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Personalized Medicine & Lung Cancer
New Therapies, Discoveries at Sarah Cannon Research Institute By MELANIE KILGORE-HILL
Guest Columns by U.S. Reps. Marsha Blackburn & Jim Cooper As the repeal, replace, repair debate continues in D.C., two well known lawmakers from Middle Tennessee weigh in with their thoughts about healthcare reform ... 5
Lung cancer isn’t the automatic death sentence it once was thanks in part to work being done in Nashville, including studies at Sarah Cannon Research Institute, the research arm of HCA’s Cancer Institute – Sarah Cannon. Daily discoveries are shedding light on the common diagnosis that is still responsible for claiming more than 155,000 lives annually.
Lung Cancer by the Numbers
According to the American Cancer Society, approximately 222,000 cases of lung cancer are diagnosed annually, and it represents the No. 1 cause of cancer deaths in both men and women. Two out of three people diagnosed with lung cancer are 65 or older, and black men are about 20 percent more likely to develop lung cancer than white men. However, the rate is about 10 percent lower in black women than in white women.
Hope through Clinical Trials
Early detection is key to survival, said oncologist Melissa Johnson, MD, (CONTINUED ON PAGE 9)
Prevent, Detect & Treat VICC Researchers Address Lung Cancer on Multiple Fronts Prevention, early detection and treatment: Those are the three pillars guiding cancer research at VanderbiltIngram Cancer Center where Pierre Massion, MD, who holds the Cornelius Vanderbilt Chair in Medicine and is the Ingram Professor of Cancer Research, has been named to direct VICC’s Cancer Early Detection and Prevention Initiative ... 6
ONLINE: NASHVILLE MEDICAL NEWS.COM
Study Highlights Higher Death Rate for Young People Experiencing an Incident Episode of Psychosis By CINDY SANDERS
A study published last month in the journal Schizophrenia Bulletin found the death rate in young people during the year following a first episode psychosis incidence was much higher than anticipated. Analyzing claims data on approximately 5,000 young people ages 16-30 with commercial insurance who had received a first observed psychosis diagnosis, researchers from the National Institute of Mental Health (NIMH) found the group had a mortality rate of at least 24 times higher than the same group in the general population in the 12 months following the index psychotic episode. With abundant clinical evidence from the United States and other countries showing a (CONTINUED ON PAGE 4)
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The Science of Mental Health
Centerstone’s Dr. Richard Shelton Looks to Accelerate Evidence-Based Care By MELANIE KILGORE-HILL
also cited the treatment of addiction as an example of lagging real world application, as breakthroughs typically aren’t applied evenly among patients or in the context of a larger program. “There are a lot of legacy practices that never get updated,” he said. “We want to push forward in providing that to clinicians right away. At the end of the day, I think this opportunity will give us resources and the tools we need to be able to pull information together about important treatment approaches and deliver that to clinicians as quickly as possible.”
It’s not uncommon for medical breakthroughs to take years, or even decades, to roll out in a real world clinical setting. Richard Shelton, MD, hopes to change that. In 2017 the clinical researcher was named chief executive officer of Centerstone Research Institute and chief medical officer of Centerstone America. In these roles, Shelton will advance the non-profit organization’s national clinical programs and lead its efforts to transform the delivery of care for those with mental health and addiction disorders.
Filling the Gap
“I’ve been doing research in this field for more than 30 years, and one thing that concerns me is a huge science-toservice gap,” Shelton said. “As scientists we generate lots of research data, but the evidence indicates a huge lag in time from when a discovery is made to when it can be operationalized. My objective is to take the best evidence we have in the field and apply that as quickly as we can in a clinical setting.”
The biggest hurdle lies in the timely collection and summarization of data from multiple sources. For example, promising research in the complex field of pharmacogenetics has been lingering since the 1990s, although the information was only recently pulled together. Shelton
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A veteran researcher and educator, Shelton served on the faculty of Vanderbilt University School of Medicine and Vanderbilt University Medical Center for nearly three decades. The James G. Blakemore Research Professor, he also served as vice chair for Clinical Research in the Department of Psychiatry, as well as a professor in the Departments of Psychology and Pharmacology. In 2012, Shelton joined the faculty of the Department of Psychiatry and Behavioral Neurobiology at the University of Alabama at Birmingham as the Charles Byron Ireland Professor, vice chair for Research, and head of the Mood Disorders Research Program. He will maintain his UAB appointment as he joins Centerstone.
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Shelton’s research has focused primarily on the treatment of depression, examining both experimental therapeutics and predictive analysis. His hope is to identify patients earlier and intervene to prevent negative outcomes including suicide. “The approach we’re taking statistically is very similar to the approach Google takes in anticipating what you’re going to type,” he explained. “We think it’s relatively unique to take multi-dimensional data, rather than just genetic or lab information, and push it through an algorithm that will help us identify people at higher risk of a particular problem.” It’s an area the Tennessee native and father of three has always found fascinating. A graduate of East Tennessee State University, Shelton attended medical school at the University of Louisville and then headed to Boston where he became chief resident at the Massachusetts Mental Health Center (now the Longwood Program), a teaching hospital of the Harvard Medical School. After residency, he was a research fellow at the National Institutes of Mental Health Intramural Program in Washington, D.C. before entering the faculty at Vanderbilt in 1985.
The son of an anesthesiologist, Shelton had plans to become an internist until his introduction to psychiatry. “Even in medical school so many of the typical medical conditions like hypertension were known, whereas in mental health little was understood,” Shelton said. “I thought that was an incredible area, with a massive need for help. There’s a tremendous amount of potential for research in mental health, and it continues to fascinate me.”
Changing Minds & Outcomes
He’s also seen a tremendous shift in views about mental illness over three decades, which he credits to the availability of treatment and the courage of those with mental illness to speak out. “When I first started, mental illness was something people uniformly hid,” he said. “The public perception changed when people would get on TV and say they got help. The stigma also declined as treatment got better, and people starting getting well. One reason I want to get treatment to people is because most can get better or recover and then open up about it.” He’s also eager to work with Centerstone’s large network of veterans programs and join them in partnering with schools across the U.S. “If you take something like depression, about 40 percent of people who will ever be depressed were depressed by age 21, and most start soon after puberty,” Shelton said. “We want to back the clock up and intervene with those kids before that age.” Advances in predictive analysis have also allowed researchers to identify children most at risk of mental illness, and Shelton hopes to work with pediatricians and schools to incorporate mental health into existing wellness programs. “As CMO of Centerstone, one of my major objectives is to develop and deploy models of care for mental illness and addiction, and I want to work with clinicians to see to it that those treatments are delivered with the highest fidelity,” Shelton said.
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Linking Primary Care & Behavioral Health Centerstone Takes a Whole-Person Approach By CINDY SANDERS
As healthcare increasingly sheds its silos, the concept of integrated care has gained rapid popularity. After all, most providers readily recognize individuals are more than just the sum of their parts. Comorbid conditions, transitions in care, medication interactions, cultural beliefs, environment, and support systems all have a direct impact on an individual’s health and well-being. An early adopter of the health home model, Centerstone continues to refine their whole-person approach. Mandi Ryan, MSN, RN, director of Healthcare Innovation for Centerstone of Tennessee, Mandi Ryan said coordinated care is important for everyone, but even more so
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 MAY: Dave Chaney, vice president of the Tennessee Medical Association, provides a wrap on the statewide association’s annual House of Delegates meeting held at the end of April, including information on resolutions and leadership transitions.
