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FOCUS TOPICS MENTAL HEALTH • NEUROLOGY • HEALTHCARE EDUCATION

Your Middle TN Source for Professional Healthcare News ON ROUNDS

The New Normal in Nursing Education Non-traditional Nursing Programs are on the Rise

The landscape of nursing education is evolving, with non-traditional and online programs now accounting for half of all nursing graduates nationwide. As more and more students head to their laptops for class, health systems, universities and colleges are looking for innovative ways to reach tomorrow’s generation of healthcare providers ... 4

SCALE Conference 2018: What to Expect CEUs, Training & Trends

From May 10-12, Nashville will play host to nearly 800 medical professionals at the 13th annual SCALE conference at the Music City Center ... 5

Healing Mind & Body Education, Early Intervention Key By MELANIE KILGORE-HILL

One in five Americans suffer from a diagnosable mental illness in any given year. Fortunately, improved awareness surrounding mental health is evolving as practitioners and researchers gain a better grasp of the mind-body connection. In Nashville, Mental Health America of Middle Tennessee (MHAMT) is helping break down age-old stigmas associated with a mental health disorder, sharing resources and spreading awareness of the need for early intervention. Founded in 1946 by Vanderbilt’s first Chair of Psychiatry Frank Luton, MD, the organization connects the community with mental health and wellness resources, provides services that improve quality of life, and promotes effective services where mental health needs exist. “People are better understanding that mental illness isn’t always schizophrenia or hoarding,” said Tom Starling, EdD, CEO of MHAMT and incoming president of the national Mental Health America organization. “So often it’s illness triggered by

Turn to this year’s special section to read about the 10 honorees selected for the Class of 2018 who are making a difference at every point along the continuum of care.

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divorce or family problems, workplace wellness, returning from war or childbirth.”

B4Stage4

Fortunately, many providers today have a better understanding of integrated, holistic care, including spirituality and the interconnectedness of physical and mental health. Starling said more and more providers are adopting integrative approaches that treat the whole person, which he said results in lower hospital readmission rates and improved outcomes. “We have to make sure the person isn’t just physically well but has the confidence and assurance to sustain themselves in less restrictive environments,” he said. “Providers are better understanding that if you do have a mental health issue, you’re not any more ‘defective’ than a person with a cholesterol problem. People are realizing there isn’t ‘health’ without mental health.” To that end, Starling is a vocal advocate for early intervention for mental illness. MHA’s campaign,

May is Mental Health Month

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Searching for Sustainable Solutions to the Physician Shortage Adequate GME Funding Continues to be a Concern By CINDy SANDERS

Women to Watch

May 2018 >> $5

Complex problems rarely have simple solutions. Certainly that is the case with the looming physician shortage facing the United States. New research published last month by the Association of American Medical Colleges (AAMC) shows increasing shortages looming for both primary and specialty care. The new data outlined in the 2018 update of “The Complexities of Physician Supply and Demand: Projections from 2016-2030” provides a forecast based on a number of supply and demand scenarios, including an aging population on the demand

Our data shows by 2030, the U.S. population aged 65 and older will grow by 50 percent. — AAMC’s Chief Public Policy Officer Karen Fisher

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New Legislation Addressing the Opioid Crisis By CINDY SANDERS

As the 110th General Assembly of the Tennessee State Legislature drew to a close at the end of April, new legislation (SB 2257 / HB 1831) was approved to address a significant part of Gov. Bill Haslam’s TN Together Plan to combat the opioid crisis in the state. As passed by the House and Senate, prescribers will now have additional rules regarding checking the state’s controlled substance database and new limits on opioid prescriptions for opioid naïve patients and for acute care patients. Although a strong proponent of proper prescribing, the Tennessee Medical Association had previously opposed several points of the plan

based on concerns that setting hard limits on dosing sidestepped clinical judgment and didn’t allow physicians to write prescriptions they deemed medically appropriate on a case-by-case basis. Despite that objection, the new law restricts treatment of an opioid naïve patient to no more than a five-day supply of an opioid and no more than a 30-day supply for an acute care patient. Furthermore, the dosage of a prescribed opioid cannot exceed a daily 40-morphine milligram equivalent (40 MME). However, as part of a compromise with TMA, the law does allow that in “exceptional cases” where the prescriber deems an additional supply of the opioid might be warranted and circumstances exist that would make it difficult for the patient to

More Money to Fight Opioid Crisis In April, Senate Health Committee Chairman Lamar Alexander announced Tennessee will receive a nearly $14 million grant from the Department of Health and Human Services in the state’s fight against the opioid crisis. The state received nearly $14 million last year, as well – both grants were funded by the 21st Century Cures Act that Alexander authored and President Obama signed into law in 2016.    “The devastation of the opioid crisis has touched nearly every community in our state, and today’s announcement – that Tennessee is set to receive another nearly $14 million to fight its ongoing opioid epidemic – will provide a major boost to Tennesseans on the front lines of a battle that is being waged county by county and doctor’s office by doctor’s office,” Alexander said at the April 18 announcement.

Congratulations Dean Veronica Mallett, M.D. On being named a Nashville Medical News “Woman to Watch”— and thank you for leading the launch of our new medical school curriculum. From your colleagues at Meharry Medical College.

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acquire a second prescription, the provider could issue an opioid naïve patient a second prescription simultaneous to the initial prescription. Written documentation of why the second prescription was written must be included in the patient record, and the provider must counsel the patient or patient representative on the circumstances under which the second prescription could be filled (no sooner than five days or later than 10 days from issuance). Additional rules for prescribing to acute care patients were also codified including the mandate that a provider must personally assess the patient and obtain informed consent before prescribing an opioid, and other “reasonable, appropriate, and available non-opioid treatments for the pain condition” have been tried first or a contraindication or intolerance of those other options have been documented. There are a number of exceptions to the rules including inpatient treatment, treatment by certified pain management specialists, and treatment of those in hospice care or who are undergoing active or palliative cancer treatment.

TMA Statement

On April 25, Nita W. Shumaker, MD, 2017-18 president of the Tennessee Medical Association issued the following statement on Tennessee’s new opioid law: “It was clear when Governor Haslam announced his TN Together plan in January that lawmakers were going to do something to try to address the state’s opioid abuse Dr. Nita W. Shumaker epidemic. With the passage of SB 2257 / HB 1831, Tennessee now has one of the most comprehensive and restrictive laws of any state. “The Tennessee Medical Association was actively engaged in the process and appreciates legislators’ willingness to consider input from physician stakeholders. From the beginning and during the past several weeks of negotiations, TMA advocated for a mindful, yet practical, approach to initial opioid supply and dosage. Most importantly, we wanted to make sure it did not unreasonably obstruct patients in legitimate pain from getting the care they need. “The final bill is substantially improved from the initial version. New restrictions on prescribing and dispensing will no doubt achieve the governor’s stated goal of reducing overall initial supply. TMA will educate doctors on the new law as part of our ongoing efforts to promote safe and proper prescribing. “Tennessee’s doctors remain concerned, however, about unintended consequences for patients who because of the new law may have more difficulty accessing effective pain management. There are not enough certified pain specialists in Tennessee to care for Tennesseans experiencing

legitimate chronic pain. Meanwhile, exploding use of fentanyl, heroin and other illicit drugs are causing more accidental overdose deaths even as opioid prescriptions decline. We still need a multi-faceted and wellfunded strategy including treatment and law enforcement to turn back this epidemic.”

