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PHYSICIAN SPOTLIGHT PAGE 2
Kevin Billups, MD ON ROUNDS
Moving at Light Speed Energy-based Procedures a Game Changer Aesthetic medicine is literally evolving at light speed, with energybased systems leading the way ... 3
Join Us to Celebrate Women to Watch 2017 Last month, we shared feature profiles on the 10 incredible industry executives selected for the Women to Watch Class of 2017 ... 7
Plays Well with Others
Healthcare Moves Closer, Continues Quest for Interoperability By CINDY SANDERS
The Healthcare Information and Management Systems Society is keenly focused on improving health and the business of healthcare through the application of information technology. To accomplish that, the global non-profit organization recognizes the very real need to improve interoperability, which is even more crucial as the United
Six Industry Luminaries Chosen for the Third Class
ONLINE: NASHVILLE MEDICAL NEWS.COM
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The New Face of Aesthetic Medicine
Health Care Hall of Fame Announces 2017 Inductees
In May, officials with the Tennessee Health Care Hall of Fame unveiled the six honorees selected for 2017 induction. The luminaries in this third class will be joining the 14 previous industry pioneers inducted since the Hall of Fame’s founding in 2015 ... 12
States moves to a value-based system that follows the patient across the continuum of care. Perhaps it shouldn’t be surprising that over the last few decades, the historically siloed healthcare industry has embraced numerous innovative programs and platforms designed to improve quality, outcomes and efficiency … without giving much forethought to how
More Options Mean Higher Standards of Care for Surgeons By MELANIE KILGORE-HILL
The trendy nature of aesthetic medicine poses a number of challenges, making it imperative for patients to perform due diligence to ensure the best care.
“One of the challenges in aesthetics is the fact that there really is no formal outcome analysis or quality assurance of the ever-growing number of procedures and services offered,” said oculoplastic surgeon Brian Biesman, MD, FACS. “Some of
Dr. Brian Biesman
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Pioneering Sexual Health
Urologist Kevin Billups Redefining Men’s Health Programs By MELANIE KILGORE-HILL Getting men to open up about their health is an age-old struggle, but urologist Kevin Billups, MD, is trying to change that. The Nashville newcomer was named executive director of Men’s Health at Meharry Medical College in 2016, bringing with him more than two decades of experience in sexual medicine.
The Road to Nashville
A New Orleans native who grew up in Baltimore, Billups’ scientific interest was peaked early thanks to the influence of two family friends who were physicians. Those connections led to summers of lab work at the nearby National Institutes of Health. After receiving his undergraduate degree at Harvard University, Billups attended medical school at Johns Hopkins University, where he became the first African American to complete a urology residency. He then undertook fellowship training in sexual medicine, male infertility and vascular biology at the University of Virginia – Charlottesville where he was honored as a Robert Woods Johnson Foundation and American Foundation for Urologic Disease scholar. Before coming to Meharry, Billups served as the director of the Men’s Health & Vitality Program and associate professor
of Urology and Medicine at John Hopkins since July 2012. He previously served as an associate professor in the Department of Urology at the University of Minnesota and as a staff urologist for the VA Center in Minneapolis.
Identifying a Need
As a medical student, his interest in urology grew out of a desire to perform surgery while still working closely with patients. Later, as a young urologist at the
University of Minnesota, Billups recognized a tremendous need for male infertility and sexual medicine specialists. The problem was no one wanted to talk about it. “No one wanted to do an erectile dysfunction clinic 20-plus years ago,” Billups said of the pre-Viagra urology world. “I found it interesting in my clinical observation that I was seeing a lot of men in their 40s and 50s coming in with ED after a heart attack. I asked when they started noticing symptoms, and it was usually three to six years before heart problems developed. I heard that story over and over and knew there had to be more going on there.” Billups started seeking out the opinions of cardiologists at the University of Minnesota to learn about the vascular connection between ED and cardiac health. He also sought counsel on how to increase health dialogue among men – especially African American men, who have the worst health assessment of any race, gender or ethnic group in the country. He then started working alongside cardiologists to perform full cardio evaluations and nutrition consults on patients. “Sexual medicine problems don’t occur in isolation, and I wanted to learn more about the underlying cause,” he said.
The Little Blue Pill
Billup’s sexual medicine practice took
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a turn in 1998 when the FDA approved Viagra for the treatment of ED. “When pills came out, it really opened the door,” said Billups, whose practice was suddenly flooded with patients seeking a wonder pill. While many doctors were quick to write a prescription and send men on their way, Billups knew that each patient presented an opportunity for conversations about cardiac health. “All of my clinical research had revolved around ED and low testosterone but didn’t explain the appropriate workup once you get a patient in your office,” he said. “How do you link him into the medical system?” The majority of his patients went on to receive follow-up care from a primary care provider or cardiologist, and many also suffered from pre-diabetes or sleep disorders, which can increase cardiac risks. “Men are much more willing to talk about ED now, but there’s still not much connection being made between that and overall health,” he said.
Advice to Providers
Billups said PCPs are sometimes uncomfortable discussing sexual health with patients, although treating sexual health as an extension of a man’s cardiovascular system could save his life. If a man has ED between the ages of 40-49, his risk of having a heart attack or stroke is 50 times greater over the next decade than a man without ED. The risk is five times greater for a patient between ages 50-59. “If you have a younger man with ED in your office, you really need to be asking questions,” Billups said.
Coming to Meharry
More than two decades into his sexual health career, Billups reached out to congratulate his former Harvard and Johns Hopkins classmate James Hildreth, MD, for being appointed president of Meharry. That conversation led to ongoing discussions of a new vision for men’s health with Billups sharing his desire to start an innovative program based on his 25 years of research. Since his August 2016 appointment, Billups has been working with healthcare providers in the Nashville community and at Meharry to discuss a different kind of men’s health initiative, which he plans to launch by fall 2017. “All men are an at-risk population, and we’re the population that’s dragging down the curve by not taking care of ourselves,” Billups said. “We want to know how to engage men to become more proactive within the healthcare system. I believe that erectile dysfunction – as a good barometer of overall health and an early symptom of developing problems – can help us get there.”
Moving at Light Speed Energy-Based Procedures a Game Changer By MELANIE KILGORE-HILL
Aesthetic medicine is literally evolving at light speed, with energy-based systems leading the way. Lasers, ultrasound, microwaves and radio frequency are now treatment methods of choice for many dermatologists including Michael Gold, MD, FAAD, of Gold Skincare in Nashville.
More Choices in a New Era
“A lot of these are Dr. Michael Gold improvements on technology we’ve had for a long time,” said Gold, who’s witnessed a laser market revolution during his 30-year career. “Our world has changed, and it’s not
that we suddenly have new technology but that we have better technology in the same categories than we had a few years back.” As an early adapter to technology, Gold has long been involved in clinical trials. “We do a lot of testing on all these devices so we know how they work and can maximize their use,” he said. “We also get to teach a lot of people.”
The latest laser making headlines is the Syneron Candela PicoWay, considered the next generation laser light for tattoo removal and de-pigmentation (see far right). A service that used to take 10-15 visits is now accomplished in half the time thanks to the ability to deliver concentrated energy to the targeted ink in a faster, shorter burst measured in picoseconds – one trillionth of a second.
SCALE in Music City Each May, medical professionals from around the world gather in Nashville for the annual Symposium for Cosmetic Advances & Laser Education (SCALE). Presented by the Tennessee Society for Laser Medicine & Surgery, SCALE is co-chaired by founders Brian Biesman, MD, and TSLMS President Michael Gold, MD. “There’s a number of non-core physicians in the field, and everyone has the responsibility to practice at the highest possible level,” said Gold. “We started the meeting for the concept of teaching people who use cosmetic procedures to make sure they keep patient safety at the forefront.” More than 600 guests and 100 vendors attended the three-day meeting at the Music City Center.
Radio frequency devices offer a more sophisticated skin tightening option and are often used with needles for treatment of acne scars. Ultrasound innovation like Ultherapy lifts skin on the face and neck through tiny holes under the skin, “That’s often a one treatment procedure, and we see really nice results,” Gold said. Another device, the UltraShape Power, is especially useful for the tightening of love handles and thighs and uses ultrasound to melt fat. Gold also eliminates fat by freezing it, a procedure called CoolSculpting. “New hand pieces and software make treatments faster and allow for fat to be removed in half the time,” Gold said.
Disappearing Ink PicoWay Technology Changes Tattoo Removal With 11 locations in the United States and more than 18,000 treatments completed, Invisible Ink Tattoo Removers became the first national tattoo provider to feature the revolutionary color-erasing 3-Wavelength PicoWay technology. Last fall, the company opened a center in Nashville located in Sieveking Plastic Surgery. The technology is able to erase tattoo colors from all skin types and typically takes about half the number treatment sessions as more traditional tattoo removal. Each session takes only a few minutes to complete.
A Skincare Pioneer
A medical dermatology pioneer, Gold was among the first in his field to use silicone gel sheeting for scars and helped launch the first pulse light hair removal device in the industry. He later became one of the first three dermatologists to use photodynamic therapy for actinic keratosis and cosmetic concerns in which chemicals are used to help destroy pre-skin cancers. “I’ve been very lucky to have been in the right place at the right time,” said Gold, who maintains seven academic appointments both domestically and abroad. “We’re very blessed here in Nashville to have the best healthcare.”