for those with mental illness. “Research shows individuals with severe behavioral health illness are dying 25 years younger than the general population, and it’s often not related to their behavioral health condition.” Instead, undiagnosed and unrelated medical conditions greatly impact those with serious mental illness (SMI). The most recent research shows 68 percent of those with SMI also have a physical condition (or multiple conditions) ranging from cardiovascular disease and hypertension to asthma and obesity. Barriers to primary care – along with the obstacles inherent in a complex, fragmented health system – exacerbate the problem for those trying to navigate life with mental, emotional and behavioral challenges. “In a health home, you have to focus on care coordination,” she stressed. She said it is critical to communicate across disciplines so that each provider knows the various treatment plans, particularly because some medications to address mental health issues put individuals at higher risk for other conditions such as increased blood pressure. Improved care coordination was one of the reasons Centerstone partnered with Unity Medical Clinics four years ago to have primary care and behavioral health providers under one roof. In addition to improved outcomes, the whole body approach also helps get a handle on costs. Care for conditions like hypertension and diabetes cost two to four times as much for patients with diagnosed mental illness and substance abuse compared to in-
dividuals without those issues. Coordinated care can bend the cost curve by keeping chronic conditions better controlled. Ryan, who has been with Centerstone for a little more than three years and in her current post for just over a year, has a varied clinical background. A nurse, she has worked in primary and critical care, in the corrections system, and for an inpatient psychiatric facility. She has found that diversity of experience is beneficial in her current role. “It gives you an idea of all the different kinds of healthcare and how they integrate and why you can’t have the silos we’ve had in the past,” she explained. Centerstone has several health home grants and coordinated care projects. One of the most recent initiatives is Health Link, a program rolled out in December 2016 by Tennessee Health Care Finance & Administration for TennCare members with significant behavioral health needs. Having applied and been approved as a Health Link provider, Ryan said Centerstone’s model includes a registered nurse as the lead care coordinator who works with a number of other specialty staff including wellness coaches, primary care providers and mental health providers to meet an individual’s needs. Supportive services include comprehensive case management, care coordination, health promotion, transitional care, patient and family support tools, and community referrals to social supports. “One of the things the state provided to us is a care coordination tool,” Ryan noted. She said the team is alerted if an enrolled patient goes to the hospital, which allows
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Mark Gelder, MD, chief medical officer for Franklin-based Pierian Biosciences outlines the role functional assays play in effective immunotherapy and chemotherapy combinations to improve patient outcomes. Nashville Health Care Council recently hosted the 12th International Health Care Mission in the United Kingdom. The event brought together a diverse group of key healthcare business executives for trans-Atlantic learning, high-level networking and global dialogue. A three-part report outlines insights and findings from this latest successful international mission.
Health Link providers to make sure individuals understand discharge instructions and get appropriate follow-up care. Ryan said a key goal is to try to prevent hospitalizations and readmissions, along with teaching the appropriate use of the Emergency Department. “We’ve been able to see results behaviorally and on the medical side, as well,” she said. Participants have reduced blood pressure and cholesterol levels and improved diabetes control. “Participants have also reported decreases in depression and anxiety and an overall improvement in well-being,” she continued. At enrollment, Centerstone does baseline measures to be able to track outcomes. Interestingly, Ryan said 35 percent of participants self-reported they had diabetes or had been told they had elevated blood sugar. However, when individuals were actually tested, 77 percent had diabetes or pre-diabetes. “A lot of our individuals just weren’t having those yearly screenings you really need to have,” she said of keeping chronic conditions in check. And, she continued, “It’s been shown that diabetes is linked to depression … you improve one area, your behavioral health improves, as well.” While Health Link is a specific state program, the success of this and other Centerstone integrated health grants and programs has led Ryan and colleagues to actively work to expand the health home model to other populations in order to improve overall health while reducing expenses. That, she said, is the classic win/ win for all involved – “Improving quality can save costs.”
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TMA Scores a Legislative Win Provider Stability Act First of its Kind in U.S. By CINDY SANDERS
The Tennessee Medical Association scored a major policy win as both chambers of the Tennessee General Assembly unanimously passed SB437/HB498, known as the Provider Stability Act. Sponsored by Sen. Bo Watson (RHixson) and Rep. Cameron Sexton (RCrossville), the legislation revises various provisions to address the timing and notification behind changes to a provider’s fee schedule by health insurance entities. The TMA, which represents more than 9,000 physicians across the state, has pushed the measure since 2014. Signed by Gov. Bill Haslam on April 5, the new law (Public Chapter 88) will go into effect Jan. 1, 2019 and is the first of its kind in the United States. “This is a huge win for physicians and all healthcare providers in Tennessee,” said TMA Immediate Past President Keith G. Anderson, MD, of Memphis. “TMA listened and has responded to members’ growing frustrations by bringing some stability and predictability to the
marketplace.” Although medical practices, hospitals, health systems and other healthcare providers entered into contracts with health plans to spell out the fees for healthcare Dr. Keith Anderson services provided to patients covered by that health insurance plan, the TMA said such contracts had been routinely written to allow insurers to lower payment at any time, for any reason. The Provider Stability Act requires a health insurance entity to provide notice to a healthcare provider of any material change made at the sole discretion of the insurance carrier to the entity’s previously released provider manual or reimbursement rule and policy at least 60 days prior to the effective date. It also limits fee schedule changes to once in a 12-month period and requires 90 days notice of those changes. TMA officials said unexpected changes in reimbursement had real-world financial consequences and could lead to
a physician dropping a specific service or dropping out of a network altogether. In those cases, they argued, patients paid the price by losing access to a service, having to pay out-of-network fees to continue seeing a physician, or being forced to switch physicians to stay in network. In rural areas with fewer numbers of physicians, specialists, practices and facilities, such scenarios had a magnified effect on access and choice. “This effort grew from our planning discussions with our members who were increasingly frustrated by having to work in shifting sand when it came to the payment policies of health insurance companies,” said TMA CEO Russ Miller, CAE. “We looked around and found no other state had addressed this issue so we Russ Miller rolled up our collective sleeves and dug in. It did take four very long years, but any time you try to break out of the mold of the way it’s always been done, you are going to face
some serious opposition.” Miller said he was particularly proud of the physician leaders and TMA government affairs staff who “weathered some brutal storms” to help make the bill into a law. “The most critical piece was having a real champion in the legislature in Senator Bo Watson, who refused to let the issue die,” continued Miller. “Because of him and our team, physicians, medical practices and other providers will find more predictability and less turbulence in their reimbursement contracts with the insurance industry.” Miller said the measure was supported by other statewide organizations, as well, including the Tennessee Hospital Association, Tennessee Medical Group Management Association, and a number of specialty organizations, teaching hospitals and nurses. He thanked the many providers and administrators who made calls, wrote letters and scheduled meetings with legislators to push for the bill and called passage of the Provider Stability Act an example of the value of organized medicine to effect change.
Study Highlights Higher Death Rate for Young People, continued from page 1 correlation between mental illness and decreased life expectancy, the NIMH research team expected there would be elevated mortality for this group but were still surprised by the findings. “I wasn’t surprised by the direction of the effect. I was surprised and shocked by the scale of the effect,” said Michael Schoenbaum, PhD, senior advisor for Mental Dr. Michael Health Services, EpideSchoenbaum miology and Economics for NIMH who led the research project. He added, “We were so shocked when we first did this analysis that we bent over backwards to check it and make sure we hadn’t used the data wrong and made a mistake.” After recalculating, the team concluded they hadn’t missed the mark … and, in fact, reported the figures using the most conservative assumptions. “To find a group in the U.S. general population with mortality as high as our conservative estimate for these young people, you have to look at Americans over age 70,” said Schoenbaum. “The upper end estimate is more than a 7 percent mortality rate in a year. In the general U.S. population, you wouldn’t expect to see that rate until people are in their 80s.” In addition to mortality, the study also looked at the healthcare treatment those ages 16-30 received in the 12 months following the initial psychosis diagnosis. That analysis uncovered the group had low rates of medical oversight and only modest involvement with psychosocial treatment providers. According to the re-
port, “In the year after index, 61 percent of the cohort filled no antipsychotic prescriptions and 41 percent received no individual psychotherapy. Nearly two-thirds (62 percent) of the cohort had at least one hospitalization and/or one emergency department visit during the initial year of care.” Schoenbaum said the NIMH has made it a strategic priority to not only discover new treatment options for those with a diagnosed mental illness but to also develop and test better ways to deliver existing treatments. “This is a devastating thing to happen in people’s lives,” he noted. “We’ve had data for a long time that suggests historically there has been a long gap in time between when a person experiences psychosis for the first time and when they receive meaningful care.” This new analysis, he said, helps confirm that suggestion and shows there is much room for improvement. The study, which looked at 2008-2009 commercial payer data, was made possible through a multi-payer claims database built by the Department of Health and Human Services using funds from the stimulus package following the financial crisis. “That dataset did two things we couldn’t easily do before this,” explained Schoenbaum. “First, it was a really large sample.” He said having access to this commercial payer information was critical since most young people in the United States have commercial insurance … if they have coverage … at the time of symptom onset. While Schoenbaum said a limitation of the study was that the team
couldn’t definitively say it was each individual’s first episode of psychosis without having lifelong data, they did single out only those young people who had no sign of psychosis in the 12 months prior to the documented episode. “The second innovation in this dataset is that it also contained information on mortality,” he continued. “In this country, it is relatively rare to link information on people’s health and healthcare on the one hand with death and mortality on the other.” There are, of course, exceptions. Schoenbaum said there is really good mortality data available for cancer and cardiovascular surgery. “But there is no place in mental health where we do that right now,” he noted. “You have to know there’s a problem before you can fix it. If we can’t study patterns of mortality, we don’t know if there’s a problem and what kind of problem it might be.” Going forward, Schoenbaum said he would like to see if their findings are replicated in other U.S. samples and to have access to more specific mortality data. The database used listed all cause death without specifying if mortality was a result of suicide, homicide, accident, or other. “It would be really valuable to not just know that they died but how they died.” He also said it’s important to implement the clinical practice guidelines that already exist more consistently and then measure the impact on mortality. Despite being identified with early psychosis, Schoenbaum said the analysis highlighted the next critical step of effectively connecting these patients to models of care didn’t
routinely happen. “This is a highly vulnerable population. We just didn’t realize how vulnerable,” Schoenbaum said of the study’s results. “We want to connect them to effective services. One hope is that people recognize that these individuals aren’t just at risk of suffering … their lives are at stake.” On the positive side, he continued, “The relatively low levels of care that we observed here underscore the potential value of the new models for treating first episode psychosis, specifically what’s called coordinated specialty care.” Congress has earmarked 10 percent of SAMHSA mental health block grant funding go to states for coordinated specialty care programs for first episode psychosis. “By 2018, all states are expected to have at least one such program, and some states will have multiple programs,” Schoenbaum said, adding such programs are measurement-based and are engineered to analyze results and make adjustments as needed. Schoenbaum’s other hope is that the study will help launch larger conversations about mental health and mortality. “Together with the national increase in suicide rates and the national epidemic of deaths from opioid overdose, I think this paper underscores the importance of tracking mortality as an outcome for people with behavioral health problems,” he said. “In the meantime, this study is a wake-up call telling us that young people experiencing psychosis need intensive, integrated clinical and psychosocial supports,” Schoenbaum concluded.
