a product message image
{' '} {' '}
Limited time offer
SAVE % on your upgrade

Page 1


Your Middle TN Source for Professional Healthcare News

March 2020 >> $5

A New Era in Nephrology


Changing the Trajectory for Kidney Disease Patients

William H. Fissell, IV, MD


An estimated 37 million Americans are living with chronic kidney disease – a diagnosis once considered dismal. Today, thanks to new initiatives on several fronts (see page 3), patients have a renewed hope of management and improved quality of life.


A New Era

“This is a time with lots of excitement for both devices and pharmacology in the treatment of kidney diseases,” said Raymond Harris, MD, associate director of the Division of Nephrology, Ann and Roscoe Robinson Professor of Medicine, and former chief of the Division of Nephrology and Hypertension at Vanderbilt University Medical Center (VUMC). “Nephrology today is equivalent to 10 years ago with rheumatology and cancer, when we were on the verge of biologics and specifics therapies.” One of the most remarkable innovations in

Preparing for Pandemic COVID-19 Poses Challenges in a Global World As the March issue of Medical News went to press, there were more than 89,000 confirmed cases of the latest coronavirus across more than 50 countries with more than 3,000 reported deaths ... 4

Solving the Rural Health Puzzle Industry Panel Brings Different Perspectives to the Discussion By CINDY SANDERS


Leading Generations


HCA Study Sheds Light on Millennial & Gen Z Nurses A recent study by HCA Healthcare is shedding light on generational changes facing employers ... 5


Panelists (L-R) Dr. Sarah Chouinard, Alan Levine and Stuart McWhorter

Women 20 20 TO WATC H

Last month, the Nashville Health Care Council and Bipartisan Policy Center (BPC) brought together an expert panel to discuss issues and opportunities facing rural health providers. “Solving the Rural Health Care Puzzle: National, State and Provider Perspectives” attracted a sold-out crowd to learn more about the challenges disproportionately impacting rural communities as the nation moves to value-based care. Bill Hoagland, senior vice president of the BPC, offered opening remarks and noted there have been more than 107 rural hospital closures across the country since 2010. Today, he continued, another 650 hospitals have been identified as ‘at risk’ of facing a similar fate. He added Tennessee is second only to Texas in the number of hospitals that have closed in recent years. The BPC plans to have a report ready late next month that focuses on four


CALL FOR NOMINATIONS Nomination Deadline: March 17, 2020 To nominate, please visit nashvillemedicalnews.com and click the Women to Watch ad on righthand sidebar.




The Kidney Project: Pioneering Hope VUMC’s William Fissell Tackling First Bioartificial Kidney By MELANIE KILGORE-HILL

The path to nephrology was far from traditional for William H. Fissell, IV, MD, associate professor of Medicine at Vanderbilt University Medical Center and medical director for The Kidney Project, a national research initiative with a goal to create a small, surgically implantable, free-standing bioartificial kidney to treat end stage renal disease.

Finding the Right Path

The New York native attended the prestigious Massachusetts Institute of Technology. However, his plans to study computer engineering succumbed to an interest in physics while developing telescope instrumentation for NASA’s Chandra X-ray Observatory. During a particularly difficult period for the college junior, Fissell took a leave of absence from MIT and witnessed a car

accident while visiting a friend in Houston. “It occurred to me that I was getting this fancy MIT education but had no idea of what to do for this injured person,” he said. That awakening led Fissell to enroll in an EMT class back in Cambridge, and he soon found himself responding to 911 calls and transporting medically fragile dialysis patients in the slums of Boston. “Over time, we got to know the patients pretty well, and one had such severe bone dis-


DOESN’T HAVE TO BE PAINFUL Our experienced healthcare advisors can help you monitor and address critical financial matters so you can continue to focus on what matters most: providing excellent patient care.

» Practice Management » Audit, Tax & Accounting » Reimbursement & Operations » Coding & Compliance

615-242-7353 ext. 184 • krafthealthcare.com 2


MARCH 2020

ease from dialysis that she wore a metal halo to hold her skull off her shoulders,” he explained. Fissell went home to New York for the summer but returned to Boston that fall and found himself transporting the same woman, who graciously asked about his summer and his dating life. “I had this lightening bolt moment – that this woman who was in constant pain and humiliation is able to be warm and social and personable and interested in others,” Fissell said. “I knew if she could do that, I could do anything.” He returned to MIT to complete degrees in physics and electrical engineering and soon was accepted to medical school and an accelerated residency program at Cleveland’s Case Western Reserve University.

The Kidney Project

While studying for his boards, Fissell had another lightening bolt moment - one that would change the trajectory of his career … and quite possibly the treatment of kidney failure. “I looked at a picture of kidney filters, and it struck me that they have the same size and shape of the diffraction gratings used in NASA’s telescope,” he explained. “I wondered if we could use the same technology toolkit to treat kidney disease.” In yet another “serendipitous moment,” Fissell soon struck up a conversation with a stranger during his wife’s office party. As luck would have it, that stranger was Shuvo Roy, PhD, a silicon nanotechnology expert at The Cleveland Clinic who had recently produced slot-shaped membranes for drug delivery. Unbeknownst to Fissell, that meeting would launch a research partnership now 20-plus years old. In 2012 Fissell was recruited to VUMC from The Cleveland Clinic, while Roy went on to work at the University of California, San Francisco, where he continues serving as technical director for The Kidney Project. The initiative now includes more than 20 researchers working to give end stage renal disease patients new hope beyond the short-term solution of renal dialysis and the longer-term, but

impermanent, solution of a living kidney transplant for which donor organs are limited. The bioartificial kidney, the size of a coffee cup, consists of two modules that work together to get rid of waste. First, a hemofilter module processes incoming blood to create a watery ultrafiltrate that contains dissolved toxins, as well as sugars and salts. Second, a bioreactor of kidney cells processes the ultrafiltrate and sends the sugars and salts back into the blood. In the process, water is also reabsorbed back into the body, concentrating the ultrafiltrate into “urine,” which will be directed to the bladder for excretion. Fissell said the procedure will be similar to kidney transplant surgery and will be performed under general anesthesia. Once the bioartificial kidney device is available publicly, the procedure can be completed at any hospital with a trained transplant surgical team.

Making Progress

“The first 10 years were spent entirely on silicon membranes, and now we’re far along in terms of successful implementation, function and biocompatibility,” Fissell explained. For the past five years, the Vanderbilt team has been learning how to successfully culture living kidney cells to accomplish their function in a bioartificial kidney. “We’re asking the tough questions people haven’t needed to ask before about why cells act like they do in the dish versus in a person, but we’ve made progress,” he said. And while other researchers focus on advances in wearable devices or stem cell growth of new kidneys, Fissell said The Kidney Project is a hybrid between present and future. “We don’t have a lot of science left to answer,” he said, noting his current challenge is raising necessary funds to get the device to the FDA for human trials. “Right now, the only thing we can offer kidney failure patients is 40-year-old dialysis technology that’s imperfect. In 15 years, we’ve moved from answering science questions to developing engineering solutions that don’t require blood thinners, immunosuppressants, pumps and wires. We just need cash to implement it, and we’re working as hard and as fast as we can,” Fissell said. “A patient’s well-being shouldn’t be held hostage to an uncertain calendar of discovery science.”