Client after 8 treatments
The 3-Wavelength PicoWay system works in a broader spectrum and utilizes titanium sapphire to deliver ultra-short pulses of energy to shatter and destroy ink particles without thermal injury to the surrounding skin. Operating in picoseconds, the system emits more powerful bursts of energy at shorter intervals than traditional lasers.
The Doctors’ Doctor
Dr. Ming Wang has Performed Surgeries on More Than 4,000 Doctors Dr. Ming Wang, Harvard & MIT (MD, magna cum laude), PhD (laser physics), has published eight textbooks and a paper in the world renowned journal Nature. He is the only surgeon in the state performing: • 3D SMILE & 3D LASIK (18+) • 3D Kamra & 3D Raindrop (45+) • 3D Forever Young Lens (50+) • 3D Laser Cataract Surgery (60+)
Whether referring a patient for care or sharpening your own visual acuity, rely on Dr. Wang’s proven expertise.
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The New Face of Aesthetic Medicine, continued from page 1 these procedures may be safe and highly effective, while others may or may not have enough science behind them to support them.” Biesman’s Nashville practice specializes in cosmetic and reconstructive eyelid and facial surgery and minimally invasive rejuvenation techniques including injectables (neuromodulators and fillers) and technology-based solutions (laser skin resurfacing, non-invasive skin tightening, body contouring, and related techniques), as well as medical grade skin care. Biesman also serves as a clinical assistant professor at Vanderbilt University Medical Center, where he holds appointments in the divisions of Ophthalmology, Dermatology and Otolaryngology-Head and Neck Surgery.
Among the more meaningful advances in cosmetic procedures is the evolution of injectable fillers. “Injectable fillers are an increasingly common request from patients, and we’re getting more and more products on the market,” Biesman said. “We’ve also enhanced our understanding of when, why, and how to better use them, and we have a broadened portfolio of products from which to choose.” Biesman said the growing market reflects a better understanding of goals surgeons want to accomplish for their patients. Injectables have come a long way
since the early days of bovine collagen, the first injectable soft tissue filler approved for use in the United States. “Back then, the goal was to treat wrinkles and lines, but over time we realized there are so many other factors involved,” Biesman said. “Aging changes are manifest in a number of ways, including changes to the skin, soft tissue and skeletal systems, as well. If we’re going to help our patients achieve the best outcomes, we have to think beyond wrinkles and lines.”
Revolumization & Facial Rejuvenation
That dialogue led to the popularity of revolumization, which remains a mainstay of rejuvenation. However, like treatment of wrinkles and lines, it proved insufficient in most cases to produce best outcomes. “When you look at facial contouring – where the light reflects naturally off the forehead, nose or cheek – revolumization can only be done to a certain point before it looks unnatural,” Biesman explained. “When we assess patients for rejuvenation today, we pay attention to facial contouring such as the relative prominence of the cheeks, forehead, chin and jawline, as well as general volume changes and superficial wrinkles and lines. Some of the most subtle changes are the most important when it comes to facial rejuvenation.”
Less Need for Surgery
Devices are often used alone or in
conjunction with injectables, accomplishing goals that could not previously be achieved noninvasively … if at all. Reduction of fat in the submental region is an example of a goal that previously required a surgical procedure and can now be accomplished non-surgically for some patients using a combination of techniques. “We can now accomplish noninvasive reduction under the neck and can use neuromodulators to deal with muscle,” Biesman said. “We also have non-invasive skin lifting procedures in conjunction with the reduction of unwanted fat. There are a lot of strategies we’re using not just to accomplish a single objective but a bigger framework to help people look more youthful in a natural way.”
Preventative treatments have also become standard. In fact, Biesman regularly sees patients in their 20s and 30s seeking out early treatment of modest lines and wrinkles. Regardless of the procedure, Biesman said managing patient expectations is key. “So much of what we do depends on the management of expectations,” Biesman said. “We want to know what they think this procedure is going to accomplish and ensure we can meet their needs.” Patients often visit a surgeon seeking out a treatment they saw on television or heard about from a friend. But Biesman
said treatments aren’t ‘one size fits all,’ and patients might not be a good candidate for the procedure requested. Biesman said honesty is always the best answer. “I tell them up front if I think their expectations are unrealistic,” he said. “Sometimes the best cases are those we never do because the last thing you want to do is disappoint someone.” He also advises consumers to find an experienced physician who is both knowledgeable and skilled rather than shopping by convenience or price alone. “Bargain basement prices on aesthetic medical care can be associated with a relative lack of knowledge or expertise,” Biesman said. “Achieving best outcomes depends not only on the quality of the device or materials used but on the skill and judgment of the operator.” He concluded, “It takes experience and excellent clinical judgment to determine energy level, treatment end points, and best safety practices. It’s all very complicated, and the commoditization that we see is unfortunate. Aesthetic procedures, like any other surgical procedures, cannot be mastered after taking a weekend course.”
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Meals 4 Health and Healing From Loss Comes Acts of Love By CINDY SANDERS
The Heimerdinger Foundation’s Meals 4 Health and Healing knows good food nourishes more than just the body … it also feeds the soul. In 2011, beloved Tennessee Titans coach Mike Heimerdinger was diagnosed with a rare form of cancer that ultimately claimed his life. During his battle, his wife Kathie recognized how vitally important it was for both of them to eat nutritious meals. Yet, rounds of treatments and appointments … not to mention the stress of just trying to manage each day … made it really difficult to plan, shop for, and prepare healthy meals. “Her experience led her to search for how cancer patients are fed and nourished during treatment,” explained Katharine Ray, executive director of the Heimerdinger Foundation. What she found was a cookbook from the Ceres Community Project of Sebastopol, Calif. Kathie Heimerdinger Katharine Ray learned the program in the Sonoma Valley created meals to nourish the critically ill and to empower teens. After a site visit, she invited the founder of Ceres to come to Nashville to help formulate a similar model to serve residents of Davidson and Williamson counties. “In January of 2013, Kathie and a handful of volunteers prepared and served their first meal to a cancer patient,” said Ray. That first meal was made in the kitchen at Calvary United Methodist Church. Now in its fifth year, the program is still using that
same kitchen, but the volume has increased considerably. “We are currently preparing and serving close to 500 meals every week,” Ray noted. She continued, “It’s amazing how much growth the program has had. By the end of 2016, we were serving more than four times the number served at the end of 2013.” Each week, volunteers create eight dishes per person for about 60 individuals … both cancer patients and their caretakers. Ray said a typical bag would include two to three healthy organic proteins like chicken or salmon, grain proteins including quinoa and millet, organic vegetables and rich, leafy greens. “We prepare, every week, a mineral broth that is rich in vitamins and minerals,” Ray outlined, noting the recipe for the broth and several other nutrient-dense meals are located on the website under the ‘Resources’ tab. “We are patterned after Ceres, and they have done a great deal of research,” she said
of menu selection, adding the organization also follows recommendations from the American Institute of Cancer Research. In addition to use of the kitchen, the church has also allowed the program to establish its own organic garden on the property. “They are an incredible partner, and we’re so appreciative,” Ray said of Calvary UMC and other community partners including Whole Foods, Bloomsbury, Herban Market and Delvin Farms. “Volunteers are really the engine behind this organization,” she continued. With the addition of a volunteer coordinator, Meals 4 Health and Healing reaches out to churches and schools to find willing hands. Ray added, “Word of mouth is getting out about this Nashville treasure.” The mission of the organization is twofold. “We really want to help people who are in crisis who have less access to good, nutritious food,” Ray said of the main goal. The second part of the mission is tied to primary and secondary prevention and a desire to help individuals establish and sustain good eating habits. “We want people to embrace this philosophy that food is medicine,” she noted. “We’re really trying to create change for a healthy diet moving forward.” Meals 4 Health and Healing not only hopes to make a change in those touched by cancer but also to impact and educate the
many young volunteers who work with them to instill lifelong eating habits that promote health. To that end, the program’s garden also serves as a great teaching tool. “It’s that full cycle from seed to table,” Ray said. “The program is really multilevel. We’re teaching the next generation about good nutrition and the beauty of giving back to someone who needs help … probably more help than they’ve ever needed in their life.” The program is open to residents of Williamson or Davidson counties in cancer treatment and their caregivers or family. Meals for the first 12 weeks are free of charge. There is an option to continue receiving meals for weeks 13-24 at a small weekly fee per person. ‘Delivery angels’ pick meals up at the church on Wednesdays and distribute to clients throughout the two counties, and each meal bag also includes a thoughtful note. “Our clients really feel like they are supported by a loving, caring community, said Ray. “We like to think this program supports cancer patients during the acute phase of their diagnosis, but it can change someone’s perspective for life and really make a difference in their survivorship, too.” To volunteer, email volunteer@ hfmeals.org. If you have patients who might be in need of meals, they can email clients@ hfmeals.org. The website also has answers to some of the most frequently asked questions.
R U UNHAPPY WITH YOUR CURRENT Something to Smile About ANSWERING SERVICE? Pinhole Surgical Technique Redefining Receding Gum Treatment By MELANIE KILGORE-HILL
Receding gum lines can damage more than self-esteem, but a procedure now available in Nashville is offering hope to patients suffering from a common dental concern. The Chao Pinhole Surgical Technique is a virtually pain-free, minimally invasive procedure in which gums are repaired in only one day.