Op-Ed: Healthcare Reform Publisher’s Note: The American Health Care Act – a Republican alternative to the Affordable Care Act backed by President Donald Trump and House Speaker Paul Ryan – was pulled before a floor vote in late March amid clashing views over the best way to rework the American healthcare system. However, plans are underway to introduce a new measure, and discussions about repealing, replacing or repairing the ACA continue as legislators from both sides of the aisle grapple with accessibility and affordability. Nashville Medical News is pleased to share the ideas and opinions of two of our U.S. Representatives from Middle Tennessee. While the ideological approaches might be quite different, the mutual desire to create a sustainable, high quality, patient-centered healthcare system should serve as a place to start a productive dialogue.
Fixing Our Healthcare System Don’t give up on reforming our healthcare system! Readers of Nashville Medical News are certainly tempted to think about something else. You are busy taking care of today’s patients. You are frustrated with the bumbling efforts at the national and state level to “improve” care for tomorrow’s patients. You have seen past reform By REP. JIM COOPER efforts backfire, adding more complexity, bureaucracy, and anxiety to your lives. In fact, it is hard to understand what those “reformers” were even trying to achieve. The reality, however, is that you need to be at the table to avoid being on the menu. Reform is going to happen with or without you, so you might as well put in your two cents. Have lunch or be lunch. Reform is not just for young people. Even physicians, nurses, and other providers who are thinking of retiring need to realize that they still have much to lose by not speaking out. You also have much to gain by helping others learn from your years of experience. Retirees have
even more to offer because they have the time to think deeply about these issues. Nashville is a healthcare capital in so many ways, but we have not led the policy debates as we should. Most congressional and state legislative policies have been decided without us, rather than shaped by us. Readers of Nashville Medical News provide some of the best care in the world, but we have not been given the respect that such high-quality providers deserve. Whether you love or hate Obamacare, there is a place for you in the policy debates. Whether you want to expand Medicaid in Tennessee or not, we need your voice. Any federal or state legislator who does not know who you are and what you do for a living — and how well you do it — will not be able to represent your views. Even better, physician, nurse, and provider groups should get together to make unified recommendations to lawmakers. Professional groups and trade associations often do this regarding reimbursement and liability issues, but they get quiet about broader issues. Just so you know where I have stood in the past, I have supported bipartisan, market-oriented alternatives to Clintoncare, Obamacare, and now Trumpcare. I have always believed that access to medical care is such a per-
sonal, urgent need that the last thing patients should have to worry about is politics. I care so much about health reform that I have taught MBA students at Vanderbilt’s Owen School of Management for 20 years. This year I was once again invited to speak to Vanderbilt’s medical school. I am a Democrat who is a strong supporter of Republican Governor Haslam’s “Insure Tennessee” plan. His plan to expand Medicaid in our state has not even been voted on in the Tennessee General Assembly after three years of waiting. His plan deserves a vote. We deserve to know where our state lawmakers stand. And our citizens deserve that medical care. Obamacare is working much better than most Republican partisans believe, but it needs many fixes. Our Republican colleagues should stop trying to repeal Obamacare and start trying to help fix it. Republican failure to pass their own, hastily-drafted AHCA in March highlighted the absence of a real alternative to Obamacare despite seven years of complaints, as well as the many problems with the box of policy Band-Aids they were offering. I mention these things, not to foreclose debate, but to open a discussion. I learn something every day and (CONTINUED ON PAGE 10)
Competition Drives Patient-Centered Care Tennessee has been hit especially hard from President Obama’s Affordable Care Act. Over 130,00 Tennesseans lost coverage last year, premiums have increased by up to 62 percent for many consumers and 73 of 95 counties have only one health insurance provider. Last year, Cigna asked for and received a 46.4 percent premium increase, Humana, By REP. MARSHA 44.3 percent, and BlueCross BLACKBURN BlueShield of Tennessee, 62 percent. After seeing these numbers, it is of no surprise that the Tennessee Insurance Commissioner said the Obamacare exchange was “very near collapse” just last summer. There is quite obviously a lack of competition, keeping companies from competing for business across state lines and keeping consumers from shopping around for their best options at the most affordable price Competition drives us forward. Whether it’s in the context of a sporting event, your career, or business, competition makes you better and drives innovation. It’s no different in the healthcare insurance marketplace where enabling consumers to choose between multiple products that adhere to their specific needs stabilizes the market. After all, individuals are far more suited to picking plans that work for them than the bureaucrats in Washington, D.C. This is why competition is necessary for driving quality care and better health outcomes. The healthcare marketplace is distressed due to Obamacare and the limitations that exist from the individual mandates and absence of competition. Americans are tirelessly waiting for the federal mandates to be nashvillemedicalnews
thrown out and the marketplace opened up, which is why I keep working on my legislation, H.R. 314, the Health Care Choice Act. This legislation would repeal Title I of the Patient Protection and Affordable Care Act and puts in place a policy that would allow for the purchase of health insurance across state lines. In other words, you can purchase what you want from wherever you want at a price you can afford. Unfortunately, that has not been the case, and I regularly talk with constituents who are more than ready for that to change. Last year, I authored H.R. 706, the Plan Verification and Fairness Act, which called for the administration to follow their own law by providing verification for populations that were enrolling into the marketplace under a Special Enrollment Period (SEP). Under current law, to qualify for a SEP, a person must provide documentation that a life-altering event has occurred. These events could include: moving, birth, marriage etc. - all situations where proper documentation is provided; and the former administration refused to verify this information so that they could drive up the marketplace’s enrollment numbers. This intentional oversight caused an imbalance within the marketplace and led to consistent abuse by gaming the system. It’s like purchasing a new car, wrecking it, and then buying car insurance. Having this ability within the exchanges allowed for common abuse. Without implementation of my bill, this was a system that was allowed to fail. The Plan Verification and Fairness Act is a common-sense solution for a failing marketplace. In 2017, my bill was implemented through rulemaking as part of the Market Stabilization Rule - and this effort resulted in a 100 percent pre-verification by the administration for Special Enrollment Periods. These solutions help those in areas like Knoxville where only one carrier remains. While this helps offer stability to the mar-
ketplace, having competition in place would help avoid future disruption. Competition brings multiple options to you and allows you to make the choice, not the federal government or the insurance company. That is what patient-centered healthcare is all about. You have the power to review the options and select what is best for you. Businesses compete for your business and work to keep you as a customer. You are in charge. Currently, if a consumer were to attempt to purchase individual health insurance, that plan is controlled by the individual states. Opening up the market would eliminate the specific state regulations to create more health plan options- regardless of state or location – providing flexibility to the consumer. Allowing for the purchase of health insurance across state lines changes the narrative. It takes healthcare coverage from a bureaucratic decision to an individual choice, stepping away from a “one-sizefits-most” plan that doesn’t encompass the variation in consumer needs. Under Obamacare now, the federal government has overstepped its bounds in mandating what insurers’ offer to their customers. The qualifications to fit the mandated health plan have, no doubt, limited how the health plans operate. This doesn’t enable competition. It’s obvious – if we continue to let the federal government take the lead in regulating individual choices, competition will be nonexistent. Therefore, it is imperative that we give both states and consumers flexibility in the options that exist when they’re purchasing a health plan that will actually accommodate their individual needs. The Health Care Choice Act will allow you to shop for health insurance like you would any other type of insurance: online, by mail, or over the phone. (CONTINUED ON PAGE 10)
Prevent, Detect & Treat
VICC Researchers Address Lung Cancer on Multiple Fronts By MELANIE KILGORE-HILL Prevention, early detection and treatment: Those are the three pillars guiding cancer research at Vanderbilt-Ingram Cancer Center where Pierre Massion, MD, who holds the Cornelius Vanderbilt Chair in Medicine and is the Ingram Professor of Cancer Research, has been named to direct VICC’s Cancer Early Detection and Prevention Initiative. The focus is directed Dr. Pierre Massion at expanding campuswide research and addressing the critical issues in early detection and prevention for a host of leading cancers.