New Data Shows Decrease in Opioid Prescribing A new report published by the IQVIA Institute for Human Data Science (“Medicine Use and Spending in the U.S.,” April 2018) shows that Tennesseans filled 6,709,154 opioid prescriptions at retail pharmacies in 2017, a nearly 9 percent decrease from the previous year and a 21.3 percent drop from 2013. Tennessee outperformed most of its contiguous states and is on par with the national average for yearover-year improvements and fiveyear trends. The Tennessee Medical Association pointed to the data as validation of the medical community’s ongoing efforts to self-regulate prescribing and reduce initial opioid dosage and supply. “This report shows that Tennessee’s medical community is driving real change in the initial supply of opioids in our state, despite the fact that clear data to help us identify who is writing excessive amounts for patients is available only to government regulators,” said 2017-18 TMA President Nita W. Shumaker, MD. “Physicians, for decades, were told these medications were completely safe and faced potential litigation if we did not treat pain aggressively. As a result, patients developed unrealistic expectations about pain management. Once we recognized the addictive dangers of these medications, we worked hard to change the culture and improve supervision. The report confirms that we are making progress.” National trends show 22.2 percent fewer opioid prescriptions were filled in 2017 than had been filled in 2013, with every state in the nation showing some reduction in the past year. In 2017, a total of 196 million opioid prescriptions were filled in the United States, representing an 8.9 percent decrease from the prior year – the sharpest single-year decrease reported by IQVIA. Prescription opioid volumes in the U.S. peaked in 2011 at 240 billion milligrams of morphine milligram equivalents and have declined by 29 percent to 171 billion MMEs.

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ACHEMT Hosts Opioid Educational Event By ANGLEA STARR

In late March, the American College of Healthcare Executives Middle Tennessee (ACHEMT) sponsored an educational luncheon involving a topic that affects every healthcare leader today: the opioid crisis. Tennessee ranks second in the nation for opioid abuse, and the event drew a record number of 131 registered attendees who heard from a variety of voices active in solving this epidemic. The opening speaker was Commissioner Marie Williams, LCSW, of the Tennessee Department of Mental Health and Substance Abuse Services and chair of the Governor’s Opioid Workgroup. Williams shared statistics from the Substance Abuse Treatment Group illustrating the variances among populations that seek out treatment for illnesses. She said 77 percent of those with hypertension, 73 percent of those with diabetes, and 11 percent of those with an opioid addiction will seek out treatment. Williams also drew attention to a National Institute of Health study that documented patients with asthma and hypertension relapse more often than those addicted to opioids. William’s task force is working hard to change the popular attitude that addiction is a moral failure rather than a disease. Panel moderator Cheryl McClatchey, vice president of Behavioral Health Programs of Blue Cross Blue Shield of Tennessee orchestrated a compelling discussion with the event panelists. Elizabeth Ann Stringer, PhD, – neuroscientist, chief science officer and cofounder of Axial Healthcare – discussed JACHO assessments on pain and the catalyst for the epidemic. She also spoke about risk stratifying and “catastrophizing,”or the ability to cope, rating. Stringer emphasized the need for the government to bring multiple stakeholders together and highlighted some of the unintended consequences that can happen when policy is instituted into law. From a neuroscience standpoint, she also emphasized the importance of setting expectations according to a patients’ ability to cope rating and recognizing that everyone’s pain progression is different. Jeff Guy, MD, vice president of Critical Care and Emergency Department services for HCA, brought a unique voice to the discussion. His prior experience as a burn and trauma surgeon was reflected in his concern regarding stigmatizing legitimate opioid prescription and use. He also shared that pain is the chief complaint in emergency rooms across the nation. Over 10 million patients per year are seeking treatment for pain through the ED. His framework of viewing the epidemic through treatment of underlying conditions, such as depression or bipolar disorder, looks to clinical effectiveness and tools of prediction, such as a history of trauma. Bill Paul, MD, director of Metro Nashville Health Department, also spoke to a patient’s trauma history, such as nashvillemedicalnews

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Panelists (L-R) Cheryl McClatchey, Dr. Bill Paul, Dr. Jeff Guy, Dr. Elizabeth Ann Stringer and Justin Lanning (not pictured) shared different perspectives on the state’s opioid crisis.

adverse childhood events, and a community’s response to this. Financially, he pointed out the significant downstream costs of opioid addiction, such as HIV and Hepatitis C. He also made several other points concerning not marginalizing victims of the epidemic, decreasing the stigma, and teaching coping mechanisms

in schools. Paul also spoke to expanding Medicaid to cover services and incorporating law enforcement, EMS and other stakeholders involved in keeping Naloxone readily available in emergency situations. Paul emphasized being “trauma informed” and teaching resiliency while decreasing silos and decreasing the sepa-

ration of behavioral health from all other areas of medicine. Justin Lanning called on his experience as CEO of 180 Health Partners and shared ideas on a “cortisol reduction programs” and coaching people to utilize healthier coping mechanisms. Lanning’s emphasis is on decreasing the number of opioid addicted babies. He also spoke to adverse childhood events. Lanning also issued a call to action involving three components. First, he said, was to provide appropriate expectations, including not emphasizing a zero out of 10 as the only acceptable pain management result but perhaps achieving a one or two out of 10 with a focus on the ability to adequately perform activities of daily living. Second, he said attention needs to be paid to helping those in need manage their stress. Third, he called for providing mentoring programs. All of the expert panelists agreed that decreasing the stigma that separates opioid addiction from other medical illnesses is essential to solving this crisis. Setting appropriate expectations and reducing the opioid epidemic will take all stakeholders involved.