Oral surgeon Spencer Haley, DDS, of Tennessee Oral and Maxillofacial Surgery, is one of several Middle Tennessee providers performing the procedure. “People have gum recession from a number of different reasons, and up until now have had to have tissue Dr. Spencer Haley grafts to correct it,” said Haley, noting the time, pain and downnashvillemedicalnews
time associated with traditional grafting surgery. “Pinhole gives us a secondary option for gum recession.”
How Pinhole Works
Training for the Pinhole Surgical Technique is offered only through the procedure’s creator, John Chao, DDS, who perfected the technique in 2006. Chao’s California-based workshops provide training to dentists, periodontists and oral surgeons like Haley. Using a specially created needle-like instrument, providers create a pinhole above the gums and shift the tissue down with very little trauma to the tissue. Tiny collagen strips are then inserted to stabilize the gum flaps, and the tiny pinhole shrinks away by the next day. “I started offering this because my patients were asking for it,” said Haley, who’s been performing the Pinhole Surgical Technique for three years. “It’s a great option and really works.”
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UVA, UVB, Vitamin D & Total Body Screens By CINDY SANDERS
Summer in the South has finally arrived, which means plenty of high temperatures and beaming sunshine. It also means patients need to be reminded of the dangers associated with the sun’s harmful rays. An active member of the American Academy of Dermatology, Lauren Ploch, MD, MEd, FAAD, was raised in New Orleans, received her undergraduate degree and master’s from Vanderbilt University in Nashville, completed her medical degree and residency at Dr. Lauren Ploch Tulane and now practices at the Georgia Dermatology & Skin Cancer Center in Augusta. With a lifetime of living and practicing in the Sun Belt, she shared some insights on Vitamin D deficiencies, tanning, skin cancer, and regular screening.
A spate of research over the past several years has warned of increasing Vitamin D deficiencies worldwide. More recent research, however, has called into question how many individuals are truly deficient, noting the amount of Vitamin
D required varies by individual and that recommended daily allowances are based on the high end of the spectrum. While there are obvious benefits to Vitamin D at the right level to help maintain strong bone health, Ploch said there is another issue with the “sunshine vitamin” that physicians need to address with patients who might think time outdoors without sunscreen is the answer for any deficiency. Noting there are two types of UV rays that reach the earth’s surface – UVA and UVB – she said, “UVB rays are what converts Vitamin D to the active form, but only 5 percent of all UV light that gets to the earth’s surface is UVB.” Ploch continued, “So 95 percent of UV light that reaches earth isn’t doing you any good and is dangerous.” And, she added, “Tanning beds only emit UVA rays.” Echoing the AAD’s position statement on Vitamin D, she said patients who actually are deficient should look to food sources and physician-recommended dosages of supplements if needed. “UV light isn’t an efficient way to get Vitamin D … and, in fact, it’s a risky way to get it.”
“We are seeing incidence rates increasing for melanoma,” said Ploch, who added that some of the rise is probably attributable to increased detection.
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Either way, she noted, almost 10,000 people are predicted to die of melanoma this year. “One American dies of melanoma every hour,” she underscored. Ploch noted, “You’re at an increased risk to develop melanoma if you have a direct family member with melanoma.” She continued, “We don’t know if it’s because of inherited behavior or genetic predisposition … nature vs. nurture.” With an abundance of evidence linking UV rays to skin cancer, Ploch said, “There’s really no good reason to lay out outside or go to a tanning bed.” The Melanoma Research Foundation notes that studies have shown just one blistering sunburn can double an individual’s chances of developing melanoma later in life and that using tanning beds before age 30 increases risk by as much as 75 percent. Recent studies, like one out of the University of Minnesota last year, have suggested indoor tanning through UV light has probably added to the burden of melanoma, particularly among young women. “That’s why we’re pushing for restrictions on tanning beds in young people under 18,” noted Ploch. She added a number of states have begun requiring a parent’s signature before allowing minors access to indoor tanning.
Which of your patients should use sunscreen? According to the AAD, the answer is simple … all of them. As long as the sunscreen offers broadspectrum protection, has an SPF of 30 or higher and is water resistant, the particular type of sunscreen (cream, gel, lotion, spray) is really a matter of personal choice. “I love mineral sunscreens,” said Ploch of zinc oxide and titanium dioxide products. “They rarely cause rashes. They rarely cause allergic reactions.” She added the vision of thick, white zinc oxide paste on the nose is no longer accurate. “A lot of companies are creating micronized particles so the particles are
smaller and not so white. They blend in better,” Ploch said. She added, “I wear zinc oxide on a daily basis, and no one can tell.” Ploch also noted there are companies creating screens that are a mix of mineral and hypoallergenic chemical sunscreens that might also be a good option for patients with sensitive skin.
Ploch is a fan of total body screens. While there are no definitive screening guidelines based on age and frequency, she noted, “I like for patients to come in annually or every-other-year if they have no risk factors.” She added that some patients with a strong family history begin annual screens in their early 20s, and those who have had skin cancer should be checked more frequently. Noting that recent research out of Belgium found lesion-directed exams to have a similar melanoma detection rate as a total body exam, she said that the more thorough head to toe screening is still her preference. “With the total body exam, I almost always find something to watch … to keep my eye on … and about 20 percent of the time, I find something to biopsy that the patient didn’t come in worried about.” Ploch said it’s always preferable for a primary care practitioner to refer a patient to a dermatologist, even for seemingly innocuous lesions. “It’s not a good idea to remove a lesion without a biopsy,” she said, adding the results are sometimes surprising. Whether it’s a matter of primary prevention or referring patients to a specialist to address any dermatologic concerns, Ploch said pediatricians, internists and other primary care providers play an important role in helping their patients take care of the body’s largest organ … their skin. They are also the first line of defense to remind patients to stay safe in the summer sun.
2017 AAD Summer Meeting The American Academy of Dermatology will host their summer meeting in New York City from July 27-30. “Summer meeting attendees will have access to a wide range of medical, pediatric, surgical and cosmetic dermatology topics,” said Jacob Levitt, MD, FAAD, chair of the AAD Scientific Assembly Committee. “In addition to the latest, comprehensive reviews of recently and soon-to-be-released medications for psoriasis and atopic dermatitis, attendees will receive a reminder of the full range of differential diagnoses and therapies at their disposal that they can bring back to their patients.” Levitt noted a number of hot topics would be covered, including information on T-cell therapy for B-cell mediated diseases; the burden of skin disease in the United States; the evidence behind platelet-rich plasma procedures; and the pathophysiology of atopic dermatitis, psoriasis and melanoma and how to use targeted novel therapies to treat patients with these diseases. “Hands-on sessions allow for acquisition of new skills post-residency – especially nail surgery, wound repair, and filler injections,” he added. Early bird discounted registration rates are in effect until 12 p.m. Central on June 21. From that point until July 19, registration is available at the standard rates. After July 19, on-site registration will be required. For more information, go online to aad.org/meetings.
NMGMATen Minute Takeaway Join Us to Celebrate By CARA SANDERS
The second Tuesday of each month, practice managers and healthcare industry service providers gather at KraftCPA headquarters for the monthly Nashville Medical Group Management Association (NMGMA) meeting. During the May luncheon, Jeanne Fisher, CPFA, CFP, MBA, a retirement plan specialist with ARGI Financial Group, spoke about the Department of Labor’s Fiduciary Rule, it’s implementation and implications. The Fiduciary Rule was initially created under the Obama administration and aims to level the playing field among financial professionals who work with retirement plans or provide retirement planning advice and to create a uniform industry standard. The rule raises those who work with retirement plans and products to the level of fiduciary, which means they must meet the legal and ethical standards of that designation to act in the best interest of their clients, explained Fisher. The Department of Labor (DOL) rule came about because of a belief that conflicted advice was widespread and was causing serious harm to IRA investors and those who trusted their advisors to work in their best financial interests even though the advisors weren’t legally bound to do so. “Because of the way that the industry was, it was actually harming people,” Fisher said of
the rationale behind the new rule. She explained conflicted advice is when an advisor accepts back-door payments, commissions or hidden fees to direct an individual toward a specific retirement product that might not be the best one suited to that person’s interests. It raises the stakes from meeting a ‘suitability’ standard to a ‘fiduciary’ one. The basic tenets of the new rule are that anyone providing investment recommendations must now be held to the higher standard and that fiduciaries must provide impartial advice in the client’s best interests, could be held personally liable for advice rendered, and must enter into a contractual agreement with the client acknowledging their fiduciary status. Fisher said the rule comes with a heavy administrative burden. Although originally slated to go into effect on April 10, 2017, the ruling has been delayed until June 9, 2017. However, many companies have already begun the process of overhauling their systems by investing time and money into advisor training, legal fees, disclosure documents and other steps to begin accommodating to the new, stricter regulations. The ultimate goal of the rule is to ensure investors receive the best, most sound advice to meet their specific needs for the future. For information on upcoming NMGMA events or to learn more about the association, go online to nmgma.com.