Prevention & Detection of Lung Cancer
“We’re trying to make progress in lung cancer management and therapeutics, but people universally recognize that it’s difficult to cure cancer,” Massion said of the three-pronged mission. “The best chance to have a large impact on the population is through prevention because it’s very difficult to move the needle once people already have cancer.” In comparing strategies for detection and intervention of lung cancer, Massion said 12,000 lives a year could be saved through early detection, while 2,500 advanced-stage lung cancer patients could be saved through progress in chemo and
targeted therapies. “The biggest news since 2011 in the field of early detection is that we know screening decreases relative risk for lung cancer mortality by 20 percent,” he said. “Many centers are striving to engage in early detection, and Vanderbilt recognized this and wanted to develop an initiative to encourage investigators to study these problems and tackle early detection and prevention, specifically at a cancer center.” A 17-year veteran of Vanderbilt, the pulmonologist stepped in to lead the initiative when it launched in 2016. “This is an exciting, forward-thinking position, and we’re trying to readjust disparities in funding and efforts.”
Promising Findings at VICC
Massion has dedicated his career to developing strategies for early detection of lung cancer and is driven by the goal of finding better strategies to identify those at greatest risk. In January, his laboratory, in collaboration with researchers in the Schools of Medicine and Engineering at Vanderbilt University, announced discovery of a proteomic “signature” from the airways of heavy smokers that could lead to better risk assessment and perhaps new ways to stop lung cancer before it starts. Their findings, reported recently in the journal JCI Insight, are based on the observation that otherwise normal-looking cells in the epithelial lining of the lungs of heavy smokers and others at high risk for lung cancer undergo the same kind of “meta-
bolic reprogramming” as do cancer cells. Massion, who served as senior investigator of the study, said the team was trying to answer the question of why and how cancer cells develop in the airways. “We wanted to know what molecular changes are happening in the airways of people at different risks, from the young who don’t smoke to those at high risk,” he said. The group took brushings of airways (windpipes) to quantify risk of developing lung cancer and methods to identify changes. “Along with increased risk in the airways, people develop a lot of changes in proteins that regulate metabolism into cells,” he explained of the findings. “Cells are growing and living in the airways, but as your risk increases and with smoking, some metabolic enzymes get more expressed and specific metabolic pathways change.” Using another method, researchers conducted the same study on a different group of patients at equally low, moderate and high risks. Their results were similar: Cells that look completely normal had undergone profound metabolic changes similar to the changes in cancer cells but without cancer. That discovery led to more questions including how cells update glucose, produce lactate, and deal with oxidized stress and glutamine demand. “This is relevant because we’re closer to understanding how changes in cellular metabolism affect genomic instability,” Massion said. “The next step is to understand how metabolic programming facilitates genomic
instability, which is a known requirement for the development of cancer.” The findings have resulted in much excitement in the scientific world, as there are proven ways to prevent metabolic changes from happening. “We’re interested in understanding how metabolism in the airway affects immune response and how eventually some people develop lung cancer because their immune response was impaired for some reason,” Massion said. “A lot revolves around immunology oncology in lung cancer.” Vanderbilt University Medical Center is one of only a few academic medical centers in the country with a dedicated hospital-wide tobacco treatment service (TTS). Launched in 2015, the Vanderbilt Center for Tobacco, Addiction and Lifestyle (ViTAL) treats an estimated 3,500 patients annually. A tobacco treatment service provides evidencebased care to tobacco users who have been identified from the electronic health record as a current or former smoker. Certified Tobacco Treatment Specialists proactively visit patients to assess use and patterns, as well as to provide counseling and smoking cessation aids to manage nicotine withdrawal. Initiating smoking cessation treatment while a patient is hospitalized has been shown to increase long-term quit rates by 40 percent or higher.
New Take on an Old Disease
Saint Thomas Takes Multidisciplinary Approach to Lung Cancer By MELANIE KILGORE-HILL
The Saint Thomas Lung Cancer and Thoracic Center is redefining the treatment of lung cancer. Their multidisciplinary approach brings together specialists from multiple fields to treat each patient’s cancer individually, while low-dose CT lung scans can detect problems long before symptoms start. It’s an initiative that thoracic surgical oncologist John Howington, MD, FACS, FCCP, said grew from the desire to revolutionize treatment of lung cancer patients while bringing together the most knowledgeable personnel possible. Dr. John Howington
Specialized Care “We wanted to change how these patients receive treatment, and we have thoracic surgeons who have a special focus on lung cancer and who are well trained in minimally invasive surgery and diagnosing nodules,” Howington said. Specialized expertise means 98 percent of procedures done through the center uti6
lize minimally invasive scopes, which results in less pain and shorter hospital stays for the patient. Saint Thomas pulmonologists are experienced in navigational bronchoscopy and endobronchial ultrasound to add to the minimally invasive diagnosis and work up of lung cancer patients.
More Screenings The need for dedicated care for this growing population resulted from a January 2015 decision in which Medicare agreed to pay for lung cancer screenings. “They listed specific criteria for who’s eligible, and there are more patients at high risk being screened than ever before,” said Howington, who has seen a 20 percent increase in screenings since last year. “This resulted in a concentrated focus on the disease and an increased need to communicate with primary care providers about lung cancer risks in the senior population so that they can have that discussion with their patients.” An Ongoing Effort Through the center, Saint Thomas pulmonologists and surgeons also partner with medical oncologists to provide patients with access to clinical trials locally and nationally.
Enrollment is currently underway for stage three and advanced stage lung cancers. To attack lung cancer on the front end, Saint Thomas works with the American Lung Association and the American Cancer Society in referring patients for smoking cessation. As immediate past president of the CHEST Foundation, Howington also contributes his efforts to the ALA’s peer reviewed patient education materials and staffing hotline and Tobacco Free America.
Changing Minds Statistics are promising, with less than 20 percent of Americans still considered smokers (although Tennessee’s rates are higher than the national average). Still, the aging baby boomer population means cancer is being diagnosed more often in the elderly, with a median patient age of 70. “While incidence per 100,000 is going down, prevalence is actually going up,” said Howington. That sobering fact has driven him to visit classrooms and high schools to discuss tobacco use and smoking cessation. “The concerning thing is that between 2000 and 2010 there was an increase in smoking among teen women, which is related to appetite suppression,” he said.
Another hot topic among today’s youth is vaping, or e-cigarettes, often considered harmless. Howington said the devices wreak the same havoc on the cardiovascular system as traditional cigarettes and that the hydrocarbons produced in the vaping process are too new to understand their long-term effects. In general, it takes 20 years after the introduction of a carcinogen before cancer starts developing.