For more topic-driven information by subject matter experts, check out our blog: nashvillemedicalnews.blog



Taking the Initiative on Kidney Care

KHI, KidneyX, New Executive Order Create Collaborative Focus By CINDY SANDERS

Recent data from the Centers for Disease Control and Prevention shows more than 35 million Americans are affected by chronic kidney diseases (CKD) … that’s one in every seven adults. Complicating the issue, it is estimated a staggering 96 percent of those with early kidney disease, when interventions are most effective, don’t realize they have CKD. Adding to the problem, the number of available treatment options have been limited for many years … although that is now beginning to change through the efforts of the Kidney Health Initiative, KidneyX and a new executive order from President Donald Trump. Prabir Roy-Chaudhury, MD, PhD, FASN, FRCP, serves as Councilor for the American Society of Nephrology (ASN), which has nearly 23,000 members across more than 130 countries. He noted the gallows humor in the field used to be that you could step away for 10 years, Dr. Prabir Roycome back, and not Chaudhury have missed a thing. Despite the status quo, he said providers and researchers have long been keenly aware of the desperate need for improved care options. “If you have 100 people starting off on hemodialysis, at the end of three years only 50 of them would be alive. That is a mortality (rate) that is worse than most every form of cancer,” he said. Yet, there have been 153 new U.S. Food and Drug Administration (FDA) approvals for cancer drugs over the last two decades compared to 23 for kidney diseases according to statistics from CenterWatch. “Kidney disease is common. It kills people, and quality of life is poor,” said Roy-Chaudhury, who serves as professor of Medicine and co-director of the University of North Carolina Kidney Center. “Despite this terrible triad, we’ve really had very little

innovation in kidney disease treatment.” However, he continued, that began to change in 2012 with a memorandum of understanding between ASN and the FDA for a unique public-private partnership, which was signed by both organization’s leadership at the time, Ron Falk, MD, FASN, and Commissioner Margaret Hamburg, MD. To marshal resources, support ongoing research, advance clinical trials and spur innovation in the development of patient-centered therapies, the ASN joined forces with the FDA to create the Kidney Health Initiative (KHI). Roy-Chaudhury, founding ASN co-chair of the KHI, noted the partnership has been a game-changer in creating a roadmap for innovation. He added KHI – which is currently led by Ray Harris, MD, PhD, of Vanderbilt University Medical Center and supported by ASN staff – is a true team effort. From 2000 through 2011, there were eight FDA drug approvals for kidney disease. There have been 15 since 2012. Although excited about the progress, RoyChaudhury said, “We should be having a lot more biologics, new devices and new drugs coming in for kidney patients.” Still, he continued, “We’re really moving in the right direction.” Recognizing the need to create a proper foundation for future innovation, Roy-Chaudhury noted, “We’ve done a lot of tangible things within the Kidney Health Initiative, but by far the most important thing is the Kidney Health Initiative has created a platform for diverse stakeholders meeting and coming together.” He added the KHI connects health professional organizations, patient organizations, large pharma, small biotech and a range of federal agencies including the National Institutes of Health, Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention, in addition to the FDA. “In the long run, this will have the most impact,” he noted of the open dialogue between stakeholders. Other large-scale projects to date include hosting workshops, setting data stan-

Dr.Associates Matthew Walker, Sr. Saint Thomas, Nephrology Partner on Transplant Legacy Breakfast Saint Thomas West Hospital, a member of Ascension Saint Thomas, and31, Nephrology Tuesday, March 2020 Associates, Middle Tennessee’s largest provider of renal care,7:30 recently announced an a.m. exclusive partnership expanding kidney transplant care. The Cal Turner Family Center The new partnership, which launched at the beginning of the year, will expand Meharry Medical College the kidney transplant program at Saint Thomas West with increased access for renal transplant patients across the region. Transplant-trained nephrologists will also amplify coverage at the hospital through a practice affiliation withSpeaker Saint Thomas Guest Patrice Harris, MD Medical Partners and Nephrology Associates. President, American Medical Association Additionally, the agreement will expedite the transplant wait list process and allow for the joint branding of certain existing Nephrology Associates locations.  “The decision to partner with Ascension Saint Thomas is a progression of Nephrology Associates’ long-standing commitment to meeting this growing public health need,” said Ashish Soni, MD, president of Nephrology Associates. “With this alignment, we are positioning ourselves to fight for the improved Dr. Ashish Soni kidney health of all Middle Tennesseans.”  



dards, publishing white papers, establishing clinical trial endpoints and creating an overall plan for patient-centered kidney disease management and treatment. “All of these outputs created a substrate, which is going to facilitate the passage of drugs, devices and biologics in kidney disease,” he said. Just as there is collaboration within KHI, Roy-Chaudhury is equally encouraged by the establishment of other kidneyfocused cooperative efforts. The kidney innovation accelerator KidneyX, led by John Sedor, MD, of the Cleveland Clinic, is another ASN public-private partnership. Working with the U.S. Department of Health and Human Services (HHS), KidneyX hosts prize competitions around specific kidney needs with funding going to winning ideas. “I think this can really change how we care for people in the next 10 years,” said Roy-Chaudhury. He also expressed great excitement over the “Advancing American Kidney Health” executive order signed last summer. CMS has proposed new reimbursement models to encourage preventive care, home dialysis and transplantation, and HHS has outlined three primary goals to improve kidney health. The first is to reduce the number of Americans developing endstage renal disease (ESRD) by 25 percent by 2030. “It’s an audacious goal,” said Roy-Chaudhury, “but I think it’s going to

push us to develop new therapies that will prevent the progression of kidney disease.” The second goal is to have 80 percent of new ESRD patients in 2025 either utilize home dialysis or receive a transplant. While recognizing there are different views on timing among stakeholders, he noted, “I think we all recognize the status quo that has gone on for such a long time has to change.” The third goal is to double the number of kidneys available for transplant by 2030. To meet that target, the executive order calls for HHS to expand support for living donors, look at reforms in organ procurement and management, and encourage development of wearable or implantable artificial kidneys. Additionally, Roy-Chaudhury said the relevant groups also are focused on public awareness and education, as well as primary and secondary prevention. “It’s a nice example of how government and the kidney community have come together to synergize development of new therapies, and I think that’s going to have exponential impact on patients,” RoyChaudhury said of the growing momentum among the collaborative efforts. “Above all, I strongly believe that if you can get smart and committed people and organizations together and get them to focus on a problem they are all interested in, then good things can happen … and sometimes it’s like magic!”

Dr. Matthew Walker, Sr. Legacy Breakfast

Dr. Matthew Walker, Sr. Legacy Breakfast The Cal Turner Family Center • Meharry Medical College Tuesday, March 31, 2020 | 7:30 - 9 am 1011 21st Avenue Nashville, Tuesday,North March 31, 2020 TN 37208 7:30 a.m. The Cal Turner Family Center Valet Parking Available Meharry Medical College Free parking available in Lots F and F Annex on the corner of 21st and Morena Street

Guest Speaker Register at bit.ly/legacybreakfast2020 or RSVP by Patrice Harris, MD or 615-340-1292 contacting Cathy Hunt atchunt@mwchc.org President, American Medical Association