Women to Watch 2017
Last month, we shared feature profiles on the 10 incredible industry executives selected for the Women to Watch Class of 2017. While their backgrounds and individual expertise varies, they also have much in common. To a person, these women are talented, passionate, intelligent, generous, dedicated, collaborative, and innovative. In short, they are people we want to watch as leaders in their respective fields modeling ways to create a more efficient, effective healthcare system. If you haven’t had a chance to read their stories, yet, we urge you to go online to do so. We also invite you to join us on June 20 as we gather to celebrate this year’s honorees at a breakfast event held at the W.O. Smith School of Music. Individual tickets and tables for the event are available
2017 Women to Watch Breakfast Tuesday, June 20 • 7:30-9:00am W.O. Smith School of Music 1125 Eighth Ave. S. • Nashville 37203 Individual Tickets: $45 Table of 8: $350 Order online at NashvilleMedicalNews. com. Seating is limited. Tickets available, as space permits, through June 14.
for purchase either online at NashvilleMedicalNews.com or by emailing CSanders@ NashvilleMedicalNews.com. This annual event simply wouldn’t be possible without the support of our longtime sponsors Kraft CPAs and the Nashville Health Care Council. We’d also like to thank the W.O. Smith School of Music, Flavor Catering, and Branching Out Floral & Event Design for helping us create a memorable morning to salute this year’s very deserving honorees.
Lucy Carter: KraftCPAs PLLC Jennifer Domm, MD: TriStar Medical Group Children’s Specialists and The Children’s Hospital at TriStar Centennial Amy Johnston Little: UnitedHealthcare Community Plan of Tennessee Lisa Kachnic, MD: Vanderbilt University Medical Center and VanderbiltIngram Cancer Center Linda Marzialo: Gould Turner Group, PC June Patterson: Nashville Health Care Council Nita Wall Shumaker, MD: Tennessee Medical Association & Galen Medical Group Amber Sims: Saint Thomas Health Corina Tracy: Compassus I. Michele Williams, MD: Matthew Walker Comprehensive Health Center
C O N G R AT U L AT I O N S Corina Tracy
Executive Vice President & Chief Operating Officer
2017 Women to Watch Award Recipient nashvillemedicalnews
Center for Medical Interoperability Moves to New HQ In April, the Center for Medical Interoperability opened its new Nashville headquarters and a one-of-a-kind testing and certification lab in the oneC1TY development off of Charlotte Pike. The new facility’s striking interior was designed around the theme of “Follow the Flow of Data.” The center, a 501(c)(3) cooperative research and development lab, was founded by health systems to simplify and advance data sharing. The center’s membership consists of health systems and other provider organizations committed to eliminating current barriers to swift and seamless communication of patient information among medical devices and electronic
health records. “The opening of the headquarters and launch of the lab are enormous steps toward addressing the difficulties that health systems share in getting medical
devices and electronic health records to ‘talk’ to each other,” said Mike Schatzlein, MD, chair of the Center’s board. “All too often,” he continued, “this prevents physicians and other caregivers from having complete information about a patient readily available when they make important treatment decisions.” The new lab serves as a research and development arm for its members to improve interoperability with the center’s technical experts and visiting engineers from industry working together to develop IT architectures, interfaces and specifications that can be consistently deployed by health systems, medical device manufacturers, electronic
health record vendors and others. The lab certifies devices and software that meet the Center for Medical Interoperability’s technical specifications. Clinicians have the ability to explore the impact Dr. Mike Schatzlein of technologies within the Transformation Learning Center at the lab to ensure solutions are safe, useful and satisfying for patients and their care teams. “The lab will help Ed Cantwell bring about a ‘plugand-play’ environment for healthcare in which there is assured interoperability and connectivity inside and outside the hospital,” said Ed Cantwell, president and CEO of the Center for Medical Interoperability.
decades of work and advocacy by the HIT community, Congress included report language in the FY17 Omnibus spending bill to address a prohibition on the unique patient identifier (UPI). The ban, which was put into place in 1998, stemmed from concern over patient privacy. The result, however, has stymied efforts to accurately match patients to their data across different systems and settings of care on a national basis. In a blog post, Carla Smith, MA, FHIMSS, CNM, who serves as executive vice president for HIMSS, noted that over the last 19 years, the UPI language has prohibited the U.S. Department of Health and Human Services from engaging in conversations with the private sector pertaining to the UPI. Over the past two decades, she said, it has become clear that a consistent patient data matching strategy is required across the public and private sectors of healthcare. While the new Omnibus language does not allow HHS to use funds “to promulgate or adopt any final standard providing for the unique health identifier for an individual” without Congressional authorization, it does open the door for HHS to be able to study the issue through the following clarification: “Accordingly, the Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology (ONC) and CMS, to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.” ONC officials have also announced the launch this month of a Patient Matching Algorithm Challenge. The challenge, which includes up to $75,000 in prize money, has a goal of spurring the adoption of performance metrics, reducing duplica-
tive entry, and improving the linkage of critical data. More information is available at PatientMatchingChallenge.com. Additionally, Sensmeier said, the ONC has been working to improve data exchange and usefulness through the Interoperability Standards Advisory (ISA). “ONC has raised the bar on identifying what standards are available in interoperability and what those standards serve,” she explained. Through the website healthit.gov/isa, there is a single public list of the standards and implementation specifications, which are published and open for comment. “It’s a huge step forward,” she said.
Plays Well with Others, continued from page 1 that technology might interact with other entities. In fact, it’s not even unusual to find multiple HIT applications that have trouble communicating under the same roof. Joyce Sensmeier, RN-BC, MS, CPHIMS, FHIMSS, FAAN, who serves as vice president of Informatics for HIMSS, said breaking down those barriers to effectively share and interpret data is a core … albeit complex … focus for HIMSS. “At the foundation of it is the Joyce Sensmeier need for standards and for everyone to be implementing those standards in the right way,” she noted.
Moving the Needle
The HIMSS Innovation Center, headquartered in Cleveland, Ohio, is the centerpiece of the organization’s interoperability efforts. ConCert by HIMSS™ comprehensively tests and certifies electronic health record (EHR) and health information exchange (HIE) vendors. Built off of the findings of the EHR|HIE Workgroup and the IHE USA (Integrating the Healthcare Enterprise USA), the ConCert seal of approval means a product has been proven to be interoperable with other products. Noting HIMSS works closely with IHE, Sensmeier said the annual ‘Connectathon,” which is usually held each January in Cleveland, fosters collaboration among competitors with the mutual goal of improved interoperability. “It’s refreshing to see them working on that in a neutral environment,” she noted of the approximately 500 systems engineers representing 100 organizations who come together to collectively improve data sharing. Sensmeier added yet another barometer of interoperability momentum was on 8
display this past February in Orlando at the Interoperability Showcase. “We had the largest number of participants this past year,” she said, adding, “Vendors have to be able to show interoperability to even participate.” The showcases typically feature about 15 different use case scenarios to provide attendees the opportunity to witness how standards-based transactions could impact care across the continuum by decreasing duplicative entry and enhancing quality and safety. “It really brings a picture of what can be,” Sensmeier said, adding nearly 10,000 attendees came through the showcase in Orlando.
Sensmeier said progress also is visible in the work being done by Regional HIEs. In the San Diego area, where Sensmeier is based, the large hospitals have worked together to enable access to patient data no matter the facility where it originated through the deployment of business agreements. While technology standards have enabled cross-communication at the base, Sensmeier said those business agreements are an equally important part of the overall interoperability equation. The success among health systems has led to such agreements moving into other healthcare sectors including the prison systems, EMS, and VA, Sensmeier noted of the local uptake in her region. She added San Diego isn’t unique and that such collaboration is occurring in pockets across the country. “There’s now an understanding it’s the right thing to do and good business,” she pointed out.
