work is solutions-based and community-minded, many of her ‘off the clock’ hours are spent volunteering for organizations with the same mindset. Reynolds has served on boards for Habitat for Humanity, Second Harvest Food Bank, Nashville State Community Foundation and The Table Advisory Council. “I enjoy making a difference in the lives of the underserved in our community and solving pressing issues impacting the Nashville business landscape,” she said. Although her interests are diverse, Reynolds said the common denominator is providing support for the environment and individuals. Counting hospital-acquired infections as her chief nemesis, she is tireless in her efforts to make hospitals safer. “It’s very rewarding to provide innovative product technologies that are cutting-edge, forward-thinking and lifesaving,” she concluded.
Nicole Schlechter, MD, PhD Chief Medical Officer | Ascension Saint Thomas Hospital Midtown President | Nashville Academy of Medicine
he daughter of immigrants, Nicole Schlechter was the first in her family to graduate from college. “I loved the sciences when I was growing up, and that Is what I excelled in at school, particularly the biological sciences,” she recalled. After graduating from the University of California, Berkeley, she stayed on as a graduate student conducting research in comparative endocrinology. “It’s humorous that I studied hormonal regulation of long bone growth since I’m five feet tall,” Schlechter noted with a grin. Completing her doctorate in three years, Schlechter said she would have continued on in the lab if not for her fiancée – now husband of 35 years – Ray Bluth, MD, who encouraged her to dream of medical school. “No one ever suggested I could, or should, be something else. He believed in me when no one before really had … certainly, I had not,” she said. With a new goal and a fiancée bound for Nashville to attend Vanderbilt University School of Medicine, Schlechter turned in her only medical school application and held her breath. “I got in and was given a scholarship that made it possible for me to attend. I am forever grateful for that,” she said. Always an advocate for women’s issues, Schlechter found obstetrics and gynecology a great fit for her interests. Besides, she added, she instantly loved delivering babies. Despite long days, Schlechter noted, “You get someone through a pregnancy and hand them a baby – there is no other feeling like it.” Even in the face of loss, she said there is a peace in helping families make it through an incredibly difficult time. A founding partner of Women Obstetrics and Gynecology, she spent more than 25 years with the practice in direct patient care. Yet, she also found herself taking on increasing leadership roles at the hospital and in organized medicine. When the chief medical officer role came up at Ascension Saint Thomas Hospital Midtown, it felt like the natural next step. Just months into her new position, the COVID-19 pandemic hit, bringing previously unimagined challenges to the role. “We basically had to close our hospital to visitors, shut down the ORs to all elective cases … then reopen them, develop surge plans for everything from PPE to beds, staff and physicians, then start up a testing program and then a vaccine clinic,” she enumerated. “We did all of that while trying to keep our associates and providers safe and happy.” Although the pandemic was tumultuous for everyone, Schlechter noted, “If you can make it less horrible for someone, that’s huge.” Now that some normalcy is returning, she’s ready to tackle new challenges including exciting building projects that will enhance care, patient experience and workflows. In addition to her own hospital, she’s also advocating for providers throughout Middle Tennessee as president of the Nashville Academy of Medicine. “I would like to work towards increasing equity in medicine and medical leadership at all levels,” she said. “I try to incorporate the issue into most everything I do.” Addressing burnout is another key issue. “I want to bring the joy back into practicing hospital medicine,” Schlechter noted. “When providers love and can focus on patient care, everybody wins.” Calling on her California upbringing, Schlechter said she is a long-time proponent of self-care to find balance. Her happy place comes from hiking with her husband and their three dogs. The couple also share an eclectic palate and love trying out new restaurants and enjoying great dinners with friends. Growing up in a home where English was a second language and money was tight, Schlechter doesn’t take the life she and Bluth have built for granted. It’s her fervent hope that every child gets a shot at making their dreams come true. “My mother was a single mom who raised me and my sister with Social Security, food stamps and minimal income. I am profoundly grateful for the opportunities that have been given to me because of the compassion that the people of this country showed my parents and the grants and scholarships that made it possible for me to get educated,” Schlechter concluded. “I feel that I have not squandered what was given to us. I think about this every day, and I hope … more than anything … that other children in similar circumstances today can be offered similar opportunities.”
Pamela Sessions Chief Executive Officer | Renewal House
rowing up in the small West Tennessee town of Covington, Pamela Sessions probably never imagined she would one day lead a unique organization dedicated to women and their children affected by substance use disorders. Back then, she just knew she wanted to find a way to help others. “I have always had a passion for helping people and am fueled by working with people who face significant challenges in their lives,” said Sessions. That passion and drive are put to use daily at Renewal House, a nonprofit dedicated to keeping families intact while treating women with substance use disorders. “We’re the only long-term provider of addiction treatment in Middle Tennessee where women and children are cared for simultaneously,” Sessions noted. She was first introduced to the field of social work as a teen and soon realized she’d found her calling. “Both my mom and aunt significantly impacted my career path and development. They did not make a choice for me, but they taught me I could be anything I wanted to be and not to allow anyone to tell me otherwise … they were very adamant about that,” she recalled with a laugh. Both her mother and aunt graduated from college in the 1950s. “They were successful and didn’t have the resources I have today. So if they could do it, they thought I could do it,” Sessions said. “They encouraged me to see hardships and challenges as opportunities and not barriers.” Completing both her undergraduate degree and her Master of Science in Social Work at the University of Tennessee Knoxville, Sessions spent 18 years working in her field in Memphis before relocating to Nashville. After nearly eight years in a leadership role for the YWCA, she accepted the chief executive position with Renewal House in 2016 where she has put both her training and the lessons learned at home to work. Renewal House is celebrating its 25th anniversary this year. The campus provides residential treatment, recovery housing, intensive outpatient services, telehealth, parenting skills and vocational counseling. “The goal is to break the cycle in terms of addiction, poverty and trauma,” she said of working with women determined to rewrite the script for themselves and their families. “Opioids are the primary substance of use for the women we’ve been seeing for the last couple of years,” Sessions noted of what has become a national epidemic. A substance use disorder has to be the primary diagnosis for the women Renewal House serves; however, many women in the program have a co-occurring mental health disorder, most often anxiety and depression, she said. While the organization has served more than 6,000 women and children, Sessions said many more need assistance. “The most challenging aspect of my field is when there are not enough resources available to meet every need or when resources are available and you can’t access them,” she said. “Support from the community makes Renewal House’s life-changing work possible.” With an average of 60 women on the Renewal House waiting list on any given day, a major capital campaign to increase capacity is underway. “We’ve started the building project,” Sessions said with evident excitement about construction on a three-story facility to be completed by year’s end. The new building includes 34 apartments, staff office space, rooms for treatment sessions and a small minor care medical clinic. “We would love to renovate the current building and turn it into long-term, affordable housing,” she said of the next goal. Ultimately, Sessions hopes to see the entire 14-acre campus developed to include an early learning center, vocational training center and more housing. “I would love to have a celebrity help us raise awareness about Renewal House and the work we’re doing,” she said of efforts to speed the timeline on long-term plans. An avid crafter, she has the ability to see raw materials and envision what they could become – whether that’s land to be developed, a blank canvas to paint or a mom trying to overcome addiction and become a better parent. Sessions, an 11-year cancer survivor, knows what it’s like to face challenging situations. She also knows it’s possible to come out on the other side with effective treatment options and a strong support system in place – the very tools Renewal House offers the women they serve. “I love seeing people beat the odds, whether it’s recovering from a substance use disorder, surviving cancer or losing 100 pounds,” she said. “There is an overwhelming sense of accomplishment and pride when you take on a significant challenge and succeed.”