Benefiting Matthew Walker Comprehensive Health Center

MARCH 2020



Preparing for Pandemic

COVID-19 Poses Challenges in a Global World By CINDY SANDERS

witnessing the uncontained global spread of this virus, and we are not Editor’s Note: Information witnessing large-scale severe dison COVID-19 continues to evolve on ease or deaths. Does this virus have a daily … and sometimes hourly … pandemic potential? Absolutely, it basis. Much of the information conhas. Are we there, yet? From our tained in this article is of a general assessment, not yet.” nature, but specific numbers referenced Instead, he said there are epibelow were accurate as of press time demics in different parts of the in late February but have almost cerworld affecting countries in diftainly changed since then. ferent ways that require a tailored response. Although there isn’t a As the March issue of Medione-size-fits-all approach to a councal News went to press, there were try’s risk assessment for COVIDmore than 89,000 confirmed 19, Tedros said there should be at cases of the latest coronavirus least three priorities for everyone. WHO Director-General Dr. Tedros Adhanom Ghebreyesus shares the across more than 50 countries “First, all countries must prilatest COVID-19 updates during a briefing. with more than 3,000 reported oritize protecting health workers. deaths. The virus is now on Second, we must engage commuhad raised its coronavirus risk assessment every continent except Antarctica. World nities to protect people who are most at to “very high” but still wasn’t calling the Health Organization Director-General risk of severe disease … particularly the outbreak a pandemic. Tedros Adhanom Ghebreyesus, PhD, elderly and people with underlying health “Our decision about whether to use MSc, has steadfastly called for facts over conditions. And third, we must protect the word ‘pandemic’ to describe an epifear. He outlined both signs of hope and countries that are the most vulnerable by demic is based on an ongoing assessment causes for growing concern in one of the doing our utmost to contain epidemics in of the geographical spread of the virus, regular addresses he has held since it countries with the capacity to do it.” the severity of disease it causes, and the became clear COVID-19 poses a global He also said it’s critical for all counimpact it has on the whole society,” he threat. tries, communities, families and indiexplained. “For the moment, we are not In a late February address, Tedros viduals to focus on preparedness should said the WHO-China Joint Mission team had returned after traveling to Wuhan, China, the epicenter of COVID-19. “They found that the epidemic peaked Putting Technology to Work for Public Health and plateaued between the 23rd of January and the 2nd of February and has been Lisa Ide, MD, MPH, chief medical officer for Minneapolisdeclining steadily since then,” he noted. based Zipnosis, a national virtual care platform, said technology Additionally, the team found no sighas an important role to play in tracking and messaging during nificant change in the DNA of the virus, public health outbreaks. Ide noted, “One of the most powerful which is good news. tools virtual care can offer us is the ability to automate triage.” As for the arc of the virus in those She continued, “In an outbreak, a key effort is to determine who contract it, Tedros said people with who needs screening.” Ide added the Zipnosis platform mild disease recover in about two weeks, guides patients to the most appropriate level of care based on while those with severe or critical disease symptoms. Dr. Lisa Ide take three to six weeks to recover. The The technology also allows telehealth companies to team, he continued, “found that the fatalquickly modify protocols and add pertinent questions that can be deployed locally ity rate is between 2 percent and 4 perfor community-specific outbreaks or across all systems for national epidemics. “We cent in Wuhan and 0.7 percent outside were able to add a travel question very quickly in our upper respiratory infection Wuhan.” protocol,” she said of screening for COVID-19. “We can add required questions to Epidemic or Pandemic Tedros noted many countries have done a good job in containing the virus so far. However, he said the sudden increases seen in Italy, Iran and South Korea in late February were “deeply troubling.” He continued, “There is a lot of speculation about whether this increase means that this epidemic has now become a pandemic.” By the end of February, WHO

Follow us on Twitter @NashMedNews 4


MARCH 2020

our adaptive interviews which deploy in our health systems across the U.S.” In the current case, Ide said the open-ended question asks patients to list places traveled in the last 14 days. As the coronavirus spreads beyond China, it allows providers to flag stays in other hotspot areas, as well. “The third way a virtual technology platform is helpful is we have real-time data on symptoms and diagnoses,” she noted. “This can be used to track patterns and the potential spread of communicable disease.” Ide said virtual care platforms also play an important role in education and the distribution of information. “We are able to embed key public health messages in our visits – both for patients and for providers.” During a measles outbreak several years ago, Zipnosis distributed evidencebased information to all patients accessing the system. Equally important, they were also able to remind providers in the affected area to be on the lookout for routine complaints that could actually be the early symptoms of measles, including fever, runny nose and dry cough. Yet another advantage of technology in any contagious occurrence – whether it be flu, measles or coronavirus – is to limit contact with others. If a reportable condition is suspected, online providers have the opportunity to direct patients to wear a mask or go to a specific area for a face-to-face appointment that is separated from the general patient population. For those with mild disease that doesn’t require patients to be seen in person, Ide added, “We can keep a lot of infectious, but not necessarily seriously ill, patients at home. We can treat them virtually and keep them out of waiting rooms.”

the spread worsen. “We do not live in a binary, black and white world … it’s not either/or,” said Tedros. “We must focus on containment while doing everything we can to prepare for a potential pandemic.” Coronavirus & COVID-19 Renowned infectious disease specialist William Schaffner, MD, professor of Medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine, noted coronaviruses are respiratory in nature. Severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome Dr. William Schaffner coronavirus (MERSCoV) are two examples of outbreaks in the recent past. “Human coronavirus is not typically serious. It just causes common colds,” said Schaffner, who also serves as medical director for the National Foundation for Infectious Diseases. “However, some circulate in other animals and occasionally, they – quote/unquote – jump species.” In the 2002-2003 SARS epidemic, he said the virus probably came from small bats and civets. Schaffner added the 2013 MERS virus was more directly linked to camels. “The current coronavirus has some bat genome, but it likely came to us through another animal that is yet to be identified,” he said. He added the death rate of COVID19 at this point appears to be less than SARS or MERS but more than influenza. Schaffner said even a low death rate, however, could have a huge global impact. “Even if the rate of death is small, since it affects so many people, the absolute number of deaths becomes large,” he pointed out. Containment “In China, they are in the midst of conducting the largest human public health experiment of all time,” said Schaffner of the massive quarantine that included not only Wuhan but the entire Hubei province. More than 15 million people have been essentially locked down, although discussions about easing some quarantine restrictions were beginning to occur at press time. “Wuhan is a teeming metropolis of 11 million people. Now it’s a ghost town,” said Schaffner. “The population obeyed (the quarantine), and that’s the whole point.” Interestingly, he added, “Much of the world did something else – they quarantined China.” International airlines cancelled flights and most interaction with China hit pause. As the virus began spreading to other countries, similar con(CONTINUED ON PAGE 8)



Leading Generations

HCA Study Sheds Light on Millennial & Gen Z Nurses Support System


A recent study by HCA Healthcare is shedding light on generational changes facing employers. Released last month, the study of millennial and Gen Z nurses cites open communication and professional development as key incentives for tomorrow’s healthcare leaders.

An Evolving Workforce

“This study came out of trying to understand changes in our workforce,” said Jane D. Englebright, PhD, RN, CENP, FAAN, senior vice president and chief nurse executive for HCA Healthcare. “HCA Healthcare is a 50-plusyear-old company, and we’ve always valued loyalty and longevity; but we started noticing different expectations Dr. Jane D. Englebright from newer employees. We wanted to take a hard look and make sure we’re as welcoming to new employees as we are to long-term employees.” Commissioned from the Center for Generational Kinetics in 2019, the study of 1,250 participants confirmed the importance of career development to millennials – and not in the traditional sense. “We realized that what it means to them is movement, to be constantly learning something new and gaining new experiences as opposed to climbing a traditional leadership ladder,” Englebright explained. Those findings and other insights are advantageous for the health system, which employs 98,000 nurses nationwide. “We bring on new nurses every day, so understanding the people we’re hiring is so important for us to be able to respond to their needs. We’re unique because we have so many hospitals, so we can offer employees any site or specialty area of interest.” More locations also mean more opportunities for internal recruitment and lateral movement. And while Gen Z and millennials often catch flack for having high expectations of employers, Englebright said younger nurses have equally high expectations of themselves. “We found that to be really affirming and positive,” she said.

factors in creating a positive work environment were nurses’ relationships, communication and ability to grow professionally: • Nearly half (44 percent) of millennial and Gen Z nurses rated team and managerial relationships as the top dynamics in a positive work environment; • 42 percent of nurses cited communication and the ability to make clinical decisions as important factors; • 43 percent said the opportunity to grow professionally through career advancement was a crucial factor impacting the work environment; and • More than a quarter (28 percent) of nurses also cited the importance of modern facilities and updated equipment as a factor in a positive work environment.

Additionally, the study looked at what helps nurses feel supported at work, as well as how nurses view career advancement and the need for training. More than half (57 percent) feel most supported through their team and co-worker relationships. Drilling down, support characteristics – such as scheduling flexibility, staffing levels, personal relationships, teamwork, training and the ability to have a voice in the organization – were consistently rated as important or very important by 43-46 percent of the nurses surveyed. Flexible work schedules was selected by 49 percent as the top way to help nurses feel supported, while 47 percent said having a clear pathway to sharing your ideas or having your concerns heard helps them feel supported. For millennial and Gen Z nurses, career advancement may not always be represented by vertical movement. Over a quarter (28 percent) of nurses rate being given increasing amounts of responsibility equal to moving to a different floor or department. Still, having a clear direction or knowing exactly what is needed to advance your career was rated as important or very

important by 46 percent of nurses, and 36 percent of nurses chose career advancement training as the most helpful type of employer education. “One of the more surprising findings was how important relationships are,” Englebright said. “We tend to think of this generation as tech-savvy individuals who would rather text than talk to you, but this showed us they really are about person-toperson connections in the career advancement space.”