Room for Improvement And while more of the aging population is being screened, Howington said there’s room for improvement in screenings among Medicare eligible patients. “One thing required is shared decision making with their healthcare provider,” he said. “We work within the system to make it easier for patients to meet with their doctor and talk about testing. They know someone with expertise is following up on them and helping; it’s not just a screening and you’re done.” He also encourages providers to talk openly to their patients about their fears and risks. “Patients need to know that not every nodule turns out to be cancer, and that there’s hope.” nashvillemedicalnews
ONcology Rounds John T. Wilson, PhD, assistant professor of Chemical and Biomolecular Engineering and of Biomedical Engineering at Vanderbilt University, has received an Innovative Research Grant from Stand Up To Cancer (SU2C). Wilson is among 10 early-career scientists to receive the grant awards focused on immuno-oncology. Wilson, who is also a member of Vanderbilt-Ingram Cancer Center, is trying to determine how a “cold” tumor that does not respond to immunotherapies can be reprogrammed into a “hot” tumor that is recognizable by the immune system.
The word to describe Tucker Williams is joy. “He is happy, fun, active, and an extremely strong little boy,” said his mother, Jessica. Just 14 months ago she might not have described her son this way. At that time, just two months old, Tucker went from being a typical newborn to a child in need of serious medical care. He went from eating six ounces of food to nearly nothing. “I knew his eating patterns, and when he refused to eat and began sleeping more than usual, I knew something was wrong. Cancer never crossed our minds,” his mother recalled. Admitted to The Children’s Hospital at TriStar Centennial, a large cancerous abdominal mass was discovered located deep near Tucker’s diaphragm. Haydar Frangoul, MD, a pediatric hematology/ oncology physician, was assigned to the case. “Tucker’s diagnosis was Rhabdomyosarcoma, a common cancer of the soft tissue that affects nearly 350 children each year,” said Frangoul. “The difficulty with Tucker’s case was the location of the tumor. It was deep within his body and comprehensive treatment would require a three-prong approach: chemotherapy, surgery, and radiation.” Almost two-thirds of Pediatric Rhabdomyosarcoma cases are diagnosed in children under six years of age, which makes standard care practices a bit more challenging,” explained Frangoul. “Surgery and chemotherapy are acceptable for a child this age but large doses of radiation – the amount needed to achieve the highest rate of cure – can result in significant long term side effects for infants.” To counteract this, Frangoul and a team of physicians employed a more targeted approach to therapy. Stephen Morrow, MD, pediatric surgeon at The Children’s Hospital and Andrew Kennedy, MD, from Sarah Cannon, pinpointed areas where Tucker needed radiation and placed catheters to deliver radiation close to the tumor site. “This targeted approach was a first for our hospital and certainly in
Dr. John Wilson has received an Innovative Research Grant from Stand Up To Cancer (SU2C).
Cancer immunotherapy harnesses a patient’s own immune system to attack cancer cells with minimal damage to surrounding tissue while also training the immune system to remember how to kill the cancer cells if they return. New checkpoint inhibitor drugs work by reactivating the immune system’s T cells to recognize cancer cells. However, many patients do not completely respond to these therapies. Wilson said there are two reasons for this lack of response: 1) patients have nonimmunogenic or “cold” tumors that evade recognition by T cells, and 2) some patients lack a sufficient number of the correct type of anti-tumor T cells necessary to efficiently destroy tumors. He plans to develop “smart” nanoparticles loaded with a small molecule that will act on inflammatory pathways to transform “cold” tumors into “hot” ones. Wilson also plans to load the nanoparticles with tumor antigens to better train T cells to recognize and attack cancer cells. “We are combining multiple approaches, using state-of-the-art bioengineering, mouse tumor models, and a series of advanced proteomics and immunology tools,” Wilson said. “If successful, this research has the potential to positively impact patient outcomes by developing a versatile, safe, and scalable drug-delivery platform for personalized immunotherapy.” nashvillemedicalnews
Tucker Williams and his mother, Jessica.
this region,” said Kennedy. “Delivering radiation with accuracy allowed us to avoid damaging Tucker’s organs near the tumor site.” Today Tucker is in full remission with a chance to grow and enjoy his childhood. “We’ve been so fortunate to have the privilege of treating him,” said Frangoul.
New Prostate Screening Recommendation for Older Men Last month a federal task force changed its recommendation about prostate cancer screening for some older men. The United States Preventive Services Task Force (USPSTF) now recommends that men between the ages of 55 to 69 consult with their physicians about getting routine screening blood tests to detect prostate cancer. In 2012 the task force recommended against routine screening with prostate specific antigen (PSA) tests for men of any age because the risk of complications from treatment appeared to outweigh the benefits of routine screening. PHOTO BY JOHN RUSSELL/VANDERBILT UNIVERSITY
One Child’s Cure Raises Hopes For Pediatric Soft Tissue Cancers
PHOTO BY JOHN RUSSELL/VANDERBILT UNIVERSITY
Vanderbilt Researcher Lands SU2C Grant
In Case You Missed It: Prostate Screening at Nashville General Kelvin A. Moses, MD, PhD, FACS is leading a screening initiative at Nashville General Hospital to reach out to men at high risk for prostate cancer. “We want to encourage AfricanAmerican men to participate because of higher incidence of Dr. Kelvin Moses prostate cancer and higher risk of high-grade cancer in black men,” explained Moses, who is chief of Urology at Nashville General Hospital. The PSCAN project, funded through the end of 2017 with a grant from Astellas Pharma US, is available at no charge to the men being screened. In addition to African-American men, Moses said other target populations include those who are uninsured, on public insurance, or who haven’t been previously screened.
Upcoming Clinic Dates: May 15 June 19 August 7
September 11 October 23 December 4
Moses is encouraging healthcare providers and staff members at area clinics to share information on the screening program with patients. To schedule a screening, individuals should call 615.341.4282 and ask for an appointment as part of the Prostate SCAN event.
Dr. David Penson, chair of the Dept. of Urologic Surgery at Vanderbilt.
Grant Benefits Nashville Hope Lodge
However, following that recommendation, a 2015 study led by Vanderbilt University Medical Center (VUMC) investigators found new diagnoses of prostate cancer in the U.S. declined 28 percent in the year following the draft recommendation against routine PSA screening. The VUMC investigators suggested that withholding screening might result in failure to detect higherrisk cancers during the window of time when the cancer is most likely to be cured. Timely treatment of intermediate and high-risk localized disease is associated with superior overall survival, diseasespecific survival and decreased spread of the disease to other locations in the body. The VUMC research and other studies helped contribute to the revised USPSTF guidelines. “This is a major aboutface for the USPSTF that brings them into agreement with most other major professional societies. Patients need to discuss screening with their doctors and decide if this is the right thing for them,” said David Penson, MD, MPH, Hamilton and Howd Professor of Urologic Oncology and chair of the Department of Urologic Surgery at VUMC.
The American Cancer Society has received a $60,000 grant from the Clark Legacy Foundation to support the operation of the Nashville Hope Lodge, which provides a free, temporary place to stay for cancer patients while they are receiving treatment locally. “If you are a cancer patient fighting for your life, the last thing you should have to worry about is where you’re going to stay when receiving treatment and how you’re going to pay for it,” said Michele Ryan, senior manager of the Hope Lodge. “We are grateful to the Clark Legacy Foundation for their gift to fund our mission and allow our guests to focus on getting well.” In 2016, Nashville’s Memorial Foundation Hope Lodge served 1,450 guests; provided 18,706 nights lodging; and offered 6,500 shuttle rides to and from treatment locally for guests from across the U.S. The Clark Legacy Foundation is the charitable giving arm of the former CLARCOR Inc., the Franklin-based industrial filter company that was recently sold to Parker Hannifin Corp., based in Ohio.