Vice President of Strategy & Development | UnitedHealthcare Community Plan of Tennessee
Partner | Hall Strategies
uzy Sonnier brings leadership informed by personal experience to her role with UnitedHealthcare Community Plan of Tennessee. Already interested in the field, she became especially committed to healthcare after the birth of her son. “Jacob was born with an extremely rare medical condition, and doctors questioned if he would live beyond the first few hours of life,” she explained. “Over the next 13 years, we learned a lot about the importance of access to a high quality, person-centered and integrated healthcare system.” Living in their home state of Louisiana at the time, Sonnier said navigating a complex health system was daunting even when surrounded by a strong support system. That experience, she continued, is even more overwhelming for vulnerable families with multiple barriers and limited resources. “I knew that I wanted to be a part of the healthcare system – to be positioned to provide leadership and to use my education and gifts, in addition to our personal experience, to drive transformation and ensure the best possible health outcomes and experience for others,” Sonnier continued. Through her son’s journey, Sonnier solidified her philosophy around the value of integrated services and care coordination. “Our pediatrician had a checklist that he would review every time Jacob had an appointment. He also kept a separate running document that included key information critical to Jacob’s care,” recalled Sonnier. “My family would carry a printed copy of the most current document to each new specialist visit, and it became a tool to inform or update providers and ensure coordination of care.” That paper precursor to an electronic health record helped ensure critical information didn’t slip through the crack. “The importance of integrated care resonated not only on an individual level but also confirmed we needed to address integration and care coordination more systemically in our communities,” she said. In her role at UnitedHealthcare, she takes a two-pronged approach to strategy. For any decision, her first thought is the impact it will have on patients, their support systems and providers. The second line of thinking is to consider how to best leverage assets to make solutions more sustainable. Sonnier is passionate about fostering collaboration and using data to solve problems and drive results. Recognizing 80-90 percent of health outcomes are impacted by factors beyond medical care, she said it takes a community effort to address social determinants of health. “There are resources that government can bring to the table, but there are also innovations and flexibility the private sector brings. When we come together around a common goal, we can often accomplish more and accomplish it more efficiently.” Like many seeking to transform the system, Sonnier revels in the constantly evolving nature of healthcare. “I love the quest for healthcare innovations that deliver greater value and better health outcomes,” she said. “I love that we have the opportunity to listen to patients, providers, state partners and community members who come to the table with differing perspectives and to engage them in developing real solutions.” She said the industry’s dynamic nature can also present its biggest hurdle. “It can be challenging to keep up with new innovations, to bring it all together and to provide a comprehensive or holistic approach that balances both outcomes and financing to the value of healthcare,” she stated. While she spends her days focused on finding the right formula for healthcare, there’s no question as to what maximizes value in her personal life. “Friends and family! I have learned not to take relationships for granted but to invest in them deeply,” she said. Sonnier is also happy to dive into new adventures. Ready for a change of pace, she and husband Chris left Baton Rouge and moved to Nashville. Determined to really experience their new city, the empty nesters live downtown and spend lots of time listening to live music, sampling new restaurants, and exploring Nashville’s many neighborhoods. Happy at home, she’s always game for a good trip, too. “Like so many others, I also love to travel – especially to see my daughter, Ainsley, who is working on her master’s degree in New York.” Sonnier said she would give anything to have had more time with her son, but she’s so grateful for the years they did have as a family and for his legacy. “Jacob taught me that you have to be persistent and not give up … that you have to be resilient and embrace change. My hope is that I always embody these values throughout my work and that in doing so, I will have a positive impact not only on the Nashville healthcare system, but healthcare systems across the country.”
Executive Director | Life Science Tennessee & BioTN
s a journalism major at the University of Tennessee Knoxville, Abby Trotter wasn’t planning a career in healthcare. Yet, her skill set perfectly aligned with the needs of a burgeoning life sciences industry in a region better known for healthcare services. “I came into healthcare from a public affairs and economic development perspective,” Trotter explained. “When I first moved to Nashville in 1995, I was very involved in both economic development and healthcare initiatives while working at a previous public affairs firm. It was there that I was first exposed to Life Science Tennessee, then called the Tennessee Biotechnology Association.” Launched in 1999, the organization stemmed from groundwork by the Tennessee Department of Economic Development to capitalize on the growth of life sciences in a state rich with resources. “Tennessee has some of the nation’s best research institutions – Vanderbilt, St. Jude, UT and Oak Ridge National Laboratory,” enumerated Trotter. “Coupled with our specialties in healthcare delivery, we had … and still have … a real opportunity to develop a new economic driver for the state.” In 2004, Trotter helped found Hall Strategies, an independent public and government relations firm working with local and national clients on a range of services including government relations and strategic communications. She continued to intersect with Life Science Tennessee through her work at Hall Strategies before being named executive director in 2012. “Life Science Tennessee is part of a national organization called the Council of State Biotechnology Associations (CSBA) managed through BIO,” Trotter explained of the statewide non-profit. With more than 100 company members, the organization’s mission is to advance and grow the industry sector through advocacy, partnership and alignment with workforce and economic development activities. Although she isn’t a researcher, Trotter’s skills have propelled the organization forward. Seeds planted over the last decade are now bearing fruit. In the last few months, Revance Therapeutics moved its headquarters from Silicon Valley to Nashville, and August Biosciences announced a major expansion. In April, Nashville was named one of the country’s 10 fastestgrowing biotech hubs for job opportunities. “Investors are really beginning to see opportunity,” said Trotter. She added the Tennessee Legislature more than doubled the funding amount allocated to match Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants. “It’s an extremely exciting time, and there’s more support than ever before.” She is also hopeful the industry will build off the success and collaboration that brought COVID vaccines to the public in record time. “That was only possible because of the partnership that was created between industry, government and providers,” Trotter pointed out. “I’d like to see us address other healthcare needs with similar resolve.” She said the nation’s opioid epidemic, which was exacerbated by the pandemic, is a prime area where biotech could offer new options. “One very promising treatment is a non-opioid-based pain medicine, Caldolor, which was developed at Vanderbilt and is on the market from local company Cumberland Pharmaceuticals,” Trotter said. “We need to look at how science and innovation can continue to solve our most complex public health problems,” she added. Most recently, Trotter took on the executive director position for BioTN. “It’s a non-profit focused on creating a pipeline of talent for the life science industry, beginning with STEM programing for secondary education all the way to workforce development programs for scientists and entrepreneurs,” she explained. “My job pulls me in a lot of directions. I’m grateful for that – and I’m mostly responsible for it, as well, if I’m being honest,” she admitted with a laugh. “I thrive in this atmosphere, but it can be challenging.” Add, wife and mom to Trotter’s roster of roles. “I am married to a high school history teacher, Doug Trotter, who leads an advanced program at Overton High School. I’m a passionate supporter of public education, and both our daughters went to Overton,” she noted. Sadie, 18, just graduated and is headed to Purdue to become a commercial airline pilot. Celia, 17, is a rising senior, so the family looks forward to another busy year of college planning. “The outdoors is my de-stressor,” she noted. “I love to be outside – in my garden, on a run in the neighborhood, a hike, or on the lake.” With momentum gathering, Trotter can use a little tranquility before diving back into busy days sharing the state’s successful life science story and growing the sector.