Cumberland Heights Breaks Ground on ARCH Academy Cumberland Heights, which has been serving people affected by alcohol or drug addiction since 1966, is expanding its continuum of services with construction underway on the ARCH Academy (Adolescent Recovery of Cumberland Heights). Expected to open summer 2019, this unique new program will provide 60 days to six months of residential care for adolescent boys, ages 14-18, struggling with alcohol and drug addiction. With adolescence being a critical time in human development, Cumberland Heights hopes to foster positive change by providing quality, long-term treatment to teens and their families. Cumberland Heights officials noted extensive interviews with parents, educational consultants and clinical referral sources indicated an urgent need in the region for a quality, long-term adolescent treatment program. Building on this knowledge and more than 30 years of experience treating adolescents, Cumberland Heights decided to develop ARCH Academy on 67 wooded acres to provide 12-step recovery, proven clinical therapy, adventure programming and licensed high school. The location of the ARCH Academy facility also will provide an environment well suited to connecting with nature and exploring spirituality though hiking, mountain biking and trail rides. The unique program also plans to include activities within the community such as fishing, softball, pottery, canoeing, camp-

Cumberland Heights celebrates groundbreaking on ARCH Academy. Pictured (L-R) Steve Rick, Dean Porterfield, Paul Wilson, Jay Perkins, Alec McDougall, and Jay Crosson.

ing and service work. “Adolescent Recovery of Cumberland Heights (ARCH) Academy is so much more than the sanctuary of 67 wooded acres,” Cumberland Heights CEO Jay Crosson said to those gathered for the groundbreaking ceremony. “ARCH Academy is a new vision for adolescent treatment that builds upon our current 30-day program (primary) and a month or so of extended care. We will incorporate those elements and combine them with outdoor adventure-based therapies with a focus on gender and development needs of the adolescent male.” He continued, “The additional time of an average six-month stay will allow us to also address underlying co-occur-

ring disorders while establishing a strong foundation of 12-step recovery and support.” He added the private academy would allow residents to continue their high school education while preparing them for a sober life. “These young men have the potential to be more than just clean and sober. We want them to continue their dreams, to be productive members of the community and rejoin their families. The ripple effect of their recoveries will be profound as they recover life,” he said. Cumberland Heights celebrated the announcement of ARCH Academy with a groundbreaking ceremony at the site in late April. For more information go to ARCH.org. MAY 2018

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The New Normal in Nursing Education Non-traditional Nursing Programs are on the Rise By MELANIE KILGORE-HILL The landscape of nursing education is evolving, with non-traditional and online programs now accounting for half of all nursing graduates nationwide. As more and more students head to their laptops for class, health systems, universities and colleges are looking for innovative ways to reach tomorrow’s generation of healthcare providers.

A Changing Field

“So many students are older or don’t have the means or time for traditional four- to five-year programs,” said Kimberly Estep, PhD, chancellor of Western Governors University Tennessee. WGU represents 16 percent of non-traditional nursing graduates nationwide, with competency-based online programs availDr. Kimberly Estep able for RN to BSN and BSN to MSN degrees. Their popular RN to BSN program is designed to further the training of registered nurses with twoyear associate degrees offered through the state’s community colleges. “Once those nurses are out working, they find that to move into management they need to complete a bachelor’s degree, and WGU provides opportunities for registered nurses already in the workforce to finish their bachelor degrees without quitting their jobs,” Estep said. WGU’s average nursing student is 37 years old, often with a family and full-time

career – obstacles that make more traditional programs less than ideal. WGU’s nursing graduates typically complete degrees within 18 months, or three terms. The competency-based program means students aren’t charged by course, so those who finish in two terms pay the same as students who finish in four. “Because of the flat rate price structure, it’s in the student and employer’s best interest to move quickly,” Estep said. Support faculty call students weekly to monitor progress and answer questions, and students are expected to spend a minimum of 20 hours weekly on their course studies. A Promising Future Some 800 RNs are currently enrolled in WGU Tennessee. Thanks to the state’s incentive programs, Estep expects that number to rise along with more traditional options. “In Tennessee, we won’t stop having a pipeline of traditional students out of high school as Tennessee Promise has been very successful in getting those students who weren’t originally going to attend community college,” Estep said. The first Tennessee Promise class graduated from two-year community colleges in 2017, and Estep expects that trajectory to increase. Meanwhile, Tennessee Reconnect is providing a cost-effective way for returning students to move from associate to bachelor degrees. Partnerships with some of the state’s largest healthcare systems help students land the jobs they want: HCA, Community Health Systems, LifePoint Health and Memphis LeBonheur Children’s Hospital are a few of the Tennessee organizations working alongside WGU.

Healing Mind & Body, continued from page 1 B4Stage4, encourages providers and patients to seek help at the first sign of illness rather than waiting till it becomes an emergency. “You would never purposefully wait until your cancer or kidney disease hit stage 4 before getting treatment, so why would you wait until hospitalization or incarceration to treat mental illness?” Starling asked. “Often times we know something’s wrong but don’t offer treatment until there’s a suicide attempt or major criDr. Tom Starling sis. By the time most people call us, they actually needed help six to eight weeks ago, and it’s now a chronic ailment. We want to encourage early prevention through screenings and education.”

three million screens, now averaging about 3,000 screenings a day. The screens, which are also accessible through the MHAMT website, are free, confidential and evidence-based. There are screens to help identify conditions from depression and anxiety to bipolar disorder and PTSD. Starling said MHAMT also works with providers to create a customized URL, which allows the provider to offer the screens to patients from their practice website. Starling said that two-thirds of those who screen positive online for mental illness have never received any sort of formal diagnosis. “If you test positive, there are places to go for help, and things you can do to get better,” he said. For example, he continued, “There are so many things you can do to treat anxiety and depression from exercise and diet to improving your sleep architecture.”

Online Screenings

MHA and state affiliates also provide “mental health first aid” training to airport personnel, clergy, law enforcement and others who might be called upon to stabi-

Since the inception of its online screening program in May 2014, the national MHA has collected more than 4

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Reaching Out

“We provide greater access to nurses, while students can access employer reimbursements funds to help them defer or drive down costs below our already low tuition,” Estep said.