Educating Leaders

HCA Healthcare also is working to bridge generations through conversations with nurse leaders. Englebright said helping older, experienced leaders understand differences is demystifying stereotypes and helping them understand the faster pace – and leadership potential – of younger generations. Her hope is to see nursing retention rates continue to improve, as the system becomes more sensitive to needs and expectations of younger nurses. She also hopes to develop more formal mentoring programs and more effective methods of tracking lateral movement to encourage career mobility. “We’ve been very conscious of doing a better job of orienting new nurses through our residency program, cross training, highlighting lateral career movement, and doing a better job of saying, ‘If you’re a nurse in med-surg and want to become a burn nurse, here’s the progression,” Englebright said of putting the study insights to work.

healthy vitals ProAssurance has been monitoring risk and protecting healthcare industry professionals for more than 40 years, with key specialists on duty to diagnose complex risk exposures. Work with a team that understands the importance of delivering flexible healthcare professional liability solutions.

Major Influences

The study identified several major influences on millennial and Gen Z nurses when evaluating current or future employment options, including the importance of team and managerial relationships, communications, ability to share ideas, opportunities for advancement, and access to the latest tools and resources for career development. Among the most important nashvillemedicalnews


Healthcare Professional Liability Insurance & Risk Resource Services

When you are treated fairly you are confident in your coverage • 800.282.6242 • ProAssurance.com

MARCH 2020



TMF Debuts Online Mental Health Screening Tool for Health Professionals Increasing mental health referrals to the Tennessee Medical Foundation (TMF) Physician’s Health Program led the organization to develop a new mental health resource for use by licensed health professionals across Tennessee. The new Tennessee Professional Screening Questionnaire, or TN PSQ, is an online self-screening tool that was made available statewide last month at tn.providerwellness.org. TMF and its partnering organizations, including the Tennessee Board of Medical Examiners, Tennessee Medical Association, Tennessee Hospital Association, and SVMIC, will share the link with their respective communities to help address rising rates of burnout, depression, and suicide among physicians and other licensed medical professionals. A phased rollout through March and April will also share the screening tool with Tennessee’s health profes-

sional schools, specialty societies, and other healthcare organizations across the state.

Proactive Approach

“As the number of mental health referrals began to rise, we began searching for helpful resources that would make an impact,” said TMF Medical Director Michael Baron, MD. “The goal is to connect more people to the help they need earlier in the process, hopefully before there’s a need for intervention by employers, a TMF referral, or licensing board action,” he added. Dr. Michael Baron “There are known barriers to getting help for mental health problems among doctors and other licensed

health professionals,” said TMF Administrator Mike Todd. “Confidentiality and existing stigma over seeking help, fears of career implications, and the perceived time and cost involved are all factors that can stop them from reaching out when they probably need it the most,” he said. TMF is the first Physician’s Health Program in the country to utilize the Interactive Screening Program (ISP), an online screening platform created by the American Foundation for Suicide Prevention (AFSP). Working in partnership with the AFSP, TMF has customized the ISP tool for the licensed health professionals it serves in Tennessee, which include physicians (MDs and DOs), physician assistants, optometrists, chiropractors, podiatrists, x-ray technologists, and veterinarians, as well as students, residents, interns, and other trainees for these professions at all levels.

The tool will be used strictly as a noncrisis service, offering an anonymous, confidential online mental health screening that will result in referrals to appropriate mental health resources and optional interaction with a program counselor. “This tool will be free, totally anonymous, voluntary, and the outcome completely driven by the user,” Baron said, adding this should address some of the fears involved in asking for help with mental or emotional illness.

Accessing TN PSQ

The TN PSQ, available at tn.providerwellness.org, is a 35-question, self-screening tool that takes approximately 10 minutes to complete. It is based on the PRIME-MD Patient Health Questionnaire and contains the nine-item Patient Health Questionnaire (PHQ-9).

Solving the Rural Health Puzzle, continued from page 1 key areas: closures, payment reforms, workforce and technology. Hoagland then turned the program over to moderator William Frist, MD, former U.S. Senate Majority Leader and a member of the BPC Rural Health Task Force, who introduced the day’s panelists: Sarah Chouinard, MD, chief medical officer of Community Care of West Virginia; Alan Levine, executive chairman, president and CEO of Ballad Health; and Stuart C. McWhorter, commissioner of the Tennessee Department of Finance & Administration. Frist pointed out 93 percent of Tennessee is rural … and health is influenced greatly by place. He added 60 million Americans living in rural areas are at greater risk of dying from chronic conditions like heart disease, cancer, stroke and respiratory diseases. “Much of health and well-being turns on the social determinants, the non-medical determinants. We’ve got to address those,” he said. “The residents of rural communities continue to face huge, huge disparities that in this century and in this great country really should not occur.” Representing the local community perspective that comes from working with a Federally Qualified Health Center, Chouinard said, “When you look at rural America, you see patients who are a lot sicker and older than those in urban areas. As a result, we have chronic illnesses that are less controlled, more severe.” She continued, “Layered on top of that now is the opioid epidemic. It really reaches every corner of everything we’re doing in the office. We have 6,900 kids who are in foster care – double what it was a decade ago – and state officials estimate that about 80 percent of those kids are impacted by the opioid epidemic.” She said what beautiful communities filled with great people are now faced with is addressing an issue that is new to them. “I don’t think the solutions are hard,” Choui6


MARCH 2020

nard noted, “We don’t need could make a difference. expensive technology to solve “The opportunity we’re this problem. We need bootsseeing is we have to bring on-the-ground people who are new jobs and support addressing issues like behavexisting industries in the ioral health and addiction.” rural parts of our state, Yet, she said, attracting a skilled and to do that we have workforce to rural communities to create more incenremains a major challenge. tive,” said McWhorter. Ballad Health serves 1.2 “You can’t draw people million people across 29 comto these areas of the state munities, taking a regional unless there are benefits, approach to rural care delivery. and we have to make the Levine said he was appreciainvestments in areas like tive for partnerships with state healthcare, education and agencies and the leadership more. These foundational they provided to address critical investments will change (L-R) Panelist Stuart McWhorter, Nashville Health Care Council areas of need. For rural hospithe trajectory for ecoPresident Hayley Hovious, Moderator Dr. Bill Frist, and Panelists Dr. Sarah Chouinard and Alan Levine tals, he said there was a threenomic development.” pronged problem that had to be Panelists agreed that addressed: 1) the movement toward valuebroader industry efforts to reform payto solve these issues will require patience, based care, which drives down utilization, ment models are valid, but they often are commitment to the effort and time.” 2) population decline in rural communities designed targeting urban healthcare cost He continued, “If you’re going to solve that comes from lower birth rates and the centers and end up squeezing already chalthese problems, you have to deal with both outmigration of young adults, and 3) social lenged rural healthcare providers. Chouisocial determinant issues at the same time determinants of health. nard and Levine said the unique challenges … bail the boat out and plug the leak.” “When you combine population of rural healthcare call for solutions that are All three panelists agreed early interdecline with the movement towards alterspecifically tailored to those communities. vention and pioneering initiatives are key native payment models that decrease the Despite the many problems facing rural to maintaining the health and well-being of volumes, you now have a business model health, Frist asked if there were optimistic rural communities. Levine cited plans Balthat’s in decline,” Levine said. He added, notes, as well? McWhorter pointed out the lad Health is developing to focus on residenrural hospitals won’t survive unless a bridge governor is very focused on rural Tennestial support for pregnant women who suffer is built to a different model of care. see and committed to improving communifrom homelessness or addiction - providing He added the need to address probties. Chouinard pointed to grassroots efforts treatment, prenatal care, parenting skills lems stemming from poverty is at a critispringing up to address issues like addition and other supports to help improve the likecal level and said the emerging science and recovery. “I don’t think these are problihood for a healthy mom and baby. Chouisurrounding the lifelong impact of adverse lems that don’t have solutions,” she pointed nard referenced Community Care of West childhood events underscores the need to out, “I just think we’re just at the tip of the Virginia’s partnership to educate teachers improve early childhood resources. iceberg in getting there.” about how to support students who have “There is the obvious problem of For Levine, he said the national encountered adverse childhood experipeople who can’t afford their medications, attention now focused on the dynamics ences. McWhorter added Tennessee Gov. don’t have transportation or food security,” causing rural hospitals to close is encourBill Lee’s proposed K-12 Mental Health said Levine. “The data shows the best soluaging. He said there is a growing recogniTrust Fund will place behavioral health tion for healthcare costs is to reduce povtion of the issues that exist coupled with a support services in schools. erty, which will close the racial and income growing will to find unique solutions. “I’m Addressing workforce and population disparity gaps and reduce the cost of healthoptimistic for the first time in a long time,” erosion is an area where McWhorter said care long-term. Whatever we’re going to do he concluded. statewide economic development efforts nashvillemedicalnews