Jennifer Weaver, JD Partner | Waller Lansden Dortch & Davis, PLLC
ever a dull moment … and Jennifer Weaver likes it that way. A Los Angeles native, Weaver earned her undergraduate degree in film and television at New York University, followed by law school at Columbia. Returning to practice in her hometown, Weaver’s story reads a bit like a movie script. The young lawyer joined a large, international firm and focused her practice on high-profile, white-collar criminal defense. Then came a move to Nashville, the epicenter of the nation’s healthcare industry, and a new focus on representing providers. “It was a natural transition. I always enjoyed trying cases against the government and helping my clients navigate treacherous government investigations,” she said of her pivot to the highly regulated industry. Weaver pointed out healthcare and defense contractors are the prime recipients of federal dollars, which makes the two areas popular targets for federal investigations and enforcement actions. Government cases often come with stiff monetary penalties and the potential for criminal prosecution – or at least the threat of it. “I have been defending healthcare providers in high-stakes government investigations and audits for more than 20 years now, and it has been very rewarding to help providers get through what can be a very challenging and emotional process,” she said. Weaver added she truly loves helping providers navigate a difficult, scary run-in with the government and come out the other side with companies and practices intact and thriving. “No matter how big a healthcare company is, they are always the underdog going up against the government,” she noted. “The government has the power to not only impose dollar fines and penalties, but they can exclude providers from participating in federal healthcare programs, which is the death penalty for almost any healthcare company.” She added, “You are not on a level playing field against the government, which is a huge challenge.” Weaver said oftentimes cases are brought by whistleblowers who might be disgruntled employees or motivated by the monetary reward that comes with qui tam cases. She added the complex and ever-changing nature of Medicare laws are easily misinterpreted by whistleblowers, and the issue is compounded by a Department of Justice eager to ferret out potential fraud. “A lot of government prosecutors have been at it a long time and get kind of jaded where everything they see looks like fraud. It’s just the lens through which they view the world,” Weaver noted. Of course, there are cases of major fraud that are splashed across the evening news, but most cases are simple human mistakes. “The government treats regular billing errors like fraud, and providers feel rightfully offended by that. If someone owes money, we’re going to pay it back, but that doesn’t mean there needs to be huge penalties,” Weaver said. “Almost every provider is going to have to deal with this eventually,” she added. “It’s a highly regulated industry so it’s the nature of the business.” Weaver is fueled by ensuring clients are fairly represented. “I have so much respect for them,” she said. She knows the feeling is mutual but also recognizes her specialty isn’t exciting for clients like a big M&A deal would be. “They’re appreciative of how I put my heart in it, but they are always like, ‘I hope we never work together again,’” she said with a laugh. She certainly understands the stress enforcement actions cause her clients. And while she is intellectually stimulated by handling these tricky cases, Weaver also needs a way to unwind and relax. For her, that means heading to her home in Arrington. “I live on a 65-acre farm with my horses,” she said. “I ride for fun. I like being in nature to decompress.” From her home base in Middle Tennessee, Weaver works with clients all over the country and is currently working on cases in five states. In addition to her focus on government investigations, she also is called in during investor disputes, particularly in the ambulatory surgery center arena. Recently, she purchased a home in Los Angeles where she still has family and is looking forward to splitting time a bit more between Tennessee and California. Despite the natural dread that accompanies a DOJ enforcement notice, clients know what they get with Weaver – a skilled, tenacious litigator who is an unflinching advocate for providers. Having a fighter on their side makes even the most stressful time a little less frightening.
Karen Winkfield, MD, PhD Executive Director | Meharry-Vanderbilt Alliance Ingram Professor of Cancer Research | Department of Radiation Oncology, Vanderbilt University Medical Center
trained vocalist, Karen Winkfield started college as a music major, but it’s her work addressing health disparities that has the medical community singing her praises. Ultimately, she majored in biochemistry at Binghamton University in New York before heading to Duke University to earn both a medical degree and doctorate. “During my second year, I had an encounter with a woman who was hospitalized with complications from cervical cancer,” Winkfield recalled. “She was terrified, and as a medical student, I had more time than other team members. We bonded, and it solidified my interest in oncology.” However, it was the large gap in outcomes, particularly between Black women with breast cancer and their White counterparts, that launched her lifelong work in health equity. In the beginning, she explained, “I wanted to use basic science to elucidate the biology behind cancer disparities.” Her research stalled when she was unable to collect enough biospecimens, despite being at a large academic center. “It made me realize that even if there was a cure for cancer, there were systemic barriers in place that would prevent everyone from gaining access to that cure,” she said. After an internship in internal medicine at Duke, Winkfield headed to Harvard for residency in radiation oncology. Following training, she stayed on as faculty at Harvard Medical School as an attending physician at Massachusetts General Hospital. Crediting numerous individuals with helping shape her career, Winkfield noted two from her time in Boston have had a major impact on her work. “Dr. Abram Recht at Harvard/Beth Israel Deaconess Medical center is one of my longest-standing mentors in the field,” she said. “An incredible role model, I have adopted many of the lessons I have learned from him into both my clinical practice and in the way I mentor others. And I must mention Dr. Bev Moy, breast oncologist at Mass General Hospital,” Winkfield continued. “She opened up so many doors for me that enabled me to take my health equity work to the next level.” Returning to North Carolina in 2016 to lead cancer equity programming at Wake Forest Baptist Comprehensive Cancer Center, Winkfield recently made the move to Nashville. “This was an opportunity for me to engage the community around health and well-being by being part of an alliance between two world-class institutions and work on building institutional capacity to support the community’s goals for health equity,” she said of her new position with Meharry Medical College and Vanderbilt University Medical Center. A national reckoning has heightened the desire for change. COVID and the death of George Floyd increased awareness of disparities across the spectrum – from health and housing to policing and educational access. “People have been struck by the fact that communities of color have been so disproportionately affected. People didn’t even want to hear about it (before), but people’s eyes have been opened,” said Winkfield. “The health of your neighbor impacts your health, as well.” While she loves the technical aspects of radiation oncology, Winkfield said her joy comes from personal engagement. “It truly is a privilege to be a part of an individual’s cancer journey; there’s nothing like it. But I have felt compelled to engage others in this quest for health equity,” she explained. “Community engagement is vital to ending health disparities.” Engagement is also the most difficult aspect of her work. “I know that sounds weird, but what I love most is actually one of the most challenging things. It takes time to develop trusted relationships. And in medicine and business, time is money. Very few institutions want to invest in the relationship-building that is required to truly make a difference in communities.” The collaborative spirt ingrained in Nashville was part of what drew her to this new post. The city’s restaurant and entertainment scene didn’t hurt either. “I am a foodie! I love good food and great bourbon … mix that in with some live music, and I’m in heaven,” Winkfield said with a laugh. She’ll have plenty of opportunities to sample her favorites in Nashville and on trips to New York to visit daughter Ashley. Widowed three years ago, husband Jeffrey Walker’s health battle changed how she approaches patients and underscored the urgency of her work. “I am honored to have a national platform that helps bring awareness to the issues and, more important, engages the community to strategize on ways to collaborate to end inequities in health and healthcare,” Winkfield said. “The only way to make sustainable change is together.”