Saint Thomas Residency Program

In Nashville, Saint Thomas Health/ Ascension have partnered with WGU to provide tuition reimbursement and mentorship opportunities through their two-year nurse residency program. Amy Wilson, RN, MSN, CPHQ, market chief nursing officer for Saint Thomas Health, said the program provides unique incentives for recent graduates – nearly 20 percent of which are non-traditional. “We’ve seen a lot of diversity in the type of applicants we’ve received in the past few years,” Wilson said. “There’s been a big shift in the number of second or third Amy Wilson degree students who went back to nursing school after entering the workforce but realized they weren’t doing the work they loved. Many realized that what they desired was a career that provided the opportunity to help others.” Wilson also is seeing more applicants attracted to Saint Thomas’ mission of caring for those affected by poverty. “This new generation has a strong desire to make a difference and do good in the world, and they desire an organization with a strong mission,” she said. The residency program ranges from

lize a situation until mental health professionals arrive. Participants learn skills to better recognize panic attacks and suicidal ideation, or how to approach a person affected by addiction. There are additional courses teach caregivers to keep dementia patients safe at home and build resiliency for themselves, while school programs provide training on managing bullies and coping with bad days and negative emotions. MHAMT also provides continuing education courses for providers, attorneys, counselors, long-term care staff, and other professionals likely to encounter those in need of mental health intervention. The specialized training, noted Starling, is especially important and helpful for frontline medical personnel, particularly those in emergency departments who are typically better trained to identify broken bones and lacerations than depression. Another service is to serve as a resource to providers and a source of information. Starling said it can be difficult to navigate the mental health system, and MHAMT can provide materials for providers to keep on hand from the National Institute of Mental Health with

100-200 RNs at any given time and includes a mixture of nurses with associate and bachelor degrees. Wilson said nontraditional students often bring life experience that can’t be taught in a classroom. Most are self-achievers, eager to draw on their own work and life experience. “Nursing is a unique combination of medical skills and education, people skills, knowledge and critical thinking,” Wilson said. “Non-traditional students bring many of those things to the table and adapt very quickly in their new medical world.” Investing in the Future The first year of Saint Thomas Health’s residency program includes a 14-week orientation followed by a period of mentoring. The second year is focused on learning to be a mentor and giving back to first-year residents. The program is open to any RN licensed in Tennessee and guarantees employment following completion of the two-year residency. For RNs wishing to further their education, the health system provides tuition reimbursement while the Saint Thomas Health Foundation offers a program specifically for healthcare education. School partnerships, like the one with WGU, provide discounts as well. “Our nurse residency program is an investment for our organization and for each nurse,” Wilson said. “Our goal is to take care of our nurses holistically, just like we do for our patients. Saint Thomas and Ascension believe in personal and professional integration and that you have to have both to become the best person you were intended to be.”

many publications being available in both English and Spanish.

Connecting Patients, Providers

As a referral helpline service, MHAMT also helps patients connect with providers to find the most affordable services available, close to home. Staff have partnered on several community-wide efforts including the Tennessee Safety Net Consortium, which connects people to charitable clinics. Their goal is to encourage preventative care and help more patients find an integrated healthcare home. MHAMT’s Nashville office also houses the Tennessee Suicide Prevention Network, which works to curb the 9th leading cause of death in Tennessee. “One of the best things we can offer providers is education and awareness for the patient or client who needs more attention,” said Starling, noting their ability to connect patients with local research studies and trials, brochures and other support materials. “We want to help providers keep patients and clients in a holding pattern until they have the treatment they need.” nashvillemedicalnews

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SCALE Conference 2018: What to Expect CEUs, Training & Trends By MELANIE KILGORE-HILL

From May 10-12, Nashville will play host to nearly 800 medical professionals at the 13th annual SCALE conference at the Music City Center. Hosted by the Tennessee Society for Laser Medicine and Surgery, the Symposium for Cosmetic Advances and Laser Surgery is the nation’s most recognized educational event focused on lasers and energy based devices, injectables for cosmetic concerns, skin care, practice management and medical dermatology. Founded by local cosmetic surgeons Brian Biesman, MD, FACS, and Michael Gold, MD, FAAD, the SCALE conference has grown to include an international audience and faculty members from across North America who are widely recognized as industry leadDr. Brian Biesman ers. Attendees receive 21 hours of continuing medical education over the three-day event. “In the cosmetic and aesthetic space, there are a lot of meetings, but Dr. Biesman and I continually Dr. Michael Gold bring in the best and brightest new faculty, which allows attendees to stay ahead of the curve,” Gold said. “Being in Nashville, we’re also in a healthcare mecca and are very fortunate to be a part of that change in this city.”

What to Expect

SCALE has continually evolved to address the latest in industry changes. For 2018, plenary lectures offer attendees three distinct tracks each day, with topics ranging from hair replacement and scar treatment to psoriasis and feminine health. Additional courses are designed specifically for practice managers, including a session on navigating negative social media reviews – a dilemma faced by most providers at some point. Also new in 2018, SCALE will include its first-ever facial dissection cadaver lab. Led by John Moore, MD, and Jason

Pozner, MD, the full-face surgical anatomy and injection course is designed to improve the safety of neurotoxin and dermal filler injections for clinicians. “Part of what we preach is knowing the anatomy under the skin, so we’re bringing in phenomenal plastic surgeons to help attendees,” Gold said. Patients will be injected on stage following the fourhour CME demonstration. Utilizing multiple camera angles and presented on two

screens in high-def, attendees will have the opportunity to immediately correlate the pre- and post- injection appearance of the live patient with the exact anatomic location on the cadaver. Working in small groups, participants also will probe and explore specimens under faculty guidance in order to observe subtle differences in facial anatomy and muscle structure variations likely to be observed in their own practices.

Always Improving

“This conference has grown up nicely because of a lot of hard work from our organizers,” Gold said. “The interesting thing is that we’re never satisfied so as soon as we’re done, we’ll regroup and say, ‘What did we do right and wrong?’ We’re always making improvements. If you want to learn from the best, there’s no other meeting like this around.”

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We strive to bring the latest theories and practices right to our physicians through online and in-person education and consultation.

Not Too Late to Register SCALE 2018 takes place at the Music City Center, located at 201 Fifth Ave. S. Group discounts are available, and same-day registration will be offered at the door. Go online to register at tnlasersociety.com or by calling (781) 7930088.

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Neurology Notes More Medicines in the Pipeline

A new report released last month by the Pharmaceutical Research and Manufacturers of America (PhRMA) shows more than 500 new medicines are in development to help treat a wide range of neurological disorders. With more than 1,000 different neurological disorders impacting nearly 100 million Americans, thatâ&#x20AC;&#x2122;s good news. â&#x20AC;&#x153;Neurological disorders affect almost one-third of people in the U.S. and cost nearly $800 billion a year â&#x20AC;&#x201C; numbers that are expected to grow in coming years,â&#x20AC;? said Michael Ybarra, MD, deputy vice president for Advocacy & Alliance Development at PhRMA. â&#x20AC;&#x153;With so many Americans affected by neurological disorders, it is critical that we continue investing in the research and development that will lead to the next breakthrough treatment,â&#x20AC;? continued Ybarra, who is also an emergency physician at MedStar Georgetown University Hospital in Washington, D.C. â&#x20AC;&#x153;Today, there are more than 500 medicines in development that reflect our improved understanding of how the nervous system works and seek to save and improve the lives of patients.â&#x20AC;? The new report, the latest in the PhRMA Medicines in Development (MiD) series, examines the 537 medicines being developed by biopharmaceutical companies as new treatments for neuro-

