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passed by the General Assembly in 2018 – is critical to stabilizing and ensuring the future of rural healthcare.” Bill Jolley, senior vice president of rural health issues for THA, agreed the Tennessee Ru r a l Hospital Transformation Act, signed into law last year by former Gov. Bill Haslam, was a first step to address the changing healthcare landscape. “It provided a mechanism to provide support to those rural Bill Jolley hospitals that are really in dire straits,” Jolley said. He explained the law makes funding available for the state to contract with consultants and professional firms with expertise in hospital turnaround strategies to assess strategic partnerships ranging from joining forces with other hospitals in contiguous geographic regions to partnering with a larger tertiary facility to improve economies of scale and overall financial viability. THA worked closely with legislators on the plan, which is under the oversight of the Tennessee Department of Community and Economic Development. Jolley said

the legislation allows for potentially $3 million over three years to create such transformation plans. While funding must be reauthorized annually, the first $1 million has been approved for work in 2019. He added the expectation is that some hospitals would ultimately need to transition to new delivery models. “The hope would be they could sustain themselves in their current state … but if that’s not possible, then at a minimum maintaining a medical presence in these communities. There are some innovative ways of delivery care in rural Tennessee and across the country.” Jolley pointed to Johnson County Community Hospital, part of Ballad Health, in Mountain City, Tenn., as an example of rethinking the traditional delivery model. The critical access hospital has a 24/7 emergency department, two inpatient beds for either general care or to stabilize a patient before transferring to a larger facility, and a host of outpatient services focused on primary care, prevention and chronic care management. Not surprisingly, communities have fought hard to keep local hospitals, even when swimming against the tide of

AMA Honors Alexander’s Service By CINDY SANDERS

Last month, the American Medical Association (AMA) presented U.S. Senator Lamar Alexander (R-Tenn.) with the Dr. Nathan Davis Award for Outstanding Government Service. “During a career dedicated to public service, Sen. Alexander has been a consensusbuilder, leader, and bipartisan workhorse Sen. Lamar Alexander on a range of public health issues, leaving a lasting impression in Tennessee, Washington and across our country,” said AMA Board Chair Jack Resneck, Jr., MD. “He has forged strong relationships and leveraged them to pass vital legislation that is confronting the opioid abuse epidemic and providing physicians with the tools they need to treat their patients.” A former governor, university president and U.S. Secretary of Education, Alexander has been widely recognized for his bipartisan approach to legislating. As chair of the Senate Health, Education, Labor & Pensions (HELP) committee, Alexander has spearheaded a number of significant healthcare bills, including the “21st Century Cures Act,” which included provisions to accelerate medical product development and expedite getting other healthcare innovations into the marketplace to benefit patients. Additionally, he has championed comprehensive mental health legislation, and the “SUPPORT for Patients and Communities Act” – a legislative package to address opioid use disorders. He worked closely with Sen. Patty 4

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Murray (D-Wash.), who serves as Ranking Member on the HELP committee, to engage key stakeholders in discussions to gain a more comprehensive picture of the opioid epidemic. The AMA specifically lauded Alexander’s efforts to pass the comprehensive SUPPORT legislation (H.R. 6) while protecting states’ ability to work directly with physicians on use of their prescription drug monitoring program (PDMP) databases, protecting patient privacy, and prioritizing new research for the treatment of pain and opioid use disorder.   Alexander, who was presented the award during the recent AMA National Advocacy Conference, told Nashville Medical News, “I am grateful for this very generous award, but I really should be thanking the American Medical Association for what they do to care for people who need help. I’m going to do all I can over the next two years to create an environment for patients that produces a better experience and a better outcome at a lower cost. I hope the American Medical Association will help with that, because we all know we’re more likely to succeed in that if we remember that doctors need to be in a better working environment with less administrative burden so they could spend more time caring for their patients.” Alexander was nominated by the Tennessee Medical Association and was one of eight honorees chosen this year to receive the Dr. Nathan Davis Award for Outstanding Government Service. The award, named after the founding father of the AMA, recognizes elected and career officials in federal, state or municipal service whose contributions have promoted the art and science of medicine and the betterment of public health. 