NMGMATen Minute Takeaway The second Tuesday of each month, practice managers and healthcare industry service providers gather at KraftCPAs headquarters for the monthly Nashville Medical Group Management Association (NMGMA) meeting. April’s program, “Swimming with the Hippos,” utilized an interactive case study to spark discussion on the process to create and sustain meaningful change. Mark Kenny, president of Franklin-based Hippo Solutions, founded the company in 2012 using an evidence-based problem-solv-
ing program to address business change, patient experience, employee retention and engagement, ownership transitions, and project implementation. The interactive case study presented at the Mark Kenny NMGMA gathering focused on a meeting between a quality management officer and a practice improvement manager to discuss process change in the aftermath of an adverse
by Cindy Sanders
patient event. The audience was broken into smaller groups to answer a number of open-ended questions after watching short video clips of interactions between the actors. The larger audience also participated in facilitated discussions led by Kenny. He asked, “How can we make great organizational change happen?” The answer: “We can’t.” Too often, he continued, leaders believe they have to put change on their shoulders and carry it through. However, he noted, it is exceedingly rare to find a
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person able to get others aligned around values and create a culture shift that is not only great but sustainable all on their own. With the most effective leaders, Kenny continued, “They don’t think about getting people behind them. They think about getting behind their people.” Kenny noted with any project or change movement, an organization needs to consider structure, tools, processes and people … with people being the key element to change that is real and enduring. Discovery is the first step in the process continuum, which he stressed is iterative … rather than linear … in nature. On the front end, Kenny said it is important to collect quantitative and qualitative data. Creating a baseline allows organizations to track improvement and sustainability over time. It’s also important to identify your ‘hippos’ at this stage. The hippos represent both obstacles to change and opportunities. Attacking hippos are the overt issues in an organization that take time and attention. Territorial hippos hold tight to a belief or process and won’t budge out of fear of change. “The third type of hippo is the most dangerous one of all, and that’s the lurking hippo,” he said. The lurking hippo hides under the water and represents what is not being said. Create is step two as an organization comes together to craft a different future. It’s the part of the process where the lurking hippos must come to light through honest dialogue. Kenny noted the interactive case studies and videos help facilitate those types of conversations. The third step is to sustain what has been created. “Whatever your performance challenges, we want outcomes,” Kenny said, noting outcomes are driven by behaviors. “Sometimes we try to modify behaviors, and it works for awhile, but it’s often not sustainable because behaviors are driven by mindsets.” Mindsets have to shift in order to get sustainable results. “If we can transform mindsets, then we can get great organizational change.” For information on upcoming NMGMA events or to learn more about the association, go online to nmgma.com.
Mark Your Calendars
SVMIC.com 800.342.2239 ContactSVMIC@SVMIC.com
Tennessee Breast Cancer Coalition (TBCC) is gearing up for the 21st Annual Celebration of Life Golf Classic and Auction Par-TEE. The event is scheduled for Aug. 10-11 at Hermitage Golf Course. Interested golfers and volunteers should call 615.377.8777.
2/1/2017 2:45:30 PM
New 3D Minimally Invasive Surgery for Myopia Makes Statewide Debut By MING WANG, MD, PhD
On April 21, 2017, the first SMILE procedure in the state was performed in Nashville at Wang Vision 3D Cataract & LASIK Center. The new procedure to treat myopia represents one of the most major advancements in laser vision correction technology in the last 20 years. Myopia is a common eye condition in which close objects can be seen clearly but distant objects are blurry without correction. LASIK and PRK (photoreactive keratectomy) have been the mainstay treatments for myopia for over two decades. In late 2016, the U.S. Food and Drug Administration approved the VisuMax Femtosecond Laser for the SMILE procedure for -1.00 to -8.00 D myopia with up to 0.50D astigmatism. SMILE stands for SMall Incision Lenticule Extraction. During the SMILE procedure a femtosecond laser, with precise short pulses, is used to make a small incision in the cornea to create a disc-shaped piece
of tissue. This tissue is then removed by the surgeon though the tiny opening which causes the corneal shape to change, permanently changing the prescription. SMILE has several unique advantages over LASIK. The surgery is minimally invasive, as the surgeon needs only to create a small, precise opening to correct vision.
The traditional flap used for LASIK is not needed. The laser incision is smaller than 6 millimeters for SMILE, compared to approximately 20 millimeters for LASIK. This helps the cornea to retain more of its natural strength and reduces the risk of rare flap complications that can arise with LASIK. Dry eye after SMILE is also reduced compared with LASIK, as nerves responsible for tear production in the cornea remain more intact in SMILE. SMILE has a proven track record of success. It has been used internationally since 2011 and over 750,000 procedures have been performed worldwide with 328 participants treated in the U.S. FDA clinical study of safety and effectiveness of the device. From the clinical study, 99.7 percent of patients were able to see without glasses or contact lenses at the level required for legal driving, and the majority of the patients were able to see 20/20 or better without glasses or contacts. The procedure itself is very fast, taking
only minutes per eye, with only about 30 seconds of laser treatment. The treatment itself is typically free of discomfort and is performed in a single-step process with one laser. Vision generally recovers quickly and most patients can resume many normal activities the day after the surgery. While SMILE provides some great advantages over previous laser surgery options, not all patients are candidates. Currently, the procedure has not been approved to treat large amounts of astigmatism and cannot treat farsightedness. LASIK is still a great option for a majority of the patients seeking laser vision correction. Dr. Ming Wang, a Harvard (MD, magna cum laude) & MIT (PhD) graduate, is the CEO of Aier-USA, director of Wang Vision 3D Cataract & LASIK Center, and one of the few laser eye surgeons in the world today who holds a doctorate degree in laser physics. He has performed more than 55,000 procedures, including over 4,000 on doctors. For more information, go online to wangcataractLASIK. com or email email@example.com.
Personalized Medicine & Lung Cancer, continued from page 1 associate director of Lung Cancer Research at Sarah Cannon Research Institute. An associate with Tennessee Oncology, Johnson is responsible for supporting the growth of Sarah Cannon’s Phase 2/3 Lung Program clinical trial portfolio, while also furthering the development of early phase compounds for thoracic malignancies in the Drug Development Unit. “We believe clinical Dr. Melissa Johnson trials are the way we’ll move the bar forward in terms of developing effective therapies,” Johnson said. “We don’t have enough (FDA-approved) therapies that are standard of care.” Sarah Cannon offers more than 500 clinical trials per year including around 50 that enroll patients with lung cancer. And while trials might seem like a last ditch effort to some, Johnson said they’re anything but. “The trials we offer add something extra to the standard of care, so a patient might be receiving a standard therapy in addition to a new drug or a combination of drugs that have already been approved individually but are now being investigated together,” she said. “Patients don’t need to be concerned they’ll be randomly assigned to a placebo alone.”
Personalized medicine is offering the most hope in the treatment of lung cancer. At Sarah Cannon, each patient’s tumor and blood are continually examined to learn how a cancer might be evolving based on treatment. This helps physicians identify the best course of treatment, and change course when necessary. “With all cancers, but with lung cancer in particular, we’re learning more and nashvillemedicalnews
more about how to personalize therapy for a particular patient’s cancer by examining the molecular changes which make up each tumor,” Johnson explained. “That genomic profiling is critical to finding the best therapy.” Over the past five years, researchers have grasped a clearer understanding of the role of genetics as the underlying cause of cancer development. “As each cancer evolves differently, we need to investigate different types of drugs, be it drugs that rev up the immune system or target particular proteins found in tumor tissue,” Johnson said. “Knowing which genes are activated within a tumor gives us much more information about how to effectively target that cancer. A personalized approach is so important these days – not just scientifically but also as we try to assign personalized care of each of our patients, who all have different needs and are trying to cope with their diagnosis.”
Big City Care, Close to Home
For today’s lung cancer patients, diagnosis is just the beginning of a very long journey. At Sarah Cannon, nurse navigators are assigned to every patient and help to arrange care, schedule appointments, and navigate across the cancer continuum. “As cancer care has become more personalized, it’s also become more complex and sub-specialized, and navigators help patients understand the process and feel more engaged,” Johnson said. Sarah Cannon has a large research and care network across the U.S. and UK. That network supports the 85 percent of oncology patients who receive treatments in the community they call home. “Our mission is to bring cutting-edge therapies to patients in communities in which they live so they have access to the leading treatments, as well as first-rate care, available at a large university,”
Johnson said. “It’s very different from most academic models, and we’re very proud of that.”