logical disorders â&#x20AC;&#x201D; including Alzheimerâ&#x20AC;&#x2122;s, Parkinsonâ&#x20AC;&#x2122;s, epilepsy, chronic pain, brain tumors and MS â&#x20AC;&#x201D; that affect the brain, spinal cord and nerves. Commenting on one of the most devastating neurological disorders researchers are trying to treat or prevent, Stephan C. Sharp, MD, medical director for Nashvillebased Clinical Research Associates, noted, â&#x20AC;&#x153;Our understanding of what Alzheimerâ&#x20AC;&#x2122;s Disease is, what causes it, how it progresses, how it can be diagnosed or detected, and how best to approach treatment is a major scientific challenge. Alzheimerâ&#x20AC;&#x2122;s Disease, as well as other less well-known dementias, affects millions of American citizens and costs billions of dollars in healthcare and management costs, as well as emotional and personal costs to the individuals affected and their families.â&#x20AC;? He continued, â&#x20AC;&#x153;For this reason, the neuroscience and pharmaceutical industries are conducting trials at academic centers, like Vanderbilt University Medical Center, Meharry Medical College and University of Tennessee Health Science Center, as well as at private research centers like Clinical Research Associates, in order to produce new technologies for diagnosis and therapies for treatment and even prevention of this tragic condition.â&#x20AC;? Current drug development programs look to help ease the cost and burden to society of Alzheimerâ&#x20AC;&#x2122;s and other neurological disorders and bring new hope to

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patients as scientists continue to unlock clues to how the nervous system works on molecular and genetic levels. Sharp said drug development cannot happen in a vacuum and takes the collective work of researchers, physicians, patients, and community leaders pulling together to lead to new discoveries. The report and associated list of drugs in development â&#x20AC;&#x201C; including drug name, sponsor, indication and phase of development â&#x20AC;&#x201C; are available for access through the online version of this article at NashvilleMedicalNews.com.

they are to be saved. These new protocols will greatly improve the odds of patients with the deadliest type of stroke having their stroke reversed, sometimes enabling them to walk out of the hospital within a few days. We hope more states follow suit,â&#x20AC;? said Adam Arthur, MD, a neurointerventionalist in Memphis and the president-elect of SNIS.

Legislature Passes Stroke Triage & Transport Bill

As part of the 110th General Assembly, the Tennessee Legislature passed a bill to improve the way first responders triage and transport severe stroke patients across the state. Signed by Gov. Bill Haslam in April, the new law goes into place beginning July 1. The Get Ahead of Stroke campaign, a national education and advocacy initiative of the Society of NeuroInterventional Surgery (SNIS), hailed the new law as one that will help reduce disability and death, as well as lower the immense costs associated with long-term healthcare. The legislation directs emergency medical services to establish protocols for pre-hospital assessment, treatment and transport of stroke patients through coordination with hospitals to best address patient needs. The protocols will include education for responders in how to identify severe stroke patients who are experiencing an emergent large vessel occlusion (ELVO). These patients are often eligible for neuroendovascular stroke surgery, which can decrease the likelihood of disability or death if performed early enough. The new law ensures these patients will be triaged and quickly transported to the facility best equipped to treat them. â&#x20AC;&#x153;This legislation is the next step forward in creating a comprehensive stroke system of care throughout the state,â&#x20AC;? said Sen. Bill Ketron (R-13), primary sponsor of the legislation. â&#x20AC;&#x153;This will ensure stroke patients get to the best stroke center as quickly as possible, and it brings Tennessee one step closer to improving stroke care.â&#x20AC;? â&#x20AC;&#x153;The passage of this legislation puts Tennessee on the leading edge of stroke care. These new protocols will help ensure every stroke patient â&#x20AC;&#x201D; not just the lucky ones â&#x20AC;&#x201D; is triaged properly in the field and that those suspected of severe stroke are taken directly to the best facilities. Because of these protocols, we will see more patients survive and thrive after stroke,â&#x20AC;? said Blaise Baxter, MD, an interventional neuroradiologist in Chattanooga and the president of SNIS. Similar to how EMS personnel triage trauma patients, the new legislation is designed to help educate first responders about properly assessing stroke severity. â&#x20AC;&#x153;ELVO patients, like trauma patients, must receive immediate specialized care if

NeuroPace Offers Option for Epileptic Seizures

The fourth most common neurological disorder in the United States, one in 26 people will develop epilepsy at some point in their lifetime. According to the Epilepsy Foundation, 150,000 Americans are diagnosed with epilepsy each year. A spectrum condition, epilepsy is characterized by unpredictable seizures and can cause other health problems. Seizure type and ability to control seizures can vary widely among patients. While medications are often effective, some patients face drugresistant epilepsy with limited options to treat debilitating seizures. NeuroPace RNS, which is being used at Vanderbilt University Medical Center and other Level 4 Epilepsy Centers across the country, offers a different approach to seizure control. Similar to a pacemaker that monitors and responds to heart activity, the RNS System is billed as the worldâ&#x20AC;&#x2122;s â&#x20AC;&#x153;first and only medical device that can monitor and respond to brain activity in real time.â&#x20AC;? The system, developed and manufactured in Silicon Valley, received FDA approval at the end of 2013 for individuals aged 18 and older who have tried at least two anti-seizure medications but still suffer from frequent and disabling partial onset seizures that come from one or two areas of the brain. NeuroPace RNS is a small, implantable device connected to leads placed in up to two seizure onset areas. The device continuously monitors brain activity, detects abnormal patterns, and in response delivers imperceptible electrical pulses to normalize the activity before an individual experiences seizures. A paradigm shift in how patients with partial refractory epilepsy might be treated, more than 1,300 patients have received the RNS System across the country so far. Data from the NeuroPace Long Term Treatment trial indicate a median seizure frequency reduction of 73 percent at 8 years, and 30 percent of patients with a >90 percent seizure frequency reduction. In addition to treating epilepsy, responsive neurostimulation holds the possibility of treating many other neurological disorders that impact the quality of life for millions of patients around the world. Â nashvillemedicalnews

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Alzheimer’s Association Sees Increase in Federal Support By CINDY SANDERS

In late March, President Donald Trump signed the massive $1.3 trillion omnibus spending bill into law to fund the federal government. Part of the spending package included a $414 million increase for Alzheimer’s and dementia research funding at the National Institutes of Health (NIH). Rachel Conant, senior director of Federal Affairs at the Alzheimer’s Association, leads the organization’s efforts to elevate Alzheimer’s disease as a federal priority. She also serves as senior political director of the Alzheimer’s Impact Movement (AIM), which is the national association’s advocacy arm. Rachel Conant “The Alzheimer’s epidemic has a profound impact on families,” she said, adding her own family had been touched by the disease. “The Alzheimer’s epidemic has a profound implication for state and federal budgets,” Conant continued. “Nearly one in every five Medicare dollars is spent on Alzheimer’s or related dementias.”