mounting financial losses. “We’re seeing it now all throughout the state with communities desperately trying to keep their hospitals open,” said Becker. “It’s a real hard pill to swallow to give up a full-service hospital. It’s part of the social fabric of the community,” he added of the role hospitals play beyond care delivery. Becker said a hospital closure causes a ripple effect. Not only is there the loss of high-paying jobs, but it also makes it more difficult to attract new businesses to the area. Craig Becker “Typically, the hospital ranks in the top three employers in a community, and sometimes as the top employer,” noted Jolley. “The population left behind that doesn’t leave these communities tend to be the elderly and the uninsured,” continued Becker. He said the Rural Hospital Transformation Act allows for the assessment of the most appropriate level of care to meet the needs of the population. “It gives them another road to keep a medical presence in that community,” he added. Telemedicine offers another opportunity to link rural communities to providers and specialists. Increased broadband access and greater acceptance by insurers have opened the door to expand the technology. “It provides an opportunity for some of our urban-based practices to partner with rural communities by linking through telemedicine,” said Jolley. Although Gov. Bill Lee has expressed

opposition to traditional Medicaid expansion under the Affordable Care Act, he has signaled his desire to focus on strengthening rural communities. Similarly, Becker said national lawmakers are increasingly cognizant of the rural healthcare crisis across the country. “Awareness … that’s the first step, and then you look at how to fix it,” he noted. Becker added not every rural hospital in Tennessee is failing. Some, in fact, are doing quite well. He pointed to Henry County Medical Center and Hardin Medical Center in West Tennessee as examples of stand-alone hospitals that have served their counties continuously for nearly seven decades. Backed by the power of TriStar Health, Cheatham County in Middle Tennessee is served by TriStar Ashland City Medical Center, a 12-bed critical access hospital that has won national recognition for quality and leadership. Becker also applauded Maury Regional Health in Columbia, Tenn., for stepping in to offer robust communitybased services in nearby counties that have lost hospitals. “They probably have the prototype of how to handle regional care,” he noted. While there is excitement about the building momentum to address rural access to care, both Becker and Jolley said a sustained focus is critical. Tennessee is second only to Texas in the number of rural hospital closures, and there are several more Tennessee hospitals currently hanging on by a thread. “It’s a lot more than a critical condition, and it’s not going to get any better until we address it,” concluded Becker.

State Hospitals Recognized as Part of National Decrease in HACs Two federal government agencies charged with reporting patient safety and quality of care data recently recognized the 88 hospitals participating in the Tennessee Hospital Association’s Hospital Improvement and Innovation Network (HIIN) as part of a nationwide effort to save lives and healthcare dollars. The Tennessee facilities and national counterparts helped prevent 20,500 hospital deaths and saved $7.7 billion in healthcare costs from 2014 to 2017, according to new data released by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS). AHRQ’s preliminary analysis estimates hospital-acquired conditions (HACs) were reduced by 910,000 from 2014 to 2017. The estimated rate of HACs dropped 13 percent.  Under the leadership of the Tennessee Center for Patient Safety, a division of THA, 88 facilities are participating in the CMS Partnership for Patients’ HIIN through the American Hospital Association’s Health Research Education Trust. Maury Regional, Nashville General, NorthCrest Medical Center, Sumner Regional, TriStar Skyline, TriStar Summit, Vanderbilt University Medical Center and Williamson Medical Center in the Nashville MSA are all part of the HIIN. While there is strong participation from Tennessee’s urban centers, many of the hospitals setting the standard for best practices and innovative programming are rural facilities located all across the state. “Tennessee hospitals are working together through this collaborative program to share best practices and continue to strive to make their facilities the safest places for care,” said THA President & CEO Craig Becker. “Tennesseans should be very comfortable knowing their local hospitals are working hard to provide the best possible care.”  Go online to NashvilleMedicalNews.com for a link to the full AHRQ report and more information on the THA HIIN, including access to best practice success stories from several of the participating Tennessee hospitals.

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