Genetic Mutations & Lung Cancer
It’s no surprise that nearly 90 percent of lung cancer diagnoses are in current or former smokers. But it’s that remaining 10-15 percent of lung cancer patients who have never smoked a cigarette that initially peaked Johnson’s interest in the field. “There’s a lot to say about tobaccorelated risk factors associated with lung cancer development, but the whole reason I’m a lung cancer doctor is because I was intrigued by the fact that never smokers get lung cancer every day,” she said. “I wanted to study that and help find effective therapies for all patients diagnosed with this illness.” Scientists are learning that these “never smokers” often have treatable mutations in their tumors triggered by a genetic predisposition. “We went from knowing about one genetic mutation to several in the past few years, and with every year we identify another small subset in a rather large population that can be targeted with molecular inhibitors. This is why clinical trials investigating targeted inhibitors are so important,” Johnson said. These mutations only exist in cancer cells themselves and can effectively be turned off through targeted therapies while preserving healthy cells. “We don’t know what triggers mutation in healthy young people who never smoked, but we do know now to look for those mutations and how to treat them,” Johnson continued. Currently, there are at least seven FDA-approved targeted inhibitors, with other agents expected to win regulatory approval within the next year. Over the past few years, Johnson said there’s been increasing recognition that all lung cancer patients
need to be tested for genetic mutations up front, as targeted inhibitors can prove more promising than chemo. In fact, 30 percent of lung cancer patients now receive targeted inhibitor therapy without chemotherapy. Many other lung cancer patients also have options other than chemo thanks to immunotherapy, which is proving especially successful in former smokers. That’s because those tumors tend to be more inflamed – a necessary attribute that makes the immunotherapy able to work. Using molecular markers, researchers are now trying to determine the genetic underpinning for patients who will respond early with immunotherapy. The science is so promising that Sarah Cannon treated 500 lung cancer patients with immunotherapy trials in 2016 alone.
Early Diagnosis is Key
Early diagnosis is the biggest challenge for patients, and the only test for lung cancer is the CT scan. Unfortunately, never smokers and smokers alike often don’t receive scans until long after symptoms begin. “We are still working out who to screen for lung cancer with a chest CT and when to do it,” Johnson said. “Its hard to know — particularly for never-smokers – when to look beyond a chest X-ray.” She encouraged patients and providers to know that with so many new and effective treatment options, there has never been a better time to start making this diagnosis earlier. Today’s therapies can offer patients a level of confidence that didn’t exist 20 years ago. “So much has evolved in this field. There’s a lot to be hopeful for,” Johnson said. “New therapies are well tolerated and can extend life and improve quality. There’s a lot of opportunity, and there’s nothing to be lost and lots to be gained for the early diagnosis of lung cancer.” MAY 2017
Fixing Our Healthcare System,
continued from page 5 am not too proud to admit it. Recently, I even cosponsored a Medicare-for-All bill because I have become so frustrated with the behavior of our so-called “private” health insurance companies. I have long been frustrated by our pharmaceutical companies. The prescription drug ads that are all over television undermine physician authority and cost billions of dollars that would be better spent on health research. As President Trump said a few weeks ago, “Who knew that healthcare was so complicated?” You and I know, and I hope you are as interested as I am in improving it. Wouldn’t it be nice to simplify it? Please contact me if you would like to have a serious, informed policy discussion so that I can benefit from your experience, and you can benefit from mine. Together, we can improve healthcare in America. U.S. Rep. Jim Cooper (D-TN 5th District) represents constituents in Davidson, Cheatham and Dickson counties. A Nashville businessman, attorney and part-time Vanderbilt professor, Cooper has more than 25 years of experience representing Middle Tennesseans in D.C. He is widely known for his work on the federal budget, healthcare and government reform and his ability to reach across the aisle on bipartisan issues. For more information or to connect with Rep. Cooper, go to cooper.house.gov.
Competition Drives PatientCentered Care, continued from page 5
Enabling Americans to make their own choices is crucial, as we know they can determine the plan that will be tailored to their specific needs. The bureaucrats in Washington have no business trying to force individual healthcare needs into a cookie cutter plan. Republicans have countless opportunities in the upcoming years to reform the federal government, but we have promised to fix our broken healthcare system. That’s why I will continuously fight for H.R. 314 as a method to cut through the bureaucratic red tape and allow states, consumers, and providers the opportunity for patient-centered healthcare and competition. A small business woman, author, mother, grandmother, and member of Congress, U.S. Rep. Marsha Blackburn (R-TN 7th District) began her political career in the Tennessee State Senate where she quickly proved herself as a fighter when she defeated a proposed state income tax. Now serving as chairman of the Energy and Commerce’s Subcommittee on Communications and Technology, she continues her diligence in working for Americans. For more information or to connect with Rep. Blackburn, go to blackburn.house.gov.
GRAND ROUNDS Basile Named CEO of Aegis Sciences Corp.
Last month, Frank Basile, MD, was announced as CEO of Aegis Sciences Corporation, filling the position left vacant when co-founder David Black, PhD, stepped away in late 2016. Basile has more than 20 years of executive leadership in the healthcare industry and previ- Dr. Frank Basile ously served as president and CEO at Miraca Life Sciences, Inc. Basile earned his Bachelor of Medicine and Bachelor of Surgery from University of Melbourne in Melbourne, Australia and an MBA from the Melbourne Business School.
FTI Consulting Adds Siedlecki to Health Solutions Practice
At the end of March, FTI Consulting announced the addition of John Siedlecki as senior managing director with the firm’s Health Solutions practice based in Brentwood. Siedlecki, who brings more than 30 years of experience, will focus on John Siedlecki helping hospitals improve operations and strengthen their overall financial performance. He joins FTI Consulting from MedeAnalytics, Inc., where he focused primarily on business development. Previously, he was a senior vice president at Cambio Health Solutions, which was acquired by FTI Consulting in 2005.
VUSM Moves to Eighth in NIH Research Funding
Vanderbilt University School of Medicine (VUSM) now ranks No. 8 in the nation among U.S. medical schools in total grant support provided through the National Institutes of Health (NIH). The new ranking raises VUSM’s standing two spots from last year. Receiving $340,049,796 in total NIH grant support during calendar year 2016, VUSM finished the year with an additional $48,854,269 in funding over its 2015 total. Support from the NIH for research continues to be increasingly competitive among the nation’s leading academic medical centers and remains a key indicator of an institution’s overall strength in biomedical research. Last year was historic in terms of VUSM’s receipt of competitively funded research support, including the largest single grant in Vanderbilt history — a $71.6 million, five-year award to support the Data Research and Support Center for the NIH’s Precision Medicine Initiative Cohort Program, now called the All of Us Research Program. This year, four basic science research departments and six clinical departments are ranked among the nation’s top 10 in NIH funding relative to similar departments at peer institutions. Biochemistry ranks 3rd; Cell and Developmental Biology, 1st; Molecular Physiology & Bio-
physics, 3rd; and Pharmacology, 6th. Six clinical departments ranked among the top 10, including: Internal Medicine, 3rd; Ophthalmology, 9th; Otolaryngology and Hearing & Speech Sciences, 6th; Pediatrics, 4th; Radiology & Radiologic Sciences, 8th; and Surgery, 8th.
Peters Named New GC for LifePoint
Jennifer Peters, who joined LifePoint Health in 2013, has been named general counsel for the national healthcare company based in Brentwood. Peters, who was previously GC, secretary and chief compliance officer for Simplex Healthcare, joined LifePoint as vice president Jennifer Peters and chief operations counsel before being named a senior vice president last November. Peters earned her law degree with a concentration in health law from the University of Maryland School of Law, her master’s degree in Healthcare and Finance Management from the Johns Hopkins School of Hygiene and Public Health and her bachelor’s degree from Buffalo State University.
TriStar Summit Announces Whitehorn’s Retirement
Jeff Whitehorn, who has served as CEO of TriStar Summit Medical Center for the last 14 years and has a 29-year career in the healthcare industry, has announced he will retire effective May 31, 2017. During his tenure at TriStar Summit, Whitehorn has led expansion and Jeff Whitehorn growth efforts, including approval from the state for an expanded emergency room at the hospital and an addition of a freestanding emergency room that will be built in Mt. Juliet. He also led efforts to expand outpatient services at Summit Surgery Center; add outpatient imaging and diagnostic centers in Hermitage, Lebanon and Mt. Juliet; and bring radiation therapy to the local community through what is now Sarah Cannon Cancer Institute at TriStar Summit. Prior to joining TriStar Summit in 2003, Whitehorn was CEO of TriStar Southern Hills Medical Center.
Gill Fills New Behavioral Health Role at Saint Thomas
Last month, former CHS exec Brian Gill began a new role for Saint Thomas Health as vice president overseeing the behavioral health service line development. He has a depth of clinical and executive leadership experience, including a background in Brian Gill behavioral health across the age spectrum. Most recently, he served as a corporate regional operations director for CHS, overseeing 10 behavioral health programs across
Read More Grand Rounds online. 10
the U.S. Prior to that, he held leadership positions in behavioral health at facilities in Arizona and Nevada. Gill earned his master’s in Social Work from Walla Walla University and his MBA from the University of Arizona.