Alzheimer’s Stats

Just days before the spending bill was signed, the Alzheimer’s Association released

a new report outlining the toll of the disease. “The 2018 Alzheimer’s Disease Facts and Figures” found increases in prevalence, deaths and cost of care. An estimated 5.7 million Americans are living with Alzheimer’s dementia in 2018, nearly two-thirds of Americans with Alzheimer’s are women, 10 percent of those 65 and older have the disease, and the incidence rates are even higher in older African-Americans and Hispanics. Alzheimer’s cases are expected to spike alongside the nation’s aging population with an estimated 14 million living with the disease by 2050. Currently, someone in the United States develops Alzheimer’s every 65 seconds. The Alzheimer’s Association predicts by mid-century, someone will develop the disease every 33 seconds. Although deaths from other major diseases have decreased, recorded deaths from Alzheimer’s disease increased 123 percent between 2000 and 2015. The sixth leading cause of death, the new report stated Alzheimer’s is the only one among the top 10 causes of death that cannot be prevented, cured, or significantly slowed. In addition to the human toll, the financial cost is staggering. The 2018 Alzheimer’s Association report cited a $277 billion cost to the nation for Alzheimer’s and other dementias with a projection that those costs could rise to as much as $1.1 tril-

lion by 2050. The current cost represents nearly a $20 billion increase over last year.

Plan of Action

Conant noted that in 2011, landmark legislation laying the groundwork to create a national Alzheimer’s strategy was signed into law. The National Alzheimer’s Project Act (NAPA) created an advisory council to make recommendations to the Secretary of Health and Human Services in three key areas: research, clinical care, and long-term services and support. “That was the first time we really saw the federal government put an emphasis on Alzheimer’s funding and research,” Conant said. She added with this latest $414 million NIH increase earmarked for Alzheimer’s and dementia research, federal funding has now risen to $1.8 billion. A great deal of work is being done to better understand the underlying mechanism of Alzheimer’s and related dementias, and there are a number of promising drug trials underway that hope to stop or slow down disease progression. “We’re really excited about the focus not only on treatment but on prevention,” said Conant. “We just announced the 2018 launch of the Pointer Study, which is a two-year clinical trial to look at multifactorial and lifestyle interventions to prevent cognitive

decline and dementia,” she continued. The intervention methods will include exercise, nutritional counseling, cognitive and social stimulation, and improved self-management of health conditions. For more information, go online to alz.org/us-pointer.

Kevin & Avonte’s Law

Also included in the omnibus bill was funding for Kevin and Avonte’s Law, bipartisan legislation to protect seniors with dementia and children with developmental disabilities who are prone to wander. Conant said AIM has spent several years working on the bill, which reauthorizes the Missing Americans Alert Program through fiscal year 2022 and expands the program to include those with developmental disabilities. Introduced by Reps. Chris Smith (R-NJ) and Maxine Waters (D-Calif.) in the House and Sens. Chuck Grassley (R-Iowa) and Amy Klobuchar (D-Minn.) in the Senate, the new law provides up to $2 million in grants each year to state and local agencies for programs to prevent wandering or locate missing individuals.

RAISE-ing Caregivers Up

Yet another legislative win for the Alzheimer’s Association and AIM came (CONTINUED ON PAGE 10)

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HEALTHCARE ENTERPRISE

Not Merely Surviving – Thriving ThriveLogic Uses TMS to Help Patients with Severe Depression By CINDY SANDERS

Board-certified psychiatrist W. Scott West, MD, DFAPA, has treated patients with mood disorders throughout his more than 30 years in practice. For patients with refractory depression, it’s far too easy to fall into a vicious cycle where the condition is exacerbated by the despair that accompaDr. W. Scott West nies yet another failed treatment. As medical director of Nashville-based ThriveLogic TMS + NeuroHealth, West gives patients with treatment-resistant depression another viable option in addition to medication and psychotherapy to improve their condition and quality of life. Just over eight year ago, he brought the NeuroStar TMS Therapy® system to Nashville, becoming the first physician in Tennessee to utilize transcranial magnetic stimulation (TMS) to improve symptoms of depression in patients where other options have failed. “It becomes another tool in our

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toolbox that we are finding to be very effective and well tolerated,” he said. “Transcranial magnetic stimulation is an outgrowth of MRI technology,” West continued. While researchers knew magnetic stimulation had a definite effect on the body, West said the question was what might happen if specific parts of the body were stimulated? In the mid-1980s, pioneering work by U.K. researcher Anthony Parker, PhD, led to the development of TMS. West said additional research by Barker and Mark George, MD, demonstrated magnetic stimulation to specific parts of the brain led to positive changes in mood regulation. TMS … or rTMS for repetitive transcranial magnetic stimulation … received FDA clearance in 2008. “The FDA indication is that TMS is effective in treating major depressive disorder in adult patients

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who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode,” West said. He added TMS delivers a magnetic pulse to stimulate the prefrontal cortex over a series of in-office, non-invasive treatments. West, a Diplomate of The American Board of Psychiatry and Neurology, first learned of the technology in the early 1990s and continued to follow the progress as researchers refined the treatment protocol. “I made the assumption this is something that would land in the academic sphere,” he said after the therapy gained FDA clearance. “As it turned out, that wasn’t necessarily the case.” Ultimately, he reached out to the NeuroStar developers to learn more about personally bringing the system to Nashville. “I have enough people who aren’t quite well or aren’t getting well with standard treatment so we need new treatment options,” West said of being open to adding other evidence-based options. ”Depression is a very nasty illness. Too many people have major depressive disorder,” he said, adding the condition impacts 6 to 9 percent of the U.S. population at any given time and that about one-third to one-half of those patients don’t achieve the desired outcomes. Not only do those patients fail to thrive, West said the depression impacts just about every aspect of their lives from work to personal relationships. “Traditionally, outside of drug therapy and psychotherapy, we had electroconvulsive therapy (ECT) and vagal nerve simulation (VNS),” West said of the most common options prior to TMS. Both, he continued, have drawbacks for patients. “ECT is the shock treatment that’s been around for 75 years. It’s much better now but still requires anesthesia so you couldn’t drive yourself,” he said of going for treatment. “With ECT, we see about a 60-80 percent response – it depends on the study you look at – and at about six months, people are showing