NMGMA 10 Minute Takeaway Hiring Smart: Attracting & Retaining Talent



Send an email to coworkers introducing Finding a fit is just the first step. the new hire before their first day. Make “You need to onboard very well. The second Tuesday of the sure the new employee’s desk or office is The first week or two can set the month, practice managers and ready for their arrival and that training tone for that employee’s tenure,” industry service providers gather for new processes, equipment or software cautioned Gurganious. for an educational Nashville Mediis set up. Assigning a mentor to help the She suggested getting to know cal Group Management Associanew hire assimilate into the team is also a the new employee’s favorite chartion (NMGMA) meeting to hear good option. ity, treat, type of food, vacation spot from experts on a variety of topics and weekend hobby. Then, she said, to improve the efficiency and sucRetaining Valued Employees create an employee data file that is cess of medical practices. In FebruAfter putting in this much work, you used to personalize rewards for great ary, Valora Gurganious, partner want to keep them … and keep them performance or as recognition for a and senior management consultant happy. “Happy employees recruit new birthday or work anniversary. Purwith DoctorsManagement, distalent for you.” Gurganious said. “If you chasing a gift card to an employee’s cussed ways to attract and retain help them succeed, the practice will sucfavorite restaurant takes no more talent. ceed.” effort than buying one for another DoctorsManagement, based She suggested making efforts to keep option but shows you have paid in Knoxville, works with more in touch after the initial onboarding with attention to their preferences. than 700 practices nationwide on a handwritten note, stop by their office Speaker Valora Gurganious (L) with DoctorsManagement and NMGMA President Laura Watkins Gurganious said the first hour the business side of the healthcare or desk to speak, or an invitation to your of employment is the most critical. equation. Although her talk cenoffice for coffee on occasion. It’s also a She suggested meeting an hour before the tered around medical practices, the obsergreat way to gain insights from those on action and feedback, which can be hard for office opens and the day’s chaos begins. vations were applicable to most business the “front lines” about office processes managers. Talk about what it takes to be successful settings. It’s common for companies of all that work well or need attention and helps Another consideration is they value in this new setting, provide another copy stripes to have a mission statement that employees feel seen and heard. short-term experiences. Where baby of the job description, have all new hire calls for delivering high quality products Harkening back to character traits of boomers expected to stay on the job for documents together and remind the new or services while meeting or exceeding millennials, she said it’s important for them five-plus years, millennials and Gen X employee of why they were chosen for this customer expectations. The ability to to receive recognition for the good, which employees anticipate being a position only position. Then, she said, allow time for make good on those promises, however, makes it easier to accept correction when two to three years. “You can bet after 18 questions. comes down to the team members carryneeded. “People need to know you are months or so, they are on Indeed looking It’s also important to do the necessary ing out the mission. noticing the good things and not just focused for their next gig,” said Gurganious. prep work before they begin employment. “One of the areas my clients struggle on the negative,” Gurganious advised. She added the primary reason cited with the most is managing staff,” said Gurfor seeking a new job is “the boss.” The ganious, a certified healthcare business flip side is that employment surveys show consultant who earned her undergraduate those who like their manager or supervisor Presented by TSLMS degree from Vanderbilt and MBA from stay longer and perform better. GurganiHarvard. Yet, she continued, it’s one of ous said job satisfaction isn’t always about the most important roles. “Staffing costs pay raises, professional development or can be anywhere from 20-25 percent of perks … although all of those things help, every dollar,” she noted. And turnover, of course. “It’s really about how you make Symposium for Cosmetic Advances she continued, is costly. “It’s not only your employees feel,” she stated. “Learn & Laser Education expensive in terms of money. It’s expenhow to communicate with them based on sive in lost production and satisfaction their communication style,” she added. overall,” she said. Healthcare has seen an accelerated Hiring rate of turnover in the last decade. Now Finding the right match begins with second only to the hospitality industry, the interview process. Gurganious advised healthcare turnover rose from 15.6 perproviding a very detailed job description cent in 2010 to 20.6 percent in 2018, that includes not only work duties and COURSE DIRECTORS: BRIAN S. BIESMAN, MD & MICHAEL H. GOLD, MD according to a CompuData survey. Gurnecessary skills but also the qualities being ganious said staffing costs are rising across sought and expectations for the employee. all positions in the face of low unemploy“Be real,” she advised. “Candidates ment, which has created a demand for appreciate that, and it results in a much higher salaries and more benefits. better marriage.” Behavioral interview questions help Talent Pool employers assess the best fit, she said. The Music City SCALE Meeting is for physicians and clinicians So how does a manager attract and ‘Describe your most stressful day at work. interested in the latest procedures in aesthetic medicine. retain talent? Gurganious said it starts with How did you cope?’ Or, ‘Describe a time understanding potential employees. “Milyou had to bend the rules to achieve a lennials are your biggest pool of candidates goal. What was the outcome?’ Also ask Music City SCALE COST: $400 per person, now with over 80 million of them born questions about what the candidate finds Cadaver Workshop between 1982 and 2000.” She added this is Pre-registration is required. appealing about the open position and July 22, 2020 a generation influenced by the “self-esteem what they find most satisfying about a job. movement,” Iraq War, 9-11, school shootThen, Gurganious continued, “Listen to LASERS 101 with ings, social media and the “gig” economy. what they say. Listen for clues. Decide if Patrick Clark, PhD, CMLSO COST: Included in registration. While millennials sometimes get a bad rap, that works for you.” Part 1: July 22, 2020 Gurganious pointed out they also come She added it’s human nature to want Pre-registration is required. with a lot of good qualities. Typically, they to hire people who mirror our own valPart 2: July 23, 2020 are pretty confident and optimistic, are ues and talents. However, she pointed out generally well educated, socially conscious, choosing a ‘mini me’ isn’t always what’s CME CREDITS ARE AVAILABLE TO MEDICAL PRACTITIONERS. value diversity, like teamwork and are best. “You may need a different personalmulti-taskers. They also like constant interity to fill gaps.”

Mussic City Mu







MARCH 2020



APP’s Clinical Excellence Academy Preps Workforce on Patient Safety By CINDY SANDERS

Brentwood-based American Physician Partners (APP), a fast-growing emergency medicine management company with more than 140 care sites across the country, recently launched a new quarterly workforce enhancement program. The Clinical Excellence Academy brings together small groups of providers for clinical training on key emergency medicine and patient safety issues. Hosted at Lipscomb University’s College of Pharmacy and Health Sciences, the two-day program debuted last month and featured both hands-on lab procedures and group learning sessions. Topics ranging from stroke and trauma management to airway management with a procedural lab were designed to enhance provider confidence and hone emergency medicine skills. Participants included clinicians from APP partner sites in six states. “We recognize that not all clinicians practicing in the emergency department

Blog Log The Nashville Medical News Blog features additional insights and information from a crosssection of industry leaders. The blog can be accessed directly through NashvilleMedicalNews. Blog or from the homepage of the main website. NEW IN MARCH:

Chris Clarke, senior vice president of Clinical Services for the Tennessee Center for Patient Safety, a division of the Tennessee Hospital Association, shares insights and efforts from their MRSA reduction campaign: Staff Stepping Up to Fight Staph. Jenny Harvey, RHIT, CPHQ, CMPA, CPC, a manager in the Healthcare Consulting division of LBMC, looks at the necessary data capture and CDC coding guidance for COVID-19. Thomas Steinbrenner discusses employers’ exposure to workers’ compensation claims in the face of coronavirus. Steinbrenner is senior vice president with Hub International, a global employee benefits insurance brokerage firm headquartered in Chicago with offices around the world, including three in the Nashville area.