ACGME Approves Longer Shifts for Residents
First-year residents can work 24hour shifts beginning July 1. The Accreditation Council for Graduate Medical Education announced approval to return first-year residents to the same schedule as other residents and fellows, moving them from a max of 16-hour shifts to the new 24-hour shift plus up to four hours to manage necessary care transitions. The maximum number of hours that any resident can log in a week remains at 80.
Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S
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Doucette Joins Premise Health in a New Role
Jami Doucette, MD, MBA, has joined Nashville-based Premise Health to lead the company’s growth and innovation strategies during a time of growing demand for worksite and near-site health centers. In the newly created position, he will be Dr. Jami responsible for acceleratDoucette ing the organization’s care delivery model into additional markets and revenue opportunities. Most recently, Doucette served as part of the core executive team for Paladina Health (a DaVita subsidiary). Prior to that, he was CEO and founder of ModernMed, Inc., a health services company providing direct primary care through employer-based, onsite clinics and private physician offices. Doucette graduated from Duke University with degrees in biology and economics and completed his medical degree and MBA in Health Management at Tufts University School of Medicine.
Execs with HCA Holdings, Memorial Health Board of Directors, and officials with the Chatham County Hospital Authority have agreed on a deal worth $710 million for HCA’s South Atlantic Division to purchase the assets of the Savannah, Ga.-based health system. Brentwood-based Corizon Health has announced a new five-member board following the company’s recapitalization. M*Modal Chairman Jeff Goldberg will serve as chair of the Corizon Health Board and is joined by former Capella CEO Dan Slipkovich and former Allinas Health president and CEO Kenneth Paulus as independent directors. Corizon CEO Karey Witty and a member of the investor group round out nashvillemedicalnews
Last month, more than 30 Nashville businesses joined the Alzheimer’s Association’s Mid South Chapter for “A New Morning Breakfast” to learn more about the disease and its impact on businesses. Speakers included Heather Rohan, president of HCA TriStar Division; Sandy LaFave, communications director of Brookdale Senior Living; Alex Soffer, Walk to End Alzheimer’s volunteer; and Phil Reynolds of TBH Global Assets. Alzheimer’s is the nation’s sixth-leading cause of death and is the only one in the top 10 that cannot be prevented, slowed, or Heather Rohan addresses a full house at the recent Alzheimer’s cured. Barring the develbreakfast event. opment of medical breakthroughs, the number of people living with Alzheimer’s will rapidly escalate, increasing from 5 million to 13.8 million by 2050, costing the country an estimated $1.1 trillion. For more information on how to partner with the Alzheimer’s Association call 800.272.3900. or visit www.alz.org.
Let’s Give ‘Em Something to Talk About! Awards, Honors, Achievements
Affinity Announces New Hire, Promotion
Brentwood-based managed IT services provider, Affinity Technology Partners, recently announced the addition of Keith Benion as client service dispatcher. He has 20 years of customer service and operations experience including serving as a traffic Keith Benion and dispatch coordinator for Comcast Communications and most recently as senior customer support representative for Computer Sciences Corporation (CSC). Michael The company also Maxwell promoted systems engineer Michael Maxwell to manager of technical sales. Maxwell – who joined the company in 2013 and has worked with clients in healthcare, education and manufacturing – will help craft the company’s business development strategy and provide technical sales support.
Ryan D. Mire, MD, FACP, has become a member of the Board of Regents, the main policy-making body of the American College of Physicians (ACP), the national organization of internists. Mire is the Vice Chief of Medicine and Chair of the Medical Advisory Committee at Saint Thomas West and is in private practice with Heritage Medical Associates. Mire is a member of ACP’s Medical Practice and Quality Committee and Credentials Committee and also holds leadership poDr. Ryan D. Mire sitions in the organization’s state chapter. Jennifer Pietenpol, PhD, executive vice president for Research at Vanderbilt University Medical Center and director of Vanderbilt-Ingram Cancer Center, has been named a chief scientific advisor (CSA) for the nonprofit breast cancer organization Susan G. Komen. She joins George Sledge Jr., MD, professor of Medicine at Stanford University Medical Center, in the CSA role, including responsibility for guiding the Komen Scientific Advisory Board. Pietenpol, a leader in breast canDr. Jennifer Pietenpol cer research, has served as a Komen Scholar since 2010. W. Kimryn Rathmell, MD, PhD, director of the Division of Hematology/Oncology at Vanderbilt University Medical Center, has been named vice president of The American Society for Clinical Investigation (ASCI). Rathmell, who is the Cornelius Abernathy Craig Professor of Medicine, will serve a four-year term, initially as vice president, then president-elect in 2018, president in 2019, and immediate past president of The ASCI in 2020. Founded in 1908, The ASCI is an elite honor Dr. W. Kimryn Rathmell society of physician-scientists with nearly 3,000 members from the upper ranks of academic medicine and industry. CRN has named TekLinks to its 2017 Tech Elite 250 list, an exclusive group of North American IT solution providers that have earned the highest number of advanced technical certifications from leading technology vendors. Baker Donelson has named shareholder Christy Tosh Crider as chair of the firm’s Health Care Litigation Group, which includes attorneys from across the firm’s 24 offices. Crider, who is based in Nashville, will continue to also serve as chair of the firm’s Long Term Care Group and its Women’s Initiative. Graduate nursing programs have been recognized by U.S. News and World Report’s 2018 rankings of Best Graduate Schools at both Christy Tosh Crider Belmont and Vanderbilt. Nationally, Vanderbilt tied for 15th and Belmont ranked 157th in the Master’s in Nursing category, and the two programs ranked 11th and 127th respectively in the Doctor of Nursing Practice. The annual rankings surveyed 532 accredited nursing schools. TriStar Centennial Medical Center earned straight A’s in the new Leapfrog Hospital Safety Grades released last month. This is the fifth year in a row the medical center has received the highest ranking from the patient safety watchdog organization. Other Middle Tennessee Hospitals to earn an A rating for Spring 2017 are Cumberland Medical Center, Maury Regional, NorthCrest Medical Center, TriStar Hendersonville, TriStar Horizon, TriStar StoneCrest, and Williamson Medical Center. In other rankings, the Human Rights Campaign Healthcare Equality Index 2017 has again named Vanderbilt University Medical Center a Leader in LGBTQ Healthcare Equality. The only organization in Tennessee to be recognized, this is the sixth year in a row that Vanderbilt received the designation. MAY 2017
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Dax Kurbegov, MD, is joining Sarah Cannon as vice president and physicianin-chief of Clinical Programs where he will oversee expansion and foster collaboration across Sarah Cannon’s cancer network. He comes to the HCA oncology subsidiary foDr. Dax cused on treatment and Kurbegov research from Coloradobased Catholic Health Initiatives. Kurbegov most recently served as physician vice president of CHI’s national oncology line, which includes 50 cancer centers across the country. Kurbegov earned his undergraduate degree from Stanford University and his medical degree from Baylor. He completed internship and residency in internal medicine at the University of Colorado Health Sciences Center and his medical oncology fellowship at MD Anderson. He also serves as chairpersonelect of the American Society of Clinical Oncology Research Community Forum and is a physician advisor for ASCO’s CancerLinQ.
Alzheimer’s Association Hosts Business Breakfast
the new board. Nashville-based Council Capital has invested in Idaho-based Triad Learning Systems, which provides test prep and continued education for behavioral health professionals. Community Health Systems, Inc. has reached a definitive agreement to sell the 125-bed Stringfellow Memorial Hospital in Anniston, Ala., to the city’s healthcare authority for a price of $25 million. Ardent Health Services completed its purchase of LHP Hospital Group in Texas in March. LHP’s interim CEO Paul Kappelman has joined Ardent as executive vice president and COO. Previously, Kappelman served as LHP’s president of Hospital Operations and was CEO of Paul Kappelman hospital in Arizona prior to that. Louisiana-based Amedisys, which has its executive headquarters in Nashville, recently announced acquisition of East Tennessee Personal Care Service. The Knoxville-based company delivers care to 600 clients, generating approximately $5 million in annualized revenue. The transaction was anticipated to close on May 1. Executives with Quality Systems said their NextGen Healthcare Information Systems subsidiary would pay more than $30 million for Brentwoodbased clinical documentation company Entrada. The publicly traded California company said the intention is to invest in the local venture, which has grown to more than 60 employees since launching in 2010. In the wake of rapid growth over the past few years, HealthStream has signed an agreement to move their headquarters to the new Capitol View project when the North Gulch development is completed in 2019.
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Kurbegov Joins Sarah Cannon
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