DEVELOPING NEW MEDICINES FOR THE FUTURE
The Next Generation of Health Tech HCA, Google Partnership Leading the Way on Mobility Innovation By MELANIE KILGORE-HILL
Today’s technology is saving lives beyond the OR, and HCA Healthcare is leading the way in real-time and mobility innovation. In late May, the hospital company announced a new multiyear strategic partnership with Google Cloud focused on analytics-driven process improvement and digital transformation to provide actionable insights to help improve care. It’s the latest in a line of high-tech investments for the healthcare leader, which operates 186 hospitals and approximately 2,000
sites of care nationwide.
Evolution of Health Tech
“I’ve seen technology move from being a support organization to an integral part of a strategy,” said Marty Paslick, senior vice president and chief information officer for HCA Healthcare. “Clinicians want to find new and better ways to care for patients, and technology offers an Marty Paslick important ingredient.” The partnership between the cloud giant and Nashville-based HCA Health-
care is aimed at building “next generation operational models focused on actionable insights and improved workflows,” according to health system officials. Paslick said it was originally the vision of HCA Healthcare CEO Sam Hazen, who took the reigns in 2019. “He really started to challenge us by asking, ‘How do we create a more real-time decision making organization?’” Paslick said. “While we do process a lot of data in real time, we knew we had opportunities to do so in a more comprehensive, enterprise manner while also providing capabilities that could further assist decision making,” he continued. “We had to take a fresh approach to what kind of tech we had available to us and ask ourselves if better infrastructure or tools would enable us to create a more realtime decision making organization.” Paslick compared the need for realtime decision support in healthcare to traffic apps that alert and reroute drivers miles before they approach a traffic jam. “Decision making can always be improved upon whether it is the depth of information or the speed in which it is delivered. We had to ask ourselves, ‘Could we create that type of transformation in healthcare?’ That had us reevaluate our infrastructure and our tools. We
knew we could do better.” Ultimately, it was Google that offered HCA Healthcare leaders the infrastructure to modernize data management in a highly secure way and help caregivers make the most informed decisions possible. “We certainly want clinicians to leverage their tremendous knowledge and experience but also consider things we might be able to share to help enhance their own abilities,” Paslick said.
The COVID-19 Factor
Real-time results proved especially critical during the peak of COVID-19, which redefined tech expectations for patients and staff, alike. HCA Healthcare providers went from 3,500 annual telehealth visits pre-pandemic to more than 1 million in 2020, creating a new demand for both virtual appointments and digital communication. “How do you create a relationship that provides convenience, whether scheduling an appointment or updating a family on a surgery, and how do we create dialogue with patients on an ongoing basis?” Paslick asked. “Healthcare is really ripe to take digital patient experiences to a new level.”
Mobility in 2021
To that end, HCA Healthcare is leading the way through mobility, connecting staff and providers through 90,000 mobile devices system wide. “We can build all the great analytics and insights we want, but without an effective mobility footprint, how do we deliver actionable insights?” Paslick asked. “Healthcare possesses one of the most mobile workforces in the world and having workflows that depend on a desktop seems counterintuitive.” Five years ago, HCA Healthcare piloted a secure communications platform from Mobile Heartbeat – technology that allowed nurses and other caregivers to securely communicate with each other. It added real meaning to the term “care team.” It was such a success that HCA Healthcare bought the company and anticipates company-wide deployment of Mobile Heartbeat by the end of 2021. “At first it seemed like a ‘nice to have,’ but that mobility footprint is as critical as any other clinical system we have,” Paslick said. “Communication is key, and the ability for our care teams to be well coordinated is foundational.” Boston-based PatientKeeper, a workflow tool for physicians, was a similar success story. Today, the HCA Health(CONTINUED ON PAGE 22)
Fueling the Future of Healthcare Automation DARVIS Delivering AI Innovation By MELANIE KILGORE-HILL
DARVIS might be a new name in Nashville, but the AI tech startup is positioned to become a game changer in the global healthcare space. A 2021 graduate of the Nashville Entrepreneur Center’s Project Healthcare, the company relocated its headquarters from Silicon Valley to Nashville in June, bringing its rapidly growing team to the heart of U.S. healthcare. DARVIS – short for Data Analytic Real-World Visual Intelligence System - is an innovative tech company utilizing augmented intelligence to automate processes in healthcare settings from digitization of clinical objects to live analysis of operational procedures.
Connecting to the NEC
“We discovered the Nashville Entrepreneur Center by accident,” explained Jan Schlueter, DARVIS co-founder and COO. “One of our long-term employees is from Memphis and told that us that Nashville had become a hotspot for healthcare. He suggested we apply for Project HealthJan Schlueter care. We did and then made the decision to move to where we can maximize our business opportunities.” Schlueter said the team was met with open arms by the NEC, who led them through a valuable networking and mentorship process during an otherwise tumultuous year. “We were in the (coronavirus) edition of the program, so it was 100 percent virtual,” said Schlueter, who was part of the NEC’s 20-member cohort
ter things to do. We’re creating value by optimizing processes and operations to create more revenue. AI companies are popping up like mushrooms, which shows there’s a market, but they’re not doing what we do,” he continued. DARVIS synthetically trains optical sensors to identify new protocols in as little as five weeks and customizes training based on each client’s needs. A Crucial Pivot During COVID, that meant DARVIS shares their AI capabilities at an open house celebrating the The company was founded just using a couple thousand health tech company’s move to Nashville. in 2015 as Hashplay, a San real world images to create cess stories with U.S. health systems. Francisco-based virtual reality company. hundreds of thousands of digital images to Working with clients, DARVIS first “We were two German guys trying to train the AI to detect proper mask, cap, identifies operational flows and installs find luck off software development in the gown, gloves, goggles, and other PPE posisensors in strategic locations to create diftioning for checks. The same protocol is U.S.,” Schlueter said. ferent zones. By extracting information being used by DARVIS clients for sterilWhen the virtual reality market from computer vision cameras and AI, ization stations, mail cart monitoring, and didn’t rise as expected, he and DARVIS DARVIS technology utilizes a platform other scenarios where tracking and anoco-founder and CEO Jan-Phillip Mohr that tracks inventory by creating dots on a nymity are desired. were forced to switch gears – a decision map. That means everything from hospi“We’re bringing awareness to hospithat would lead to something even bigger tal beds to sterilization containers can be tals and caretaking facilities to understand as the team switched focus to become a tracked in real time. they can improve operations and autocomputer vision company built to deliver “Many of our future clients don’t mate inventory, which is very easy with solutions to enable patient-centered care know where their things are,” Schlueter us,” Schlueter concluded. while minimizing the rate of healthcaresaid. “Putting a dot on the map for everyacquired infections. thing from beds to IV stands helps give “We had luck and great clients that them situational awareness in real time.” helped us find the right path,” he said. “We Schlueter said their technology is 20 times pivoted from the base of a platform we cremore accurate than Bluetooth or RFID ated years ago. The essence of everything solutions, which typically operate blind, we did in the last six-plus years makes us continued from page 5 and offers clinical staff a 30 percent times unique for what we’re doing today.” savings. “The value is being created by • Ensure staff is not submitting duplisending information to the people who Meeting a Need cate claims. care where things are and need to be Today, the company builds solutions • Make sure all CPT and ICD-10-CM helped by automating,” he explained. to fuel the hospitals of the future. While codes are effective for the date of service “Normally, a nurse pushes a bed out of DARVIS’s first partnerships were hospibeing billed. a patient room and goes to a computer or tal groups in Germany, through Project • Verify there are no missing payer calls someone to move it, but she has betHealthcare, they’re replicating those sucIDs. in 2020. “We participated in a weekly session, which helped us improve on many levels so that after almost a year, we had the final pitch which helped us with potential clients and investors.” While their 3,500-squarefoot Nashville facility opened in June, DARVIS employs a global team of more than 60, with hopes to add another 20 by year’s end.