MARCH 2020

setting are necessarily board certified and residency trained in the specialty of Emergency Medicine,” Tony Briningstool, MD, FACEP, chief medical officer for American Physician Dr. Tony Briningstool Partners, explained of the impetus behind the new program. “Our goal is to foster a collegial environment for learning, to eliminate potential gaps in training, and to enhance procedural confidence and critical decisionmaking in high-acute areas.” Another topic highlighted at the

recent Clinical Excellence Academy was sepsis, which is the subject of a nationwide quality improvement effort by APP. Briningstool has headed the push to ensure best practice protocols are in place to quickly identify and address sepsis across all APP facilities. Sepsis is among the leading causes of hospital readmissions, among the most expensive conditions for inpatient stays and is the most common cause of death in the hospital setting. Called the ‘silent killer,’ early symptoms and warning signs are often tied to other conditions, making it difficult to diagnose quickly. Yet, time is of the essence in properly identifying and treating sepsis. For every hour treatment is

delayed, sepsis mortality increases by as much as 8 percent. Under Briningstool’s leadership, APP has launched the “Champions for Sepsis” program and best practice toolkit, which has increased sepsis protocol compliance from 60 percent to 100 percent across all facilities. The company also achieved SEP-1 status within the American College of Emergency Physicians and earned national recognition from E-QUAL Sepsis for performance improvements. While the accolades are a reminder of the hard work undertaken, Briningstool and clinicians across APP sites have noted the most important outcome is the number of lives saved.

Preparing for Pandemic, continued from page 4 tainment efforts were undertaken – from keeping passengers on cruise ships to quarantining evacuated nationals back in their home countries. Following a sharp spike in cases in late February, Italy quarantined a wide swath of the northern region and enforced a ban on public events in 12 municipalities. “If people can’t congregate, the virus can’t spread,” said Schaffner, adding that if COVID-19 does continue spreading despite quarantines, that would be greatly concerning. “Now is about the time we would expect to see cases drop if this is working,” he continued. The effectiveness of quarantines also has to be factored into any review of the containment process. “The cruise ships clearly provided a challenge to public health,” said Schaffner. “That turned out to be much less successful than anybody anticipated.” Fluid Figures Another issue hampering analysis of the outbreak has been fluid definitions of confirmed cases coming out of China. “The case counts and what they mean have been very difficult to interpret,” said Schaffner. “How you identify cases was defined and redefined and redefined again.” While glad WHO has been on the ground in China, Schaffner said he would have liked to have the Centers for Disease Control and Prevention there, as well. Having the CDC on site, he added, would have helped iron out definitions for COVID-19, but China did not extend permission to the U.S. experts. Had they done so, Schaffner said, “We would have been receiving a more rigorous and sustained flow of information.” Editor’s Note: New cases reported in China have seemingly slowed significantly over the past few days. Meanwhile, cases in other countries are increasing. Public Health & Patient Safety While it’s impossible to be perfectly prepared or to predict exactly how much

damage COVID-19 will cause going forward, Schaffner said the United States, led by the CDC, has marshalled resources. “They have done an absolutely splendid job of educating healthcare providers,” he said. In diagnosed cases, patients are being immediately isolated, Schaffner continued. He added those with confirmed cases have been admitted to hospitals and are receiving safe care, and providers are being protected, as well. “In close cooperation, our public health officials – local, state and federal – have worked hand-in-glove with clinicians to identify all the contacts of those infected and notify them,” he said of the U.S. containment protocol. That said, the spread of COVID19 in other countries has led the CDC to predict additional cases in the United States will be “inevitable.” Going forward, providers who encounter patients with a fever and respiratory complaints should ascertain whether they have recently traveled to an affected area or been in contact with someone who has. If the answer is yes, Schaffner said to immediately put a mask on the patient, isolate them and call the state health department. “They will help you manage the patient from then on,” he noted. One issue that has frustrated public health officials has been the ongoing problems surrounding the rollout of testing kits. CDC officials said they have modified the testing protocol and worked out technical difficulties, which should improve timely diagnostics. Editor’s Note: At press time there were six deaths from coronavirus in the United States, and the CDC had confirmed at least three cases of coronavirus of ‘unknown origin’ in the country, raising the specter of community spread. As a result, the CDC has broadened its criteria for testing. System Stresses When it comes to treating large-scale public health concerns, it requires an ‘all hands on deck’ approach utilizing clini-

cians, technology, researchers and all available community resources. Global epidemics put major stress on broader medical and financial systems. Even if COVID-19 only caused mild illness, Schaffner said, “It would have profound economic and social implications.” In an increasingly global marketplace, that toll has been evident. Entire towns and regions are being told to stay home, bringing commerce to a halt. Plants are closed in China so parts can’t ship, which in turn halts production of goods across the globe. In a three-day span in late February, the Dow Jones lost more than 3,000 points in response to the coronavirus. The medical system is also strained in the face of pandemic. Pointing to the 2009 influenza strain, Schaffner said, “It stressed the medical care system in the United States. It will do that wherever you go.” He noted no country can be “perfectly prepared” for such events. Hospitals don’t sit empty waiting for an outbreak. No one stocks enough ventilators or masks to care for the majority of the population. “Any society is going to be severely stressed if you have a genuine new pandemic,” Schaffner added. Those natural stresses are exacerbated by shrinking dollars. “We have a robust public health setup in the U.S., but public health departments at a state, local and federal level have had their budgets trimmed and whittled over the last 20 years,” he said. While, the president’s current budget calls for significant cuts for the CDC, the administration did request $2.5 billion specifically for the coronavirus fight, indicating they would ask for additional funding as needed. Schaffner pointed out being prepared to battle novel coronaviruses or other emerging threats requires sufficient, sustainable funding to lay the groundwork long before the flames are licking at the door. “If you’re going to fight fires, you better have highly trained firefighters in place,” he concluded.



Bass, Berry & Sims Releases Annual Healthcare Fraud & Abuse Report By CINDY SANDERS

Last month, Bass, Berry & Sims released their annual review of federal healthcare fraud and abuse enforcement actions for 2019. The report provides insight into issues of interest and analysis of trends and policy announcements surrounding compliance with the key federal statutes governing healthcare claims and referral relationships. The Healthcare Fraud & Abuse Review is a collective effort of the firm’s Healthcare Fraud Task Force and attorneys within the Healthcare Practice Group. The effort tapped into the expertise of more than 30 attorneys to create and edit the content. Civil fraud recoveries attributable to healthcare companies were $2.6 billion for the fiscal year that ended Sept. 30, 2019. That number was up just slightly from the $2.5 billion in FY2018 recoveries and marked the 10th consecutive year that healthcare fraud recoveries topped the $2 billion mark. “Healthcare companies must continue to invest in compliance efforts as fraud enforcement hasn’t wavered at all during significant political and healthcare industry changes over the last decade,” noted Brian D. Roark, head of the Bass, Berry & Sims Healthcare Fraud Task Force. “In an election year, where health policy is a crucial issue, we don’t expect anything but continued robust Brian D. Roark enforcement efforts across all healthcare sectors.” A number of significant developments … from important judicial decisions to trends in whistleblower approaches to the False Claims Act … were highlighted in this most recent report. One such trend was the rise of the “professional relator.” The False Claims Act (FCA) allows private citizens to bring actions on the government’s behalf based on allegations of wrongdoing in filing healthcare claims. As an incentive to turn in those engaged in fraudulent activity, whistleblowers receive a percentage of any monies recovered as a result of the lawsuit. While traditional relators have had personal knowledge of alleged false claims, the lucrative incentives have given rise to professional relators who mine Medicare claims data and other public information sources to develop FCA cases against healthcare providers with whom they have no personal relationship. “The drive for transparency in healthcare is making claims data and similar information available to analytics firms looking to make FCA cases,” explained Matt Curley, a member of the firm’s Healthcare Fraud Task Force and editor of the Review. “Providers must understand what their publicly available data show, because nashvillemedicalnews


the government and relators see this data as fertile ground for FCA cases.” Taking a deeper dive on the information in this latest Review, Curley and Roark – who teach the HealthMatt Curley care Fraud and Abuse Course at Vanderbilt University School of Law where they are adjunct professors– jointly answered questions about this year’s highlights for Nashville Medical News.

cases of the past year was an Eleventh Circuit decision holding that a claim cannot be deemed false under the False Claims Act based on a difference in clinical opinion between the government’s and defendant’s experts. Rather, FCA liability requires some objective falsehood, such as the physician did not review the patient’s medical records; the physician did not believe the diagnosis; or no reasonable physician could have reached the diagnosis. The court’s rationale should make it harder for the government or relators to bring FCA cases based on lack of medical necessity.