Movement is also happening on a national level. Last month, after nearly two
“The nut to crack is that providers and hospitals need to be requiring interoperability in the systems they purchase,” Sensmeier stressed, adding interoperability should become a foundational part of the procurement process. “If the customers are asking for it, the vendors are more likely to make sure it’s there,” she noted. “I think the will is there,” Sensmeier continued of movement across public and private sectors to address interoperability. “We have the standards now, and we’re pointing people to them.” While the U.S. is still probably several years out from deploying a comprehensive national strategy, Sensmeier said it is encouraging to see more pieces and parts come online. She noted interoperability certification programs are now in place; there is increasing patient demand and expectation that health information travels with the individual; and new provider reimbursement methods require improved connectivity across the continuum of care. In meeting these demands, HIT products and systems should be well on the way to fulfilling the promise of enabling providers to deliver safer, more cost effective care. nashvillemedicalnews
Being Held Hostage by Ransomware By CINDY SANDERS
Last month’s WannaCry attack was certainly aptly named. No doubt the more than 300,000 computers in 150 countries rendered useless by the hack made the individuals and organizations impacted quite tearful. For those who had independent backup systems in place, the hack was inconvenient and a nuisance. For those who didn’t have adequate backup, files were most likely locked and lost. WannaCry was the latest ransomware attack where computers were hijacked and a ransom fee demanded. “Ransomware falls into the category of malware – malicious software – but most people would know them more as computer viruses,” explained Mark Burnette, CPA, CISSP, CISM, QSA, a shareholder with LBMC Information Security. “In the beginning, Mark Burnette the ransomware attacks were kind of clunky, but they’ve become more and more sophisticated,” noted Sam Felker, CIPP/US, a shareholder with Baker Donelson and a member of the firm’s Data Protection, PriSam Felker
vacy and Cybersecurity Group. “They’ve become more innovative in how they carry out their attacks, and they are also targeting markets where they believe they can make money.” Burnette said most ransomware is written to look for a particular weakness in a computer system. In the case of WannaCry, it has been documented that the U.S. National Security Agency (NSA) discovered the vulnerability and then subsequently had their information and tools leaked. Deploying such ransomware is typically a gamble as to whether or not the targeted victims will take the bait. “In most cases, it requires the user to install and take action in order for the ransomware to activate, and that often comes in the form of a phishing email,” said Burnette. “What made WannaCry different is that it was wormable, which meant it didn’t require user interaction to spread,” he continued. “This one was able to selfpropagate without user interaction. That’s why it spread so quickly.” Once deployed, the malware encrypts the hard drive of a computer, rendering it useless unless a victim pays the ransom to receive a decryption key to restore the system to working order. Felker said the ransom is usually requested in the form of bitcoin, a digital currency that is virtually untraceable. Oftentimes the ransom isn’t exorbi-
tant. “Ransoms are usually in the neighborhood of several hundred dollars,” said Felker. “Some are more,” he continued. “A hospital is Southern California paid $17,000, according to press reports, to get their system back.” The hackers recognize keeping the ransom price within reach for companies and individuals increases the likelihood of people paying. Felker noted, “The FBI recommends you not pay the ransom.” While agreeing that’s probably prudent for several reasons, not the least of which is that paying ransom rewards the criminals, he said it isn’t quite that simple when critical data is locked up. “We tell our clients it’s really a business decision for each individual company.” Before making any decision, Felker said, “You really have to get a forensic expert in quickly to determine the extent of the encryption that has taken place. Then, you look at whether you have backups and see if you can simply restore those files or if they are lost to you.” Opting to pay the ransom is also risky. “Paying it doesn’t necessarily mean the bad guys will send the decryption key … the might, but they might not,” said Burnette. According to numerous news reports, WannaCry was seen as a double scam because it didn’t have an automated decryption key, which meant those paying ransom had to hope the criminals behind the attack would manually free their sys-
tem. As of press time, most of the ransoms paid had not resulted in computers being restored. Felker and Burnette agreed the best offense is a good defense … stopping attacks before they can occur. There are a number of steps that should be taken to prevent ransomware or other malware from bringing business to a halt. Inventory: “You have to identify and inventory all the sensitive data you have,” said Burnette. “You can’t protect what you don’t know you have.” He added a proper inventory requires knowing what data exists, where it’s stored, and how it’s processed and transmitted. Backups: Burnette pointed out organizations that had backups before the WannaCry attack could retrieve the clean data and rebuild their systems. Felker concurred, saying it’s key to identify critical information in advance and have it backed up. “You have to have some separation there so those backups are protected,” he added of keeping those files safely disconnected from the network. Patching: “The most significant thing companies can do … and are doing … is patching,” Burnette continued. He noted the patch to protect against the variant targeted by WannaCry was actually released in mid-March by Microsoft … two months before the attacks occurred. “Those who installed the patch would not (CONTINUED ON PAGE 14)
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Cybersecurity: It’s All About the Holes Cybersecurity is about what is not secure. It’s about the blind spots, the weaknesses, the potential problems with the systems and the people. These are things most of us don’t think about because we assume someone else is thinking about it … or worse, we haven’t considered it all. So we need to start looking at cybersecurity the right way. It’s not about the security so By JULIE-KAREL ELKIN, JD much as it is the vulnerability. We have to be able to spot the vulnerability before it gets exploited. Since all healthcare providers are legally required to maintain good cybersecurity practices, it is something we should be thinking about on a regular basis. When most people consider cybersecurity, they think of it as something the IT guy has to worry about or that “just hap-
pens” with computers, when, actually, the opposite is true. Yes, the IT department is, or should be, worrying about cybersecurity. And yes, computers and software applications are designed with security features. However, the real danger is in complacency … the failure to keep up with changes – and now, most recently, the availability of information about the user, which can be exploited as easily as outdated encryption. Everything is secure until someone breaches it, and when that someone has nothing better to do all day than to let their computers search for vulnerabilities on your computers, you have the potential for serious cyber-insecurity. Hackers are criminals. They are thieves and terrorists, and they are getting better at what they do, which is stealing, ransoming, and exploiting insecure data. Unfortunately, they love the data from medical providers because it usually contains sensitive personal information. The criminals are always looking for unattended data, and they are using public information to make the medical community easier targets. Several recent breaches included the use of information from social
media accounts and company websites to make it appear as though the message containing the malware, spyware, virus, or worm came from a legitimate source. To stay ahead of them, medical professionals have to be able to look at the data system like a criminal, which is not easy to do since most of us have no desire to misuse or misappropriate anything. Our brains are at a distinct disadvantage. Don’t think about how secure your network, software applications, or web portals are; instead, look at how secure they aren’t. What information is there, and how could someone get it? For example, patient portals are a wonderful tool, but the healthcare industry is way behind when it comes to cybersecurity. A cybercriminal has nothing better to do than to work on that portal day and night, which means it needs to be constantly monitored to avoid a major infiltration. If much of this information seems foreign to you or if you think this stuff only happens to big hospital systems, then you should wonder about how cyber-ready your office really is and think about the fact that if you do not know the questions
Financing the Deal DONN JONES PHOTOGRAPHY
More than 300 executives ophthalmology, GI and care managegathered for the Nashville Health ment platforms for community-based Care Council’s annual “Financing frail elders, are poised for growth.” the Deal” panel discussion to hear “More than anything, we look firsthand perspectives from investfor companies that are on the right side ment experts on the state of the of change in healthcare, and those that market and the outlook for fundwe can specifically help grow with our ing various sectors of the healthrelationships,” Jackson said. care industry. Panel members made note of The panel was moderated Nashville’s significant concentration by Tom Wylly, senior partner, of healthcare companies and the Brentwood Capital Advisors; benefits of collaboration within the and included Diane M. Daych, industry through the city’s network. partner, Apple Tree Partners; The city is home to more than 800 Grant Jackson, managing companies working in the healthgeneral partner, Council Capital; care sector and serves as headquarTodd Sisitsky, managing ters to 18 publicly traded healthcare partner, Capital Business and companies. co-head of Healthcare Services, “I have been working in NashTPG; and Mark D. Taber, Financing the Deal panelist Diane Daych makes a point during the recent ville since 2002, and it’s amazing to managing partner, Great Hill Nashville Health Care Council program. see the growth that has happened in Partners. that time. Nashville has always been models,” she said. Topics central to the discussion were a healthcare town, but it has grown into The panelists mentioned several secquality and quantity of deals in the cura tech hub, as well. I could fill a week just tors – particularly behavioral health, addicrent market, paths to successful exits, and meeting with interesting companies. The tion therapy and EHR support technology outlook for the rest of 2017. The panelists city’s unique culture of collaboration is – as areas with plenty of growth potential. noted that, regardless of the debates in one-of-a-kind,” Taber said. Now that 90 percent of providers have D.C., healthcare continues to shift from “Nashville is home to an extraordimade the switch to EHRs and have taken volume- to value-based care reimbursenary group of healthcare innovators,” Sisadvantage of meaningful use, the focus is ment, and investment strategies would itsky added. “The leaders here have a lot shifting to helping providers become more largely continue in the same direction no to teach us about healthcare, and I hope efficient in the use of this technology. matter what ultimately happens with the it is the people here, rather than those in “A model that addresses the conAffordable Care Act. Washington, who chart the course for the sumer and increases transparency and However, Daych pointed out that it future of the industry.” efficiency is on the right track,” Sisitsky is important to meet payers where they Jackson, the only panelist based in said. “We are looking for companies that are and noted that many payers aren’t yet Nashville, explained, “Nashville has a are value-added partners to existing proequipped for value-based reimbursement. unique mix of can-do attitude and a pracviders – not competition to health systems, “That is the direction, but it is important tical, get-things-done approach. A high but effective partners.” to be flexible and make sure the business proportion of businesses are successful Daych noted, “Sectors that touch the model can manage under both fee-forhere because of that attitude and the spirit aging population, such as dermatology, service and value-based reimbursement of collaboration.” 10
to ask, you are probably not getting the answers you really need. For an analysis of cybersecurity, you need to look at both ends of the transaction. Consider the network storing and/or transmitting the data and the people who input and/or use the data. People and technology must work together to form a successful cybersecurity system. The network must be constantly monitored; and whether you have internal or external IT professionals at your disposal, you have to ask questions regularly because the status of cybersecurity changes every time the criminals find and exploit a new tool or weakness anywhere along the vast system of software and hardware. Hackers get information from unintended leaks like New York University publishing the U.S. Military code breaking mechanism or the constant and relentless probing of the security mechanisms tech companies like Microsoft continue to develop. Don’t make it easy. Continuously re-evaluate the system. Regularly schedule analyses of devices, such as stationary computers, laptops, iPads, tablets, and smart phones. You don’t know if you don’t ask, but someone in your workforce probably has protected health information (PHI) or other sensitive data, such as passwords, on a smart phone. Then there are all the plug-ins – scanners, printers, fax machines, camera systems, thermostats (yes, anything that can be controlled remotely is a potential hole in your security), not to mention all the wearables and implantables that continue to be developed. As those devices become more common, we have to know how they are communicating with the network in order to maintain cybersecurity. We also have to invest in personnel training, which is sometimes more difficult to control than the network system because human beings can be, let’s just say, uncooperative. And it is not because they don’t care, but we may have failed to create a real culture of cybersecurity. We need to invest in personalized training for all employees, including medical practitioners. Internet tools such as video presentations, webinars, online curricula, and quizzes are all good interim reminders. However, as a recent PHI breach proved, a workforce member who just attended an online training session – which included instruction on an almost identical phishing scam – is not enough when the workforce does not take that instruction seriously. Personnel training cannot be an afterthought, and physicians must set the tone for the workforce. The culture of the office will ultimately determine its level of cybersecurity or cyber-insecurity. Start looking for holes and constantly evaluate your system to become truly secure. Julie-Karel Elkin is a member and chief compliance officer at Spicer Rudstrom PLLC. She is the head of the Health Data Privacy and Security practice and has been helping companies and providers, large and small, with all aspects of their compliance needs for more than 20 years. For more information, go to spicerfirm.com. nashvillemedicalnews
Part 1: What the H?