Key Strategies to Reduce Claim Denials,
• Make sure billing software is utilized to its fullest capabilities. Claim edits should be reviewed to make sure they are current and kept up to date. Consistency, vigilance, and persistence are the keys to success. Clean claims submission and clearing house rejection reports should be monitored daily. The appropriate manager or director should monitor trends and respond proactively to prevent future denials. Make certain that denials are addressed not only by high dollar amounts but by volume, as well. Issues should be corrected in real-time and prior to initial claim submission when possible. Don’t hesitate to escalate your concerns by reaching out to a payer provider representative or a payer supervisor when the situation warrants.
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Embracing Innovation & Change Benefits Us All There’s no question: Nashville reigns as the healthcare capital of the United States. If we embrace innovation, our vibrant city can retain – and expand – its By ERIC THRAILKILL, leading edge. For years, Project Healthcare top names in healthcare have conducted industry-changing work here, while building a harmonious and collaborative community within the sector. To stay competitive, Nashville’s healthcare leaders must recognize the signposts and grow accordingly. While our city boasts some of the nation’s top corporate names in the industry, we are also home to hundreds of smaller, highly innovative healthcare companies working on the next wave of industry-changing solutions. To put it in Music City terms, Nashville’s current healthcare sector is akin to country music royalty. This is the golden moment – the career pinnacle – where the artist must choose. Keep blazing creative trails or fall back on greatest hits? Fortunately for Nashville, our city’s inspired DNA compels us to keep moving forward, exploring new frontiers together. We will not fade into the sunset if we keep expanding our horizons. What does that look like for our healthcare sector? Our team at the Nashville Entrepreneur Center’s Project Healthcare initiative sees firsthand the power in collaboration across sectors within the industry. Much like movable social determinants of health determine roughly 80 percent of length and quality of life according to some studies, Nashville’s healthcare industry’s future will be determined by how much we embrace growth and innovation. We cannot afford to neglect this. My best-case scenario would involve key players recognizing the value of Nashville healthcare innovators and entrepreneurs in telehealth, artificial intelligence and machine learning, virtual care technologies, and community and social services programs – each addressing the industry challenges of cost, access, quality, safety, and equity. This collaboration will contribute to the vibrancy of the sector and those larger institutions directly. Fortunately, many leading companies already see this as part of their corporate strategy. To progress, we must rally together to accelerate these capabilities – combining the knowledge, wisdom and experience of
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industry giants with the exuberance and enthusiasm of cutting edge entrepreneurs. Our entire industry will flourish if we do. As Nashville’s leading healthcare entrepreneurship initiative, Project Healthcare exists to bridge the communities of healthcare business leaders and
entrepreneurs. To those who have built the Nashville healthcare sector as we know it, I offer thanks for your decades of commitment and an invitation: Come join us as we map out our future, together. Just like Music City’s greatest hits are often co-writes, collaboration will pave the
way for healthcare’s brightest future. Healthcare executive Eric Thrailkill is chairman of Project Healthcare, an initiative of the Nashville Entrepreneur Center designed to provide innovators the tools and resources to successfully scale solutions targeting healthcare industry challenges. For more information, go to ec.co.
Women Who Tech Launches Grant Programs to Fund Women-Led Health Startups
In late June, Women Who Tech, one of the largest nonprofit organizations that funds and showcases women-led ventures, launched its first worldwide FemTech and HealthTech Grants Challenge to help close the funding gap for womenled startups and accelerate innovation to address pressing global healthcare issues. To help fund the future of innovation - by women for women - while spurring more cutting-edge advancements, Women Who Tech is deploying capital and resources to FemTech and HealthTech startups working to champion greater
healthcare access on a global scale, bolstering the medical tech ecosystems, and bringing more effective digital health solutions and technologies to market. Five early-stage women-led startups with a focus on FemTech and/or HealthTech will be selected to compete for $20,000 in equity-free grant funding. The W Fund, SteelSky Ventures, Citrine Angels, and others will also be evaluating the startups for further investment. Women-led startups experience persistent and significant barriers raising investment from VC firms. “Only 3
percent of total healthtech funding went to FemTech startups in 2020 - a hugely missed opportunity given that global healthcare spending is predicted to reach over $10 trillion by 2022,” said Allyson Kapin, founder of Women Who Tech. “Within FemTech alone, the market will scale to $1.07 trillion by 2026 – now is not the time for VCs to overlook diverse innovation that’s right in front of them.” Full criteria and submission details can be found on the website at womenwhotech.com. Applications close July 18, 2021, 11:59 p.m. PDT.
Celebrating 75 Years of Service and Supportive Partnerships AIG Retirement Services
Amerigroup of Tennessee
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Ascend Federal Credit Union
Rogers Behavioral Health
CAT Financial Centerstone
Rolling Hills Hospital
Community Health Systems (CHS) CoreCivic Enterprise Solutions HCA Healthcare Jack C. Massey Foundation KidLink Treatment Services Mathis Refrigeration, Inc Mental Health Cooperative Nashville Electric Service Otsuka America
Mental Health America of the MidSouth salutes our Mental Health Champions. These corporations were originally sponsoring a 2020 fundraising event that was cancelled due to the pandemic, and they generously chose to contribute their gifts as a 2021 unrestricted donation. Thank you for supporting MHA’s 75 years of serving Middle Tennesseans!
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Expanding Evidence-Based Care for Dementia, continued from page 1 believe developing Alzheimer’s is a normal part of aging, but we know that’s not the case.” While age is the greatest risk factor, most seniors do not develop Alzheimer’s while approximately 200,000 Americans under age 65 do. Gender and ethnicity also play a role in developing the progressive disease (see Facts & Figures box). Moreno added it’s important for people know and understand the warning signs and to eliminate other health concerns. “You want to make sure your symptoms are getting addressed appropriately,” she said. Moreno pointed to urinary tract infections and thyroid disease as two potential Monica Moreno issues that could cause symptoms that mimic some dementia behaviors.