a decline with return of symptoms.” VNS, he continued, is more akin to deep brain stimulation. “It’s a surgical procedure and has about an 18 percent response rate and takes about six months to achieve response,” he said. With TMS, there’s no sedation so patients are able to drive themselves to an appointment. “You can leave a treatment and go to school, to work, to the gym, to the store, and do anything you want,” West noted. “The most common side effect is discomfort at the site of stimulation,” he added, noting some patients also report headaches that are treated with over-the-counter pain relievers. “One side effect of more concern is seizure activity, but TMS does not cause seizure disorder. The instance of seizure activity is 0.1 percent over the entire course of the TMS procedure,” he noted. “ECT is a generalized stimulation with the intent to cause a seizure. TMS is a focal stimulation of a specific part of the brain … that’s a big difference between the two,” West continued. Although each treatment is TMS short, the therapy does require a time commitment. “The protocol we generally us is 30 treatments over six weeks, Monday through Friday, 3,000 pulses per treatment.” In his practice, he said people generally begin responding after about 20 treatments. “Oftentimes, family sees subtle changes first. Typically, people start being more positive and animated,” he noted. West has been pleased with the results. “The initial studies that looked at people in the research realm took people off of all medications, had a washout period and no psychotherapy. In those studies, we had response rates of about 55 percent.” He added that in a real-world application, patients could use TMS in combination with other therapies. NeuroStar, he continued, has started a registry with de-identified information to track patient response. “There are about 1,500 people in the national registry at this point, and 62 percent of people are responding to TMS,” he said of the most recent data available. West added this number takes on greater significance in light of the fact that patients utilizing TMS have not responded, on average, to 2.8 courses of antidepressant medications. Statistics, however, can’t compare to patient experience. “After treatment, one person said it was the first time in 20 years she had felt joy,” West recalled. “To us, that’s really powerful.” nashvillemedicalnews

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Council Hosts A Conversation with Jonathan Bush By MELANIE KILGORE-HILL

phenomenon in the world.” He continued, “It’s hard to sell rock pit skills, and it’s true of medicine. New frontiers are being created all the time, and we need to get that dinosaur part of the brain out.” While a doctor might not be required to make as many gut calls on medical conditions, Bush suggested the physician focus on what he can control, such as using algorithms and technology to benefit patients. “Doctors can see how much all drugs cost at all locations, and that’s where we are a leader in healthcare,” Bush said. “That can have enormous consequences across millions of encounters and patient lives, so physicians can forget about how depressed they are about losing their hammer skills and get excited about the next big thing.

“Entrepreneurship is the act of filling a need we didn’t know we had.” That line from athenahealth CEO Jonathan Bush kicked off a lively discussion hosted by the Nashville Health Care Council on April 6. Moderated by Sen. Bill Frist, MD, the conversation touched on a wide range of topics, from innovation and technology to patient privacy and policy. More than 400 Council members heard Bush’s candid perspective on entrepreneurship, the role of government in health IT, data’s impact on the future of care and the recent influx of disruptors entering the industry.

Tech Trailblazer

Since its founding in 1997, athenahealth has grown from a California-based birthing practice to one of the most universally connected healthcare networks in the country. Today, athenahealth’s 5,200plus employees connect 111,000 providers and 106 million patients through clinical and financial services including electronic health records, population health tools, revenue cycle management and care coordination. The impressive growth has occurred under the guidance of Bush, a tech trailblazer who co-founded the company.

Need for Entrepreneurship

Bush challenged the audience to lean in to entrepreneurship and innovation within corporate structures in order to solve today’s complex healthcare issues. He also spoke about the importance of creating jobs that don’t yet exist. “Otherwise, people with more assets than you will do it … but better,” he quipped, noting the competitive advantage and freedom that accompany creating your own niche. With his strong public-sector background, Bush stated his position on the need for government to support rather than create innovation to address today’s healthcare problems. “Government has a role in encouraging innovation but not doing the innovation. I think the job of government is to protect the garden, and then let the garden grow. Currently, the government is both the referee and a player on the field,” he said. He added the confluence of new artificial intelligence plus nontraditional healthcare companies like Apple, Walmart and Amazon entering the market gives him hope that healthcare is headed in the right direction, regardless of what happens in Washington. He asked the leaders in the room to be open to disruption and to embrace entrepreneurship as Nashville continues to lead the nation in collaborating to improve patient care. Bush also compared potential utilization of government data assets to current accessibility of weather and air traffic control data from any mobile device. “Let data nashvillemedicalnews

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It’s part of the American state of mind today, and it’s relevant in the practice of medicine too.”

Nashville as a Leader

When asked about Nashville’s influence on the healthcare industry, the Massachusetts-based CEO was quick to note the city’s unparalleled position as a healthcare leader. “Nashville is extraordinary, and few understand how much activity is here,” he said. “Nashville’s social and cultural network effect in healthcare is unmatched. There is no other community like this anywhere else. If that social network can converge with a tech network effect – and I think it’s going to happen – it’s going to change the world.”

Sen. Bill Frist and Jonathan Bush engage in a lively discussion ranging from technology to entrepreneurship.

be opened up to be used,” he urged, later noting that, “If data is the new oil, healthcare in the U.S. is the new Saudi Arabia. We’re in a good position.”

Evolving Role of Providers

Frist questioned Bush about physician burnout and the general loss of autonomy felt by many providers, particularly seasoned physicians who have witnessed a tremendous shift – and subsequent loss of decision-making abilities – in the marketplace. Bush likened the shift to John Henry and the steam shovel, calling it “the oldest

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.

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Searching for Sustainable Solutions, continued from page 1 side and heavier reliance on other physician extenders on the supply side. Recognizing it is impossible to accurately predict exactly how market forces will play out over the coming years, each supply scenario is paired with a demand scenario to create a projected shortfall range. Part of AAMC’s commitment to annually updating physician workforce projections, the latest report increased the forecasted physician shortfall to between 42,600 and 121,300 by 2030. This is up from last year’s report, which projected a physician shortfall of 40,800 to 104,900 by that same year. The shifting demographics of the U.S. population continue to be a key driver of demand. “Our data shows by 2030, the U.S. population aged 65 and older will grow by 50 percent,” said AAMC’s Chief Public Policy Officer Karen Fisher. She added the supply side of the equation is impacted by several factors including the hours physicians are willing to work, the number of providers nearing retirement, and the quantity of young physicians completing training to fill in those gaps.

Schools Step Up

Allopathic and osteopathic medical schools have both seen increases in enrollment over the last several years as academic centers have pledged to help alleviate projected workforce shortages. According to AAMC data, there were 21,338 new enrollees in allopathic medical schools for the 2017-2018 academic year, a 1.5 percent increase over the previous year. Total enrollment for 2017-18 was 89,904 students compared to 81,936 in the 201213 year, a nearly 10 percent increase over the last five years and closer to a 20 percent increase over enrollment a decade ago. The American Association of Colleges of Osteopathic Medicine (AACOM) saw first-year matriculation jump with a nearly 7 percent increase in fall 2017 enrollment over the prior year. Preliminary figures from AACOM placed 2017 total enrollment at 28,981, an all-time high for the 34 accredited colleges of osteopathic medicine in the United States.