HIPAA, HITECH & HITRUST: The Essentials of Healthcare Security Compliance Any entity that handles health information or other sensitive data should be intimately familiar with HIPAA, HITECH and HITRUST. Unfortunately, some entities and/or their employees view these H-words as mere suggestions or someone else’s responsibility. Others are By GINA B. PRUITT, CPA confused by how these terms apply to them. If you’re already muttering, “What the H?” — this series is for you. In Part 1, we’ll explore the differences between these important acronyms, as well as how these concepts build upon each other to play a significant part in securing protected health information (PHI).
Perhaps the most well-known term in the bunch, HIPAA (Health Insurance Portability and Accountability Act) became federal law in 1996. The first of the two major components of the law protects workers from losing health insurance if they lose or change jobs. The second component (what most people think of when they hear the term HIPAA) has been a transformative force in the healthcare world, helping to ensure the privacy and security of PHI. It also attempts to standardize the methods by which healthcare entities store and exchange sensitive healthcare information. At a high level, this component consists of the: Security Rule: This portion provides the administrative and technical requirements that healthcare entities (and their business associates) must meet to ensure confidentiality and security of PHI. Under the Security Rule, entities must assess their own potential for risks to PHI and take “reasonable and appropriate” measures to secure systems and processes. For instance, a minimum level of security for PHI is to encrypt the data. Privacy Rule: This rule, which provides rights to individuals, grants some permissions to healthcare entities for use of PHI for care and other specified purposes. If entities would like to disclose consumer health information for purposes that are not explicitly permitted by the Privacy Rule, the consumer must first give written permission using a valid HIPAA authorization. Entities then must specifically tell the consumer how they plan to use that information. HIPAA also empowers individuals by granting them greater access to and control of their health records. For example, consumers can request removal of inaccurate information on their record, or specify that healthcare providers may not share PHI with certain parties. NASHVILLEMEDICALNEWS
The main requirement for HIPAA compliance is an annual risk analysis, a process that focuses on several key requirements and controls outlined in the Security and Privacy Rules. (More on that in Part 2 online) HITECH, or the Health Information Technology for Economic and Clinical Health Act, was enacted in 2009 as part of the American Recovery and Reinvestment Act. It operates as an update and extension of HIPAA. Therefore, while HIPAA built the structure for regulation of health information technology, HITECH builds upon that foundation to provide more details and increased enforcement measures for HIPAA violations. HITECH also extends HIPAA’s stipulations to business associates of covered healthcare entities. This means that any organization that has access to PHI must be HIPAA-compliant. Some examples of qualifying entities include health information exchanges, insurance companies, CPA firms, billing firms, and medical transcriptionists. Whereas enforcement of HIPAA was previously perceived as somewhat lax or inconsistent, HITECH institutes steep penalties for “willful neglect” and mandates audits by the Department of Health and Human Services (HHS). HITECH also brings new breach requirements. HHS defines a breach as “an impermissible use
or disclosure under the Privacy Rule that compromises the security of the PHI.” With the implementation of HITECH, entities are required to notify individuals when their information has been breached. They must also notify both the HHS and local media when the breach affects more than 500 patients. (Sound scary? Read Part 3 of our series online for real horror stories that illustrate the importance of being in compliance.) Unlike HIPAA and HITECH, the Health Information Trust Alliance (HITRUST) is not a law. It is a private organization of providers (hospitals, physician practices, etc.) and payers (insurance companies) that created a certifiable framework for healthcare technology security: HITRUST CSF. This framework is designed to ensure compliance with HIPAA and several other existing security frameworks. While HIPAA lays out the guidelines for compliance, it does not give a clear blueprint for achieving it. HITRUST, on the other hand, gives covered entities a detailed path to compliance, as well as invaluable tools for governance and risk management. It also offers an exhaustive certification process to show that an entity meets all existing security regulations for the handling, storing and transmission of PHI. HITRUST does not use a one-size-fits all approach. Rather, its third-party asses-
sors make recommendations to entities based on their size, scale and unique security issues. Additionally, HITRUST’s CSF is not static. As specific security issues evolve, so do the requirements for HITRUST certification. If an entity completes the lengthy process of certification, it must recertify every two years. The certification makes healthcare entities a more attractive option for consumers, as the exhaustive certification process lends credibility to their commitment to PHI security. But HITRUST is not just related to enhancing security measures. In fact, many of the large payers are requiring entities they contract with to become HITRUST-certified by the end of 2018. At that time, in order to contract with and get paid by most payers, entities will need to obtain HITRUST certification … And that means they need to get started soon! The good news? We’ll tell you how to get — and/or stay — in compliance in subsequent part of this series online. Gina B. Pruitt, CPA, CITP, CISA, CGMA, CQA, CRISC, CEMB, CCSFP, CHFP is member-incharge of the Risk Assurance & Advisory Services practice at KraftCPAs PLLC and has more than 30 years of experience in public accounting. A HITRUST Certified CSF Assessor, KraftCPAs works extensively with healthcare providers and related entities. For more information, contact Gina at email@example.com.
Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website.
NEW IN JUNE: Kelly Holt, CHC, Paradigm Group wellbeing strategy consultant and certified health coach, looks at the cost of employee stress on your business and provides insights from national workplace stress experts who shared innovative solutions at Paradigm Group’s third annual Workplace Wellbeing Conference. In this blog post, Holt recaps how to support employee health, increase productivity, and cut healthcare costs. Gina Pruitt, CPA, member-in-charge of the Risk Assurance & Advisory Services practice at KraftCPAs PLLC, continues the ‘What the H?’ series started in print this month. Now that we know what the H’s are, the logical next step is to learn how to comply with the rules. Part 2 (“How the H?”) outlines the specific measures you can take to ensure you are in compliance. Part 3 (“Why the H?”) explains the importance of HIPAA, HITECH and HITRUST for you and your consumers, including examples of the consequences of noncompliance.
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Health Care Hall of Fame Announces 2017 Inductees Six Industry Luminaries Chosen for the Third Class Last month, officials with the Tennessee Health Care Hall of Fame unveiled the six honorees selected for 2017 induction. The luminaries in this third class will be joining the 14 previous industry pioneers inducted since the Hall of Fame’s founding in 2015. A pioneering female surgeon and state lawmaker, renowned transplant surgeon and national policymaker, visionary healthcare executive, innovative physician-entrepreneur, Nobel Prize-winning researcher, and groundbreaking physician-scientist-executive were chosen by this year’s selection committee. Nashville Health Care Council President Hayley Hovious said, “This impressive group of inductees represents some of our state’s greatest talent. With individuals from all across Tennessee who have made a significant impact on their communities through their work as leaders, politicians, practitioners, scientists, philanthropists and innovators, the Hall of Fame is honored to induct such a deserving group of healthcare heroes.”
The 2017 Inductees
Dorothy Lavinia Brown, MD: The first African American female surgeon in the South, member of the Tennessee House of Representative and General Assembly, a longtime educator and chief of surgery at Riverside Hospital and clinical professor at Meharry, and a passionate advocate for women’s health, rights and education. Former Senate Majority Leader William “Bill” Frist, MD: A former U.S. Senator from Tennessee and Senate Majority Leader, Vanderbilt Transplant Center founder, first heart and lung transplant surgeon at Vanderbilt, founder of NashvilleHealth and Hope Through Healing Hands, co-leader of the Council Fellows program, and a senior fellow at the Bipartisan Policy Center. Joel Gordon: The 47-year healthcare veteran who introduced physician ownership/joint ventures as a business structure, founder of GeneralCare and Surgical Care Associates, co-founder of HealthWise of America, owner of Gordon Group Investment Management, and visionary advisor for numerous councils, boards and ventures.
Be a Part of the 2017 Induction Ceremony!
Harry Jacobson, MD: Physician, entrepreneur and investor who has founded or co-founded eight companies, the past chair of the Nashville Health Care Council Board of Directors, executive-in-residence at Belmont University’s Jack C. Massey College of Business, past vice chancellor for Health Affairs at Vanderbilt University and former CEO of Vanderbilt University Medical Center. Stanford Moore, PhD: The recipient of the Nobel Prize for Chemistry in 1972 for his work with proteins and their composition which led to the first understanding of the complete chemical structure of protein and ultimately informed decades of scientific work surrounding disease and drug discovery, and graduate of the University School of Nashville and Vanderbilt University. Donald Pinkel, MD: The first director and CEO of St. Jude Children’s Research Hospital, recipient of the Lasker Award for Medical Research, Kettering Prize for Cancer Research and Pollin Prize for Pediatric Research, and leader of the development of the first treatment for childhood acute lymphoblastic leukemia, increasing the cure rate from 4 to 50 percent.