“Alzheimer’s disease affects every person differently. That’s what makes it really challenging for caregivers,” noted Moreno. She added the new program is designed to educate caregivers on evidence-based best practices around assessment, detection and care planning including medical management, dementia-related behaviors, activities of daily living, supportive environments, transition and coordination of services and other recommendations. “All of that information can prepare
and empower caregivers to be better prepared for the future,” pointed out Moreno. “They’re actually being proactive instead of reactive.” While many individuals with Alzheimer’s still live in the community, care needs do increase as the disease progresses. “Statistically, about 48 percent of nursing home residents have some form of dementia, and about 42 percent residing in assisted living have Alzheimer’s or another form of dementia,” said Moreno. It’s particularly important in longterm care settings where those providing care aren’t intimately familiar with someone’s history to make an effort to learn about the person as an individual. “The practice recommendations are grounded in person-centered care,” Moreno stated. “The diagnosis is only part of who they are … it’s not who they are.” Personal preferences and life experiences should shape approaches. Moreno cited an example of a resident who unlaced her shoes and tied the closet door shut each day. If caregivers touched her closet, she became extremely agitated. As it turns out, the woman had been forced to flee with the clothes on her back earlier in life. That experience impacted how she felt about her possessions. “She didn’t want them to even take clothes to the laundry, but it would not be serving her to allow her to wear soiled clothes,” Moreno recalled. “So, they devised a strategy to get her clothes while she was in an activity and get the clean clothes back before she even knew they were gone.” A simple accommodation, it made a
big difference in the woman’s quality of life.
Creating the Program
“The training is reflective of the practice recommendations. While these recommendations were peer reviewed and evidence based, which was critically important, it wouldn’t move the needle if they just sat on a shelf,” Moreno said of the impetus to disseminate the information. “There’s really a larger footprint we’re trying to create.” The goal, she continued, was to access professionals across the full array of care settings – nursing homes, assisted living, home care, home health, adult daycare and hospice. At the end of 2020, the Alzheimer’s Association debuted the new online training, which has six modules and is self-paced. Once completed, the essentiALZ Exam® tests the individual’s knowledge with a 45-question exam. Moreno said a score of 90 percent or higher results in a two-year certification. Individuals who wish to become certified can access the program and exam for less than $60. There are also packages for providers committed to training staff. And, Moreno continued, the association has a curriculum review program that compares an organization’s training program to the practice recommendations with feedback on how to address gaps in care. “It’s another channel to make sure direct care works have access to content that is reflective of these evidence-based practices,” she concluded.
FDA Approves Controversial Alzheimer’s Drug On June 7, the Food & Drug Administration approved Aduhelm (aducanumab) to treat Alzheimer’s patients, making it the first new drug approval for a disease impacting more than six million Americans in almost 20 years. While the Alzheimer’s Association strongly supported FDA approval, citing a 22 percent reduction in cognitive and functional decline in clinical trials, the drug by Biogen Inc. was approved without the recommendation of the Peripheral and Central Nervous System Drugs Advisory Committee. By mid-June, three members of the advisory panel had resigned in response to the controversial approval. In an article outlining the FDA’s process, Patrizia Cavazzoni, MD, director of the FDA Center for Drug Evaluation and Research, noted Aduhelm’s late-stage development program consisted of two phase 3 clinical trials where one study met the primary endpoint in showing reduction in clinical decline but the second trial did not meet that endpoint. “At the end of the day, we followed 20
our usual course of action when making regulatory decisions in situations where the data are not straightforward,” Cavazzoni wrote. “We ultimately decided to use the Accelerated Approval pathway — a pathway intended to provide earlier access to potentially valuable therapies for patients with serious diseases where there is an unmet need, and where there is an expectation of clinical benefit despite some residual uncertainty regarding that benefit. In determining that the application met the requirements for Accelerated Approval, the Agency concluded that the benefits of Aduhelm for patients with Alzheimer’s disease outweighed the risks of the therapy.”
In response to the uproar, the Alzheimer’s Association reaffirmed their support, noting their research experts and advisors are deeply familiar with the science that led to the approval and agreed with the decision. The organization also called on the confirmatory trial that was part of the approval process to begin promptly. The statement further reads: “Our focus has and will continue to be access to this treatment for all likely to benefit. Approval is the fundamental first step to access. The first drug in a category invigorates the field, increases investments in new treatments and encourages greater innovation. “Following approval, the manufacturer, Biogen, announced their intention to price Aduhelm at $56,000 per year. This price is simply unacceptable. For many, this price will pose an insurmountable barrier to access, it complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity. We call on Biogen to change this price.”
The Latest Facts & Figures Alzheimer’s Disease Facts and Figures, an annual report released by the Alzheimer›s Association, reveals the burden of Alzheimer›s and dementia on individuals, caregivers, government and the nation›s healthcare system. The 2021 publication reports: Prevalence: An estimated 6.2 million Americans age 65 and older (11.3 percent, or 1:9) are living with Alzheimer’s today. That number is projected to hit 12.7 million by 2050. Risk: Women and people of color are disproportionately affected. Almost two-thirds of Americans with Alzheimer’s are women. Older Black Americans are about twice as likely and older Hispanic Americans about 1.5 times as likely to have Alzheimer’s or other dementias as older White Americans. Disparities: Despite increased risk for Alzheimer’s and other dementias, Black and Hispanic Americans are less likely to be diagnosed than White Americans. Half or more dementia caregivers – 63 percent of Native Americans, 61 percent of Black Americans, 56 percent of Hispanic Americans and 47 percent of Asian Americans – said they have faced discrimination while trying to navigate healthcare settings for their care recipient. People of color want healthcare providers who understand their unique experiences and backgrounds by fewer than 3 in 5 believe they have access to culturally competent providers. Mortality: One in three seniors dies with Alzheimer’s or another dementia. Between 2000 and 2019, deaths from heart disease decreased 7.3 percent. Deaths from Alzheimer’s have increased 145 percent. On top of that, just during the COVID-19 pandemic, Alzheimer’s and dementia deaths have increased 16 percent in the U.S. Cost: In 2021, Alzheimer’s and other dementias are projected to cost the nation $355 billion, including a combined $239 billion in Medicare and Medicaid payments. Without a treatment to slow, stop or prevent the disease, the figure is projected to rise to more than $1.1 trillion by 2050. Caregivers: More than 11 million Americans provide unpaid care for people with Alzheimer’s and other dementias. In fact, 83 percent of the help provided to older adults in the U.S. comes from family members, friends or other unpaid caregivers with nearly half of that group providing help to someone to someone living with Alzheimer’s or another dementia. Last year, those caregivers provided an estimated 15.3 billion hours of uncompensated care valued at nearly $257 billion.