NMN: Bass, Berry and Sims has produced this annual report since 2012. What overall trends have emerged? Curley & Roark: During that time, the civil and criminal enforcement efforts of government regulators have remained robust both locally and nationally. We also have seen huge numbers of whistleblower lawsuits filed under the False Claims Act, with more than 3,500 such lawsuits filed by whistleblowers during the last five years. Results from enforcement actions concerning hospitals and health systems, as well as physicians, continue to make up a significant percentage of the recoveries involving healthcare fraud and abuse issues.

NMN: With both traditional and professional relators on the lookout for opportunities to file FCA claims, what should providers keep in mind? C&R: Data can be a great source of evidence for regulators or whistleblowers to bolster allegations of fraud against healthcare providers. It can show trends and how a provider stacks up relative to peers. Healthcare providers should proactively undertake to analyze and understand their own data, as that analysis may identify issues that need to be more closely reviewed or evaluated.

NMN: Was there a particular segment of healthcare that was more vulnerable to FCA actions in 2019? C&R: The government and whistleblowers continue to focus on arrangements between physicians and hospitals and whether those arrangements comply with regulatory requirements such as the Stark law and the Anti-Kickback Statute. There also is a continued focus on whether particular care or services are medically necessary. Both types of cases are important from the perspective of regulators because they implicate questions of patient harm and whether clinical judgment has been compromised. NMN: Speaking of Stark and the Anti-Kickback Statute, what should providers know about proposed changes and how those might impact the way they practice and refer? C&R: Proposed regulatory changes are intended to address the healthcare industry’s shift to a value-based payment and delivery model and movement away from the traditional fee-for-service reimbursement model. While the specifics of the proposed changes are too voluminous to catalogue here, these changes, if implemented, could go a long way to easing some of the impediments to moving toward a value-based model, many of which stem from enforcement actions challenging the appropriateness of financial arrangements between referral sources. NMN: What about the issue of medical necessity? C&R: One of the most significant

NMN: There are many private equity firms in Nashville that are instrumental in scaling up healthcare companies. What liability do they face if an FCA action is brought against a company in which they are an investor? C&R: There is no question that private equity firms are increasingly investing in companies across all sectors of the healthcare industry both in Nashville and throughout the country. There have been recent efforts by whistleblowers and regulators to hold private equity firms responsible under a theory that those firms caused their portfolio healthcare company to submit false claims to government payers. The more closely a private equity firm is perceived as involved in the day-to-day operations of a company, the higher the risk that whistleblowers might seek to bring that firm into the scope of their theory of liability. NMN: What course of action should someone take if facing an allegation of fraud or abuse or if an issue comes to light through a self-audit? C&R: Inquiries from the government (whether by subpoena, civil investigative demand, agent interviews, or through some other means) should always be taken seriously. Respond promptly, investigate any issues raised, and consider disclosing and resolving any problems found. Providers should evaluate their compliance programs and ensure that sufficient resources are in place to ensure that these programs are effective. If and when compliance issues are identified, providers must be sure to investigate and remediate those issues and should document those remedial efforts in the event those issues become the subject of whistleblowing or enforcement focus in the future. Providing appropriate feedback to

individuals who raise compliance issues is an important part of a compliance program. Individuals often become whistleblowers and pursue remedies outside of the organization when they do not believe their concerns have been heard within the organization. Downloading the Full Report The 2019 Healthcare Fraud & Abuse Review is available online both at Nashville MedicalNews.com and at BassBerry.com.

Mark Your Calendars Dr. Matthew Walker, Sr. Legacy Breakfast • March 31 Cal Turner Family Center at Meharry Medical College Join Moderator Phyllis Hildreth, JD, for a conversation with Juvenile Court Judge The Honorable Sheila Calloway, JD; Jeanette Norden, PhD, brain disorder specialist at Vanderbilt University; and Robin Williams, MD, breast surgeon with Saint Thomas Medical Partners and president of the Nashville Academy of Medicine. In addition to the panel discussion, the event will honor Michele Johnson, JD, with the Tennessee Justice Center, and Stephanie Bailey, MD, of Meharry Medical College. The 7:30 am event is free, but donations are appreciated and reservations required. For more information, go to MWCHC.org.

Friends & Fashion • April 6 Music City Center Don’t miss the 30th year celebrating Friends & Fashion benefiting Monroe Carell Jr. Children’s Hospital at Vanderbilt. Marketplace shopping begins at 10 am with the luncheons and fashion show running from 11:30 am-1 pm. For more information, go to ChildrensHospitalVanderbilt.org/ friendsandfashion.

2020 Walk to Cure Arthritis • May 3 & 17 Middle Tennessee State University Murphy Center Vanderbilt University Recreation & Wellness Center Join forces with other Middle Tennesseans to battle arthritis in the fight for a pain-free future. This year’s combined fundraising goal for the two events tops $160,000. To register, donate or learn more about the 2020 Murfreesboro event, go to WalktoCureArthritis.org/ Murfreesboro. For the Nashville event, go to WalktoCureArthritis.org/ Nashville.

MARCH 2020




T.J. Martell Foundation’s 202 Nashville Honors Gala


In late February, the T.J. Martell Foundation held a star-studded evening at the Omni Hotel to toast professionals in medicine, entertainment and business making a difference in the fight against cancer here in community and beyond. The 12th annual event, co-chaired by entertainment executive Steve Buchanan and Sweet Talk Publicity President/Owner Jensen Sussman, their fundraising record at the 2020 Nashville event surpassing $1 million. The night’s honorees were: GRAMMY award-winning contemporary Christian artist Amy Grant  –  Tony Martell Outstanding Entertainment Achievement Award (L-R) Clint Higham, Jim & Laurie Seabury, Amy Grant, Pat Emery and Dr. Jordan Berlin. President of Morris Higham Management,  Clint Higham – Chairman’s Award Associate Director for Clinical Research and Director of Phase I Research at Vanderbilt-Ingram Cancer Center, Jordan Berlin, MD – Medical Research Advancement Award Commercial real estate developer and CEO of Hall | Emery, Patrick Emery – Spirit of Nashville Award Community builders Jim and Laurie Seabury – Lifetime Humanitarian Award  The T.J. Martell Foundation is the music industry’s leading foundation that funds innovative medical research focused on finding treatments and cures for cancer. The Foundation was founded in 1975 by music industry executive Tony Martell and colleagues in memory of his son T.J., who died of leukemia. The Foundation has provided more than $280 million for research at flagship hospitals in the United States.

A New Era in Nephrology, continued from page 1 nephrology today is the ability to slow progression of diabetic kidney disease, which accounts for roughly 40 percent of kidney patients at VUMC. Harris said tremendous innovation has been made through the development of two new classes of drugs: SGLT2 and GLT1 Dr. Raymond Harris inhibitors, both proven in large, multicenter trials to slow progression of damage by 20 percent (on top of conventional therapy). By blocking key proteins, the therapies reduce blood glucose by allowing it to be removed from the body through urine. They have also proven effective in lowering blood pressure and weight, and researchers are hopeful the treatments could delay dialysis in some patients up to 20 years or more.