The induction luncheon is set for Oct. 17, 2017 at Belmont University’s Curb Event Center. For details or more information on sponsorship opportunities, go online to tnhealthcarehall.com.
About the Hall of Fame
With a mission to honor men and women who have made significant and lasting contributions to the health and healthcare industries, the Tennessee Health Care Hall of Fame was created by Belmont University, the McWhorter Society and Founding Partner the Nashville Health Care Council. A selection committee made up of health and healthcare leaders from across the state chose the 2017 inductees. The nomination process began in January and was open to practitioners, executives, entrepreneurs, mentors, teachers, scientists, researchers, innovators or any person with a connection to the health or healthcare field. Nominees must have: • Been born, lived or have worked in Tennessee, • Made a significant impact and last(CONTINUED ON PAGE 14)
DON’T MISS THE THIRD ANNUAL INDUCTION
honoring these health care legends
With a mission to honor men and women who have made significant and lasting contributions to the health care industry, The Tennessee Health Care Hall of Fame seeks to recognize and honor the pioneers and current leaders who have formed Tennessee’s health and health care community and encourage future generations of health care professionals.
BELMONT UNIVERSITY, CURB EVENT CENTER OCTOBER 17, 2017
Sponsorship information available at
Dorothy Lavinia Brown, M.D.
William “Bill” Frist, M.D.
First female African American First heart and lung transplant surgeon in the South surgeon at Vanderbilt
Joel C. Gordon 47-year health care veteran Introduced physician ownership/joint ventures as a business structure
Longtime practitioner and professor
Former U.S. Senator and Majority Leader
Harry R. Jacobson, M.D.
Stanford Moore, Ph.D.
Donald Pinkel, M.D.
Physician, entrepreneur and investor
Nobel Prize-winning biochemist
Former CEO of Vanderbilt University Medical Center
Longtime scientist and researcher
First Director and CEO of St. Jude Children’s Research Hospital
Founding Partners: The
HIT Parade: News from Healthcare’s Tech Sector Health:Further, TN HIMSS Partner on Major Health Event
Mark Your Calendars for August 22-25 This August, two extremely popular healthcare events are coming together to provide attendees with business and industry insights from national speakers, timely healthcare content, networking and mentor opportunities, roundtable discussions, and an investor forum at the Music City Center.
Health:Further’s Marcus Whitney and Vic Gatto
Health:Further is expanding this year to a unique festival format over four days with TN HIMSS becoming the exclusive health IT programming partner, hosting its popular Summit of the Southeast as part of the larger overall event. Additionally, Life Science Tennessee has joined forces with Health:Further to deepen the perspective on biotech, diagnostics, medical device and policy issues, and Hedgeye Risk Management is co-producing the investor forum on Aug. 25. In addition to the Summit of the Southeast, the event will feature a firstever consumer summit, wellbeing track, evolution of the industry track, and an investor forum. Among the confirmed speakers are: John Bass, founder and CEO of blockchain venture Hashed Health; Mary Mirabelli, vice president of global healthcare serves at Hewlett-Packard and current chair of the Healthcare Financial Management Association; Scott Monty, co-managing partner at Brain+Trust; Neil Patel, president at Healthbox; Lisa Prasad, director of global innovation at the Henry Ford Health System; Marquise Stillwell, principal and founder of Openbox; and Jessica Sweeney-Platt, executive director of athenaResearch. For a more complete list of speakers, agenda details or to purchase tickets, go online to HealthFurther.com.
FCA Venture Partners Leads Latest Vericred Funding
Last month, healthcare data services company Vericred, announced the closing of a $5.5 million Series A funding round led by Nashville-based FCA Venture Partners, with participation from existnashvillemedicalnews
ing and new investors. The company will use the capital to accelerate sales growth and product development to advance its position as the enabling data layer to the health insurance and employee benefit industry. FCA’s co-managing partner Matthew King has joined Vericred’s Board of Directors. Technology companies are looking to build Matthew King robust solutions that help individuals and businesses enroll, understand, and use their health insurance and employee benefits. The lack of a centralized data platform providing reliable, structured data had historically inhibited the building of such solutions, but Vericred has addressed the data problem so that technology companies can focus their resources on creating modern user experiences. “Vericred’s centralized data platform is unique and highly scalable. With its combination of a strong management team and great technology, Vericred is positioning itself to power health insurance and employee benefit related applications, transactions and insights across the industry,” said King.
Aylward Named CEO of Preferral
Nashville-based technology firm Preferral, a web-based application for managing and scheduling patient referrals between physicians, recently named healthcare veteran Jim Aylward as CEO. He joins founder and Chief Technology Officer Jon Gautsch in expanding the health-tech startup that aims to eliminate referral phone calls, cut administrative costs, and address the large number of specialist referrals that never get scheduled. Aylward previously led Sy.Med and MedCenterDisplay. Immediately prior to his new appointment, he held an executive position with PatientPoint.
emids Across the Pond
Last month, Nashville-based emids announced they have opened shop in London. The HIT company, which also has a presence in India, is focused on technology services and solutions for healthcare payers, providers, and HIT vendors. In business for nearly two decades, emids offers a range of services from application development and product design to data migration and management. “The United Kingdom, along with the rest of Europe, offers a wealth of life-sciences talent and expertise, and is home to many life-science firms with branches in USA,” Saurabh Sinha, CEO and CoFounder of emids, said Saurabh Sinha of the decision to open a third office.
Lipscomb College of Pharmacy, IBM Partner on Business Intelligence Technologies
This spring, IBM and Lipscomb University College of Pharmacy announced an initiative to help train the next-generation of pharmacists on business analytics and insight-derived decision-making. As the first college of pharmacy in the nation to add IBM Watson Analytics into its curriculum, Lipscomb University is helping their students graduate with an understanding of data and business analytics that can be applied in the workforce. At a time when healthcare companies expect individuals at all levels of an organization to act on data-driven insights, future pharmacists need to analyze and understand data to help deliver more informed answers in patient care. Watson Analytics is a cloud-based analytics service that enables users to upload accumulated data and find actionable insights without deep technical or coding expertise. The easy-to-use interface combined with cognitive capabilities like natural language processing guides users through advanced analytics without letting personal bias seep into the analysis. Students will learn how to analyze their dataset, as well as integrate new external data sources into their existing data, to uncover the insights they need.
“Lipscomb University has been at the forefront of the Pharmaceutical education field – offering not just pharmacy-focused degrees but also dual degrees to help our graduates in areas such as healthcare informatics,” said Roger Davis, PharmD, dean of Lipscomb University’s College of Pharmacy & Health Sciences. “Being the first College of Pharmacy in the nation to offer access to Watson Analytics continues this mission by helping give Dr. Roger Davis our student pharmacists an advantage in predictive analytics and data mining, learning, and research.”
Satchel Health Appoints Hyde as CEO
Nashville-based Satchel Health, a healthcare technology company facilitating innovation in healthcare accessibility through telemedicine solutions for post-acute care providers, announced the appointment of Lanson Hyde as chief executive officer last month. Hyde is a seasoned executive who brings decades of experience leading and growing companies in the healthcare space. Most recently he served as chief operating officer of the hospital division and president of the Ambulatory Surgery Center division at Surgical Development Partners. (CONTINUED ON PAGE 14)
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Being Held Hostage, continued from page 9 have been susceptible to this particular malware,” he stated. Harden the Computer System: “The premise of hardening computer systems is turning off unnecessary services and capabilities,” Burnette said. He noted computers typically come with a lot of programs installed that aren’t needed yet provide another entry point for those seeking to do harm. “If you harden your systems properly, then the services the bad guys are targeting might not even be on and available to be attacked,” he reasoned. Education: Felker said part of a healthy cyber defense is pre-planning by keeping employees educated and alert to new and evolving threats. Risk Assessment: Under the HIPAA security rule, healthcare organizations should already be conducting risk assessments to identify areas of vulnerability. Once identified, action should be
taken to close the loopholes. Monitoring: Burnette said there are many monitoring tools and services available to watch for changes in the operating environment and alert companies quickly. Legal Action: “If you can find the culprit, you have legal recourse. But realistically many times it’s impossible to find the source, and often they are from foreign countries,” Felker said pragmatically. Insurance: Cyber coverage is something Felker said his team often discusses with clients. “Clients need to make sure their insurance coverage includes cyber attacks including ransomware,” he counseled. Some policies exclude such attacks and others simply aren’t broad enough. While a good policy could help offset the costs to rebuild and replace, proactive steps to thwart an attack on the front end ultimately save everyone time, money and frustration.
Health Care Hall of Fame, continued from page 12 ing contribution to healthcare at the local, state, national or international level, • Exhibit the highest ethical and professional character, and • Serve as an outstanding role model in their community. In addition to recognizing Tennessee’s most influential industry leaders, The Hall of Fame serves as an ongoing educational resource to document the rich history that has contributed to Tennessee’s position as a leader for national healthcare initiatives. Belmont President Dr. Bob Fisher said, “One of the things I am incredibly grateful for is Belmont’s placement in Tennessee – a state that is widely recognized as a central hub for healthcare in the United
States, with Nashville at the helm. Our community continues to see the efforts of so many as individuals and organizations take significant strides towards shaping and advancing the health and healthcare industries. Meanwhile, Belmont continues to play an increasingly significant role in undergraduate, graduate and executive healthcare education.” He continued, “The induction of these six healthcare legends, and those that will come after them, will help Belmont inspire the next generation of healthcare greats, while further promoting our state’s booming success as the nation’s premiere healthcare hub.”