NOW IN NASHVILLE
VUMC Researchers Discover Role of Protein Linked to Neurodegenerative Diseases By MELANIE KILGORE-HILL
Vanderbilt researchers are making headway in the fight against amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases. Vanderbilt researchers have discovered a protein implicated in conditions like ALS prevents the activation of an innate immune response that leads to cell death. The protein, called TDP-43, regulates the accumulation of double-stranded RNA — genetic material found in both pathogens and in our own cells. The findings, published in the journal Cell Reports, reveal an intricate relationship between innate immune responses and control of gene expression, said John Karijolich, PhD, associate professor of Pathology, Microbiology and Immunology. The discovery was led by graduate research assistant William Dunker and authors Xiang Ye, PhD; Yang Zhao, PhD; Lanxi Liu and Antiana Richardson.
“I was talking to John a year or two before this paper was published, throwing out new ideas, and started to look at how RNA binding proteins affect interferon responses,” said Dunker, who received his bachelor of science in biochemistry from the University of Minnesota. “I was targeting several RNA binding proteins by knocking down and depleting them and focused on TDP-43 because of its role in ALS and other diseases.” Interferons are a group of signaling proteins made and released by host cells in response to the presence of viruses. TDP-43 is an essential RNA binding protein taking on several roles in the cell. Karijolich said cells can discriminate what should and shouldn’t be present (i.e. an infection), and that double-stranded RNA is a sign there’s something wrong in that cell. According to a Vanderbilt release, TDP-43 is essential for cell viability (without it, cells die). The researchers found that reducing TDP-43 levels resulted in the accumulation of doublestranded RNA, activation of immune signaling pathways, and robust interferon production. Investigators pursued the idea that RNA binding proteins might act as controls to prevent the accumulation of “immunostimulatory” double-stranded RNA. They identified a collection of potential regulatory proteins and focused on TDP-43 because of its connection to neurological diseases such as ALS and frontotemporal lobar dementia (FTLD).
Karijolich said some patients with
ALS and FTLD have elevated levels of interferon in their cerebrospinal fluid, supporting a link between TDP-43, immune pathway activation and neurological dysfunction. Dunker said there’s evidence that inherently dangerous cellular RNAs are produced all the time, but through different mechanisms. “This paper looks at preventing immune responses and viewing gene expression as a double-edged sword with both good and bad aspects,” he explained, noting significant findings surrounding double-stranded RNA in the past few years. Dunker’s next step is to look at TDP-43’s potentially broader role as a recruiter for various mechanisms of cell death, including possible therapeutic uses. “We want to start targeting pathways to inactivate and prevent accumulation of interferons to prevent disease,” said Karijolich, whose lab has studied double-stranded RNA receptors since 2016. “There might be cases where you want to activate it or turn the pathway off, so we’re understanding what controls turning the pathway on or off. It’s become obvious that the fundamental gene expression processes can activate the immune system, which is what led to Will’s work digging into individual factors. It’s helped bridge our thinking about cancer-causing issues and disease like ALS.” Karijolich continued, saying the discovery’s significance to the greater healthcare community could mean more precise targeting of cells aimed at controlling the body’s immune response. Dunker, who will graduate late 2021, also is leading a study on more effective treatment of herpes virus infections.
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Hope for Parkinson’s Patients Another VUMC paper released last year in Neurology represented the world’s first study of deep brain stimulation, or DBS, for early stage Parkinson’s, defined as within four years of disease onset. The study found a pair of ultra-thin electrodes surgically implanted deep into the brain might slow the progression of Parkinson’s disease, according to five-year outcomes from a 30-patient randomized clinical trial conducted by investigators at Vanderbilt University Medical Center. David Charles, MD; Mallory Hacker, PhD; and colleagues are studying how deep brain stimulation might help slow tremor progression in early-stage Parkinson’s disease patients.
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The Next Generation of Health Tech, continued from page 17
care-owned company now helps 12,000 providers care for 250,000 patients a month through its mobility capabilities. A third mobile app, MyHealthONE, provides more than 3.5 million account holders appointment reminders, clinical data, class information and other actionable insights.
Leap of Faith
While few providers are positioned to purchase their own tech companies, Paslick said the questions leaders should be asking are the same. “It doesn’t matter the size of the entity, it all comes down to the value you derive from an investment,” he explained. “You have to weigh the value of an opportunity. Moving into the mobile world required a small leap of faith we knew we had to take. The results have exceeded our expectations.”
16th Annual SCALE Returns Live to Music City, continued from page 8
bers include internationally known keynote speakers Mitchell Brin, MD, a respected botulinum toxin research expert; facial plastic surgeon Stephen Dayan, MD, discussing the psychosocial aspect of cosmetic surgery; Botox pioneer Jean Carruthers, MD, FRCSC; and astronaut Rhea Seddon, MD, one of the first six women accepted by NASA. The former astronaut and veteran of three space shuttle flights is a national speaker and award-winning author. “We’re continually growing and offering attendees a relaxed, fun atmosphere with easy accessibility to the world’s top experts,” Biesman said. “Everyone has the opportunity to intermingle, so it’s not like a society meeting where the faculty and attendees are so busy running to different buildings with a packed agenda that they barely have time to breathe.”
The event will include more than 140 exhibitors and sponsors. A handful of speakers will also offer virtual lectures, and the entire event will be available on demand for 90 days. SCALE organizers have continued their flexible registration fees for 2021, with residents and fellows receiving free admission. Office staff can attend for half price, and non-physician providers receive a discount, as well. A significant discount also is available for virtual only attendees. Registration information is available at scalemusiccity.com. “SCALE is a nice mix of great academics and exposure to top quality faculty, which have been carefully selected,” Biesman said. “For the investment I don’t think you’ll find a better return in any meeting anywhere.” 22
Vibativ® Shown to Help Treat Secondary Bacterial Infection in COVID-19 Patients In late June, Nashville-based Cumberland Pharmaceuticals Inc. released a series of case reports showcasing the effectiveness of Vibativ® (telavancin) in treating secondary bacterial infections in COVID-19 patients – particularly those with other significant health problems, such as obesity, diabetes and heart disease. Joseph Reilly, PharmD, a clinical pharmacist specialist for infectious disease and critical care at AtlantiCare Regional Medical Center in Pomona, N.J., provided two of the COVID-19 patient cases for the dossier. Both patients had underlying health conditions – one presented with MSSA hospital-acquired bacterial pneumonia (HABP) and the other with MRSA ventilatorassociated bacterial pneumonia (VABP). “In these patients, bacterial pneumonia developed and likely contributed to their failure to improve clinically,” said Reilly. “Within 48 hours of switching antibiotic therapy to telavancin, blood cultures were clear of MSSA and MRSA.” Vibativ is a patented, FDA-approved injectable anti-infective for the treatment of certain serious bacterial infections including HABP and VABP that can result from COVID-19, influenza and other infections. Vibativ addresses a range of Gram-positive bacterial pathogens, including those that are considered difficult-to-treat and multidrug-resistant.