Educating Diabetics

T. Alp Ikizler, MD, chief of the Division of Nephrology and the Catherine Mclaughlin Hakim Chair in Vascular Biology at VUMC, said the therapies are a game changer but added educating diabetic patients is as crucial as ever. “Diabetes and high blood pressure contribute to the progression and development of kidney disease in different ways,” he Dr. Alp Ikizler explained. “They not only cause it but worsen the progression. Teaching patients about better control of blood pressure and diabetes is so important for those with kidney disease, because it slows down progression and protects them from damage over time.”

Home Dialysis

As one of the largest nephrology programs in the nation, VUMC also is leading the way in kidney transplants, with nearly 10


MARCH 2020

300 performed in 2019 alone. Researchers also are investigating new ways to create bridges to transplant and count home dialysis among the most effective options. In fact, 40 percent of dialysis patients at VUMC now receive treatment at home, compared to a national average of about 10 percent. Ikizler said home dialysis patients live longer, get transplanted easier and enjoy a better quality of life. “Our division is at the forefront of dialysis therapies, as we improve the way patients receive treatment at home instead of centers,” said Ikizler. “We’re vocal advocates for these patients. Ten years ago we knew this is what we should be doing for patients, and now there’s an executive order saying that’s what everyone should be doing.”

National Initiatives

Signed July 2019 by President Donald Trump, the Advancing Kidney Health Initiative marked a significant milestone for the nephrology community. The executive order aims to increase the number of transplant patients, cut costs for live donors and recipients, increase home therapies, and promote the development of new therapies including wearable and implantable kidney devices to reduce the need for classic dialysis. “The presidential initiative puts a spotlight on kidney disease in general because it’s been under the radar in many aspects, although kidney patients account for nearly five percent of the Medicare budget,” Ikizler explained. “This has been very important.” Similarly, the Kidney Innovation Accelerator known as KidneyX is another national initiative moving the science forward. “KidneyX has generated a lot of excitement in the nephrology community,” Harris said of the public-private partnership between the U.S. Department of Health and Human Services and the American Society of Nephrology. The incubator looks to accelerate the development of drugs, devices, biologics and other therapies across the spectrum of kidney care including prevention, diagnostics, and treatment.

The Forefront of Science

VUMC also continues to make strides in research with more than 70 faculty in 15 independent nephrology labs targeting a broad portfolio of research. Scientists are currently working with Bayer to identify novel therapies for kidney disease and have also partnered with their research facility in Germany to develop more treatments. “We’re looking at understanding mechanisms around kidney disease and developing new targets for therapies,” Harris said. “Our research is very focused on translatability and has really built up in the last decade with scientists at the forefront of so many clinical trials. We’re committed to understanding genetics and really pioneering novel therapies in kidney disease, including acute and chronic kidney injury.” He continued, “What’s really unique about Vanderbilt Nephrology is that we cover a wide spectrum, from the most basic research to patient-centric studies, in every aspect. We’re always putting the patient first to provide the best clinical outcomes.”

Changing Outcomes

Because kidney disease often goes undiagnosed for years, Ikizler also hopes to encourage the medical community to test at-risk patients earlier. Simple blood and urine tests can show signs of kidney disease before symptoms develop … but often go unordered. “Urine analysis, creatine and blood pressure all can identify patients at risk for kidney disease, but the general public hasn’t understood the importance of these tests like they do for cancer or heart disease,” he said. “This is a big issue, but a lot of people still have a nihilistic approach that you can’t treat kidney disease. This is a new era, and it’s time for primary care physicians, nephrologists and cardiologists to come together and implement new therapies that will change outcomes for patients and make a huge public impact over the next decade. The earlier we do this the better.”

PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Maggie Bond Wade Elder Pam Harris MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Melanie Kilgore-Hill Cindy Sanders CIRCULATION subscribe@nashvillemedicalnews.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 (FAX) 615.673.8819 or e-mailed to: subscribe@nashvillemedicalnews.com

Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.

NashvilleMedicalNews.blog NashvilleMedicalNews.com @NashMedNews

More Grand Rounds Online NashvilleMedicalNews.com




LBMC Adds National Healthcare Advisor Last month, Nashville-headquartered LBMC announced a key talent acquisition to the company’s Healthcare Consulting Practice. Mark Armstrong, MHA, FACHE, FHFMA has joined LBMC, a leading accounting and busiDr. Mark ness consulting firm, as a Armstrong shareholder. Throughout his career, Armstrong has acquired deep experience working in or advising for-profit and not-for-profit health systems, hospitals, physician practice organizations, and other types of provider organizations – both public and private, urban and non-urban. The first 18 years of his career were in C-Suite roles within hospital systems, including two community hospitals and a large academic health system.  Active in numerous professional organizations, he received his MHA, Health Systems Administration from Xavier University and an undergraduate accounting degree from Georgetown College.

Belmont University was recently notified its four-year-old Mental Health Counseling program  has received accreditation from the Council for Accreditation of Counseling and Related Educational Programs (CACREP for both the Clinical Mental Health Counseling (M.A.) and the Marriage, Couples and Family Counseling (M.A.) Mental Health Counseling Degree Program tracks. Last month, Frost-Arnett announced the retirement of President Emeritus George Buck. Buck, who is widely recognized as a national source of thought-leadership and actionable

best practices for the Accounts Receivable Management (ARM) and collections industries, led the company through strategic growth and success for four decades. He George Buck has consulted with federal regulatory agencies in need of healthcare-specific insights and analysis on proposed legislation and has been a presenter for numerous industry organizations. Buck plans to stay active in the industry through related industry and consumer organizations.

Brentwood-based IT services company Affinity Technology Partners (ATP) recently announced that CRN®, a brand of The Channel Company, has named ATP to its 2020 Managed Service Provider (MSP) 500 list in the Pioneer 250 category. This popular list identifies North American solution providers that deliver operational efficiencies, IT system improvements, and a higher rate of return on investments for their customers. “Being selected for the Pioneer 250 list is a huge honor for us,” said Sean Wright, president and founder. “It is a great affirmation of the hard work our team has embarked on.”

Boyd Named CEO of TriStar Horizon Jason Boyd has been appointed chief executive officer of TriStar Horizon Medical Center, effective March 2, 2020. Boyd, who has served as chief operating officer of TriStar Skyline Medical Center for the past five years, will have oversight of operations of the 157-bed Jason Boyd hospital in Dickson, as well as the 68-acre TriStar Natchez campus. Previously, he was interim CEO of the Metropolitan Nashville Hospital Authority, COO of Nashville General Hospital and COO at Magnolia Regional Health Center in Corinth, Miss. Boyd earned his

bachelor’s degree in healthcare administration from Western Kentucky University and his MBA from University of North Alabama.

Let’s Give Them Something to Talk About! Awards, Honors, Achievements

The pharmacy informatics residency program – a collaboration between LifePoint Health and the Lipscomb University College of Pharmacy & Health Sciences – has been awarded an eight-year accreditation by the American Society of Health-System Pharmacists (ASHP). The accreditation is effective through 2027, representing the maximum timeframe a residency program can be accredited by the organization. Developed in 2016, LifePoint’s pharmacy informatics residency is a 24-month program that combines participants’ postgraduate year one (PGY1) and postgraduate year two (PGY2) residencies, and is one of the few programs of its kind in the U.S. nashvillemedicalnews


Foresight in 2020. We believe that your malpractice insurance team should be ready and available when you need them most. SVMIC is built on this kind of reliable and dedicated relationship, so you can focus on your practice and we can focus on protecting it.

Move forward with us at


MARCH 2020



A New Ready-to-Use Non-Opioid Product

Caldolor® Available In A Pre-Mixed Bag


Profile for Medical News

Nashville Medical News March 2020  

your primary source for professional healthcare news

Nashville Medical News March 2020  

your primary source for professional healthcare news