HIT Parade, continued from page 13 Ryan Macy, founder of Satchel Health, has transitioned to chief product officer with the appointment of Hyde. He previously served as CEO since the company’s inception in 2014. Macy was inspired to create Satchel after experiencing the devastation of the 2010 earthquake in Haiti where a lack of basic medical infrastructure prevented people from accessing care. Today, Satchel Health builds intuitive software to expand clinical reach and provide intelligent insights on care delivery and operations. The care platform allows clinicians to examine patients remotely through live-streaming, two-way video and digitally connected biometric devices that provide real-time data and actionable insights on the patient’s condition.
Symplr, Vistar Join Forces
In May, symplr®, a leading provider of software as a service (SaaS) based healthcare compliance and credentialing solutions, announced it has joined forces with Vistar Technologies, a leader in the development and support of provider management software for healthcare providers,
managed care and payer organizations. Combined, the symplr and Vistar product portfolios create the broadest provider management software platform covering: credentialing, privileging, payer enrollment, event reporting, professional practice reporting, peer review, network management, contracting, recruiting, onboarding, provider relations management, quality management, and systems integration. The functionality of the combined provider management software platform supports all aspects of provider data management for healthcare delivery. In other company news, Nashvillebased Julie Walker has joined symplr as vice president and general manager of Vendor Credentialing Business. Walker previously served in an executive role in business development for ProviderTrust. She earned her underJulie Walker graduate degree from Valparaiso University in Indiana and her MBA from Lipscomb University.
GRAND ROUNDS Let’s Give Them Something to Talk About! Awards, Honors, Achievements
Christine Lovly, MD, PhD, assistant professor of Medicine and Cancer Biology at Vanderbilt University Medical Center, has been elected to The American Society for Clinical Investigation (ASCI), an elite honor society of physician-scientists. Lovly Dr. Christine Lovly is among 64 new ASCI members elected by the active segment of the membership, and she joins a 2017 class of physician-scientists representing a diverse range of disciplines, specialties and institutions. Joshua Taylor, MD, general surgeon, The Surgical Clinic, recently performed the first robotic transversus abdominus release (rTAR) in the state of Tennessee at TriStar StoneCrest Medical Center in Smyrna. Taylor performed the rTAR to repair a complex hernia using the da Vinci® Surgical System Dr. Joshua Taylor through 6 small incisions, three on each side of the abdominal wall. The robotic procedure adds reinforcement to the abdominal wall to prevent the recurrences or other hernias from developing, recovers the abdominal wall functionality, prevents the intra-abdominal organs from protruding through the abdominal wall and provides a cosmetically pleasing appearance. Tammy Hawes was named 2017 Outstanding Alumna during the East Tennessee State University awards banquet and annual meeting last month. A graduate of the ETSU Class of 1983, Hawes is the founder and CEO of Brentwoodbased Virsys12, which specializes in healthcare transformation and workflow automation through Tammy Hawes technology. Charlotte C. Burns, FACHE, vice president of network affiliates for HCA’s TriStar Division, has been appointed to the Council of Regents, the legislative body of the American College of Healthcare Executives (ACHE). Burns also Charlotte Burns currently serves as president of the local ACHE chapter, ACHE of Middle Tennessee.
Cumberland Pharma Enters Agreement for Kristalose® Nashville-based Cumberland Pharmaceuticals has entered a co-promotion agreement for Kristalose® within the United States with Poly Pharmaceuticals Inc., a privately held U.S. specialty pharmaceutical company. Poly’s sales force will more than double the number of nationwide physicians called upon in support of the product. Kristalose is a dry powder, crystalline formulation of lactulose that is designed
to enhance patient compliance during treatment of acute and chronic constipation. It is the only prescription laxative available in pre-measured powder packets, making it convenient and easily portable.
Steward Health Care Buying Iasis Boston-based Steward Health Care, which recently bought eight hospitals from CHS, plans to purchase Franklinbased Iasis Healthcare. The move will create one of the nation’s largest private forprofit hospital companies with 36 facilities in 10 states.
COA Middle Tennessee Launches New Online Directory The Council on Aging (COA) of Middle Tennessee serves older adults, caregivers and communities by addressing unmet needs through information, advocacy and education throughout the year. Recently, the organization launched their new online Directory of Services and customized care guidance tool, Roobrik. The directory offers unbiased information for older adults, caregivers and professionals. Copies of the printed directories are available at public libraries, the COA office and other select locations throughout Middle Tennessee or accessible online at http://directory.coamidtn.org.
Marger Appointed CEO of TriStar Summit
Brian Marger, FACHE, has been appointed chief executive officer of TriStar Summit Medical Center effective June 1 and will be responsible for operations at the 200-bed hospital and related care areas. Prior to this new role, Marger served as COO of sister facility TriStar Centennial Medical Center. A 14-year HCA vet- Brian Marger eran, Marger has also previously served as vice president of operations of Sarah Cannon, COO of Osceola Regional Medical Center, and as assistant vice president of HCA’s Strategic Resource Group. He earned his undergraduate degree from Duke and his MBA with a focus on finance and healthcare from Vanderbilt’s Owen Graduate School. Marger replaces Jeff Whitehorn, who announced his retirement earlier this year.
LifePoint Health Promotes Ross to SVP Brentwood-based LifePoint Health recently promoted Jason Ross to senior vice president, revenue and network management for the organization. Ross formerly served as vice president, population health. In his new role, Ross will oversee LifePoint’s revJason Ross enue cycle processes and reimbursement strategies, in addition to continuing to lead the company’s population health work. nashvillemedicalnews
GRAND ROUNDS Mitchell Promoted to EVP, Finance for ChanceLight
TOA Adds Williams, Expands Cookeville Hours
Last month, Nashville-based ChanceLight Behavioral Health, Therapy and Education, a leading provider of behavioral health and education solutions for children and young adults, announced Kevin Mitchell has been promoted to executive vice president Kevin Mitchell for finance. Mitchell has been a key member of the ChanceLight accounting and finance team since joining the company in 2004 and leads acquisition efforts. A CPA and chartered financial analyst (CFA charterholder), Mitchell earned both master’s and bachelor’s degrees in accounting from the University of Mississippi.
Recently, Tennessee Orthopaedic Alliance (TOA) announced the addition of Richard I. Williams, MD to its large network of providers. With the addition of Williams to TOA’s Cookeville office, the location has become a full-time care center, open five days a Dr. Richard Williams week. A graduate of Dartmouth College, Williams earned his master’s and medical degree from Indiana University, where he was elected to the Alpha Omega Alpha medical honor society. He completed an orthopaedic residency at the University of Cincinnati, followed by a Sports Medicine Fellowship with Kentucky Sports Medicine in Lexington. Head team physician for Tennessee Tech University, Williams was named ‘Sports Medicine Person of the Year’ in 2006 by the Tennessee Athletic Trainers Society.
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Ammar Joins Children’s Hospital at TriStar Centennial The Children’s Hospital at TriStar Centennial has announced the addition of pediatric gastroenterologist M. Samer Ammar, MD, to TriStar Medical Group Children’s Specialists. Ammar specializes in the treatment of abdominal pain, gastrointestinal bleeding, constipation, diar-
rhea, encopresis, Celiac Disease, IBS, and general pediatric gastroenterology, hepatology and nutrition concerns. After earning his medical degree from Dr. Samer Ammar Damascus University School of Medicine in Syria, he completed his pediatric residency at Louisiana State University Medical Center and pediatric fellowship in gastroenterology, hepatology and nutrition from the James Whitcomb Riley Hospital for Children at Indiana University School of Medicine. Ammar is board-certified by
the American Board of Pediatric Gastroenterology.
Aaron Named CHS CFO Last month, Community Health Systems, Inc. announced Thomas J. Aaron has been appointed executive vice president and chief financial officer. Aaron joined CHS in November 2016, following a 32-year career at Deloitte & Touche LLP, where he led teams for many of the firm’s largest national healthcare provider and payer clients including CHS. Aaron succeeds W. Larry Cash, who retired May 16, 2017, after 20 years of service as the company’s CFO.
University Community Health Services Now Connectus Health
For 25 years, University Community Health Services has provided high-quality, affordable healthcare to Middle Tennesseans through non-profit community clinics and women’s care centers. The organization is now being rebranded as Connectus Health to better reflect its comprehensive mission and reach. Two Connectus community clinics – one at Vine Hill on Benton Avenue in the Wedgewood Houston neighborhood and another on Murfreesboro Pike in Antioch – offer primary, women’s, pediatric, specialty and behavioral health care, along with Pictured (L-R): Connectus Health Co-CEO Caroline Portis-Jenkins, CFO Ricky Davidson and Co-CEO midwifery services for expectant mothers. Suzanne Hurley The locations often serve new Americans and English language learners, and translation services are offered at no cost. As a Federally Qualified Health Center, the Connectus fee schedule is applied on a sliding scale based on income. TennCare, Cover Kids, Medicare/Medicaid and most private insurance plans are accepted.
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