Richardson Tapped as Ardent COO
Ardent Health Services has appointed Terika Richardson to the position of chief operating officer. In her new role, she will oversee the operations of Ardent’s 30 hospitals and more than 200 sites of care across six states. Richardson most recently served as president of Advocate Aurora Health’s Central Chicagoland Patient Service Area where she oversaw Terika Richardson the operations and strategic growth of their hospitals, clinics and ambulatory operations. Prior to joining Advocate Aurora in 2016, she was chief executive officer of Retreat Doctors’ Hospital in Richmond, Va. She also held various leadership roles for HCA and Northwell Health. Richardson earned both an undergraduate degree in biopsychology and cognitive science and a master’s degree in public health from the University of Michigan. A fellow in the American College of Healthcare Executives, she serves on the board of directors for the American Hospital Association’s Innovation Committee and Institute for Diversity and Health Equity.
Council Announces Board The Nashville Health Care Council recently announced the appointment of the organization’s 2021-22 board of directors, effective July 1. David Dill, president and CEO of LifePoint Health, has begun a two-year term as board chair. “This is a transformational time in healthcare when meaningful colDavid Dill laboration is driving the development of exciting new ideas and opportunities,” said Dill. “I look forward to each of our talented board members bringing their leadership, insight and expertise to the table as we strive to move our industry forward and make a difference together.” Several new members were appointed for the 2021-22 year: Andrea Cleeton, LifePoint Health (Leadership Health Care Board Chair); Eric Evans, Surgery Partners; Ray Guzman, SwitchPoint Ventures; James E.K. Hildreth, MD, Meharry Medical College; Lynn Shapiro Snyder, Epstein Becker & Green; Maggie Spalding, Lockton Companies; Herman Williams, MD, BDO USA; and Andrea Willis, MD, BlueCross BlueShield of Tennessee. The complete list of board members is available online at NashvilleMedicalNews.com.
Centerstone Promotes Two, Hires One Centerstone has announced the promotion of two clinicians to the executive leadership team for the organization’s regional operations in Tennessee, Georgia and North Carolina. Centerstone Military Services also announced a new chief executive officer to lead that division. Matt Hardy, PsyD, has been named chief operating officer. Previously a regional vice president, Hardy joined Centerstone in 2000 as a therapist, specializing in the treatment of adolescents and adults with severe and persistent mental illness. Hardy received his Dr. Matt Hardy doctorate in psychology from Wheaton College and is a licensed clinical psychologist. Additionally, he is a critical incident responder and also helped launch three Steven A. Cohen Military Family Clinics at Centerstone. Brad Nunn, PhD, has been promoted to chief clinical quality officer. Previously vice president of quality improvement, Nunn joined Centerstone in 1987 and has helped establish both research and data analytics functions at the organization. Nunn received his doc- Dr. Brad Nunn torate in clinical psychology from Auburn University and has been a licensed clinical psychologist in Tennessee since 1988. (continued on page 23)
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More Grand Rounds Online Details on these and other announcements online at NashvilleMedicalNews.com
GRAND ROUNDS Blas Villalobos, DSW, a veteran of the U.S. Marine Corps, comes to Centerstone with more than a decade of specialized experience working with veterans and the military community, most recently serving as the director of Veterans Affairs for Chapman University in Dr. Blas Villalobos Orange, Calif. Villalobos holds doctorate and master’s degrees in social work from the University of Southern California, as well as a bachelor’s degree in psychology from California State University – Long Beach.
recipients of the 2021 Burroughs Wellcome Fund (BWF) Career Award for Medical Scientists. The highly competitive program provides $700,000 over five years to physiDr. Celestine cian-scientists who are Wanjalla committed to academic careers as they transition from fellowship and postdoctoral positions to faculty service. Cha’s award recognizes her research on sexual dimorphism in diabetes, while Wanjalla was recognized for her studies of the long-term immunologic effects of aging with HIV.
Let’s Give Them Something to Talk About! Awards, Honors, Achievements
The Wellness Council of America (WELCOA) has announced Nashvillebased Wellview is a 2021 Well-Being Trailblazer Award recipient for their proactive, population care solution that uses behavioral data to connect employees to highest-value health resources in a hyperpersonalized, simple, and cost-sustainable way. Two physician-scientist Instructors in Medicine at Vanderbilt University Medical Center – Jeeyeon Cha, MD, PhD, and Celestine Wanjalla, MD, PhD – are among 12 Dr. Jeeyeon Cha
Monroe Carell Jr. Children’s Hospital at Vanderbilt was recently ranked No. 1 pediatric hospital in Tennessee and the Southeast by U.S. News & World Report. In the 2021-22 report released last month, Children’s Hospital again achieved a maximum 10 out of 10 nationally ranked pediatric specialty programs, making it one of only 22 pediatric hospitals in the nation to rank in all 10 specialties, and the only one
in Tennessee. Pediatric Urology continued to be ranked in the top 10, earning a spot at No. 8. Urology also ranked first in the Southeast Region. The other ranked specialties are: Cancer (21); Cardiology and Heart Surgery (34); Diabetes & Endocrinology (32); Gastroenterology and GI Surgery (18); Neonatology (17) Nephrology (42); Neurology & Neurosurgery (28); Orthopedics (39); and Pulmonology (17). The Nashville hospital shared first place for the region with Children’s Healthcare of Atlanta. Williamson Medical Center recently received the 2021 Women’s Choice Award® as one of America’s 100 Best Hospitals for Patient Experience. Sumner Wound Care, a department of Sumner Regional Medical Center, has again been recognized as a recipient of the Center of Distinction award by Healogics®, the nation’s largest provider of advanced wound care services. Stacie B. Dusetzina, PhD, associate professor of Health Policy and Ingram Associate Professor of Cancer Research at Vanderbilt University School of Medicine has been appointed to a three-year term on the influential 17-member Medicare Payment Advisory ComDr. Stacie B. Dusetzina mission (MedPAC).
AIHM Scholarships for October Session The Academy of Integrative Health and Medicine (AIHM) Interprofessional Fellowship in Integrative Health & Medicine, a 1000-hour hybrid program for clinicians who aim to become leaders in integrative health and medicine, has expanded its program and is accepting applications for October 2021.Scholarships are available on a limited first come, first served basis in several areas including: licensed providers working with the underserved; allied healthcare professionals; and licensed providers from and/or working with BIPOC communities. For more details or to apply, go online to: aihm.org/ fellowship.
LifePoint Health to Acquire Kindred In late June, Brentwood-based LifePoint Health entered into a definitive agreement with Kindred Healthcare to acquire the Louisville-based specialty hospital company. In combination, the company will create a leading community healthcare platform with a full array of complementary services across the healthcare continuum, standardized bedside care, opportunities to develop and expand critical behavioral health services across the country, and an investment of $1.5 billion over the next three years to improve care in the communities the combined company will serve.
Want to learn more about telehealth? The South Central Telehealth Resource Center (SCTRC) provides telehealth education and assistance to healthcare providers in Arkansas, Mississippi and Tennessee. The SCTRC website, LearnTelehealth.org, focuses on telehealth media and education, offering a range of items from podcasts, webinars, course modules, resources, telehealth training, and so much more. Join us for our monthly webinar, “Telehealth 101: The Easy Basics of Telehealth & Telemedicine” to get started on your telehealth journey! Register at UAMS.info/Telehealth101. Proud to be part of the National Consortium of Telehealth Resource Centers.
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