GME Bottleneck

While growing medical school enrollment is a positive step, Fisher and colleagues point out increasing the number of students won’t translate into more physicians and surgeons if there aren’t adequate training slots for graduates. “The Medicare program has been a key financer of graduate medical education,” said Fisher, who added Medicare historically funded GME on a proportionate share of a resident’s training. For example, if a resident trained at a facility where Medicare made up 30 percent of the patient population, then the federal program would pay 30 percent of the physician’s GME cost. However, continued Fisher, “In 1997, Medicare placed a cap on that support … so for over 20 years, Medicare’s support has been capped at the number of residents in 1996.” For every resident above the hospital’s cap, she said, the facility has had to absorb that extra cost. “It’s like they 10

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are taking a cut every year by virtue of that cap,” Fisher added. For the most part, she continued, there have been slots available for graduates because hospitals have borne the additional training costs. In some cases, states have stepped in to help with additional funding, as well. However, Fisher said sustaining the current setup is an ongoing concern. “When clinical revenues get tight, we’re very concerned about the ability of teaching hospitals to continue to train residents above the cap,” she said. “It’s important that we continue to receive stable, predictable financing to offset the significant costs associated with training new physicians.” AAMC, along with AACOM, strongly supports legislation that would moderate the chilling effect the current cap has on physician training. “We’re asking for 3,000 residency positions each year for five years for a total of 15,000 residency positions,” noted Fisher. The bipartisan Resident Physician Shortage Reduction Act of 2017 (HR 2267, S 1301) was introduced last May but didn’t make it out of committee. However, Fisher said there might be another chance to gain some traction if Congress takes up infrastructure this year. “I think the physician workforce is an important infrastructure need for the health of our country,” she pointed out.

Other Options

AAMC officials have repeatedly stressed the need for a multi-pronged approach to addressing the physician shortage. While enrollment and GME are huge components to the solution, there are other factors being addressed, as well. “Overall, our modeling certainly looks at the role and growth of nurse practitioners, physician assistants and telehealth,”

she said of utilizing teams and technology to extend the delivery system. AAMC also supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps, loan forgiveness programs and Title VII/ VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities. Fisher said foreign-born physicians are another potential part of the solution and noted those trained outside of America must undergo a rigorous assessment before being allowed to practice in the United States. “They are an important source of physicians in this country,” she said. “Many of them tend to practice in rural and underserved areas,” she added of filling gaps in care. Additionally, AAMC has been a champion of increasing the physician workforce in a manner that embraces diversity and cultural competency to mirror the nation’s changing demographics and to work towards eliminating health disparities. Fisher noted the AAMC also has released several statements calling for healthcare workers with DACA status to be able to continue their education, training and research. Similarly, the organization has expressed concerns over executive actions on immigration and travel impacting researchers and clinicians. In an issue brief from March 17, 2018, the organization noted, “Because disease knows no geographic boundaries, it is essential that we continue to foster, rather than impede, scientific cooperation with clinicians and researchers of all nationalities as we strive to keep our country safe from all threats.” Fisher concluded, “We certainly support national security, but we believe this is an issue of national health security.”

Alzheimer’s Association, continued from page 7 earlier this year with passage of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. “From the Alzheimer’s perspective, we know there are more than 15 million caregivers providing unpaid care to individuals,” said Conant. The 2018 Facts and Figures report estimated these individuals provide 18.4 billion hours of care valued at over $232 billion. Research has shown caregivers of people with dementia report higher levels of stress, depression and worse health outcomes than those caring for individuals without dementia. In 2017, these additional stressors led to Alzheimer’s caregivers incurring an extra $10.9 billion in health costs. Sens. Susan Collins (R-Maine) and Tammy Baldwin (D-Wis.) and Reps. Gregg Harper (R-Miss.) and Kathy Castor (D-Fla.) introduced the bipartisan legislation. The new law directs the Department of Health and Human Services to develop a national strategy to provide education and training, long-term services and supports, and financial stability and security for caregivers. Conant said her organization worked closely with AARP to push for passage of RAISE, which was modeled off of NAPA.

“It will require a plan to be updated annually,” Conant said. “It’s also going to create a National Family Caregiving Council to provide recommendations to the (HHS) Secretary.”

Providers & Care Planning

Conant said the Health Outcomes, Planning and Education (HOPE) for Alzheimer’s Act that passed in November 2016 provides a funding mechanism for providers to be reimbursed for assessing and discussing a diagnosis of Alzheimer’s disease and available treatment and support options to improve or maintain quality of life. “Beginning in 2017 for the first time, people living with Alzheimer’s now have access to care planning with a medical professional, and it’s paid for by Medicare,” she said, adding the Alzheimer’s Association has a downloadable care planning toolkit for providers. For more information, go online to alz.org/careplanning.

Moving Forward

“The goal is to prevent or effectively treat Alzheimer’s by 2025,” said Conant. “We’re excited about our progress, but we know we have a long way to go.”

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Nashville Biosciences Launches Last month, officials with Vanderbilt University Medical Center (VUMC) announced the creation of a wholly owned subsidiary, Nashville Biosciences, to harness the power of its extensive genomic and bioinformatics resources to advance drug and diagnostics discovery and development. Through Nashville Biosciences, pharmaceutical and other life science companies can leverage the wealth of data contained within VUMC’s genomics and health information technology resources to accelerate the discovery and development of new treatments for patients, while helping to support institutional research efforts. “Partnering with the pharmaceutical and broader life sciences industry through Nashville Biosciences will enable VUMC to expand and support its mission of advancing translational and precision medicine,” said Leeland Ekstrom, PhD, founder and chief operating officer of Nashville Biosciences. The new company will serve as a commercial interface between outside companies and the formidable research resources housed in VUMC, including its comprehensive databank BioVU® which contains more than 250,000 DNA samples collected over the last decade, coupled with 2.8 million de-identified patient records. “The creation of Nashville Biosciences will dramatically accelerate our ability to work with pharmaceutical and other partners to advance human health by accelerating rational drug and diagnostics development and use,” added Dan Roden, MD, VUMC’s senior vice president for Personalized Medicine. Among the capabilities that will distinguish the company are analytical methods developed for “mining” DNA datasets. For example, researchers led by Josh Denny, MD, MS, vice president of Personalized Medicine, have pioneered techniques such as PheWASTM that can link specific genetic mutations to their key clinical characteristics (known as disease phenotypes). Among academic medical centers, VUMC is widely recognized as a leader in the application of genomics and bioinformatics to drug development, an effort that is transforming the pharmaceutical industry, Ekstrom said. Even before the launch of Nashville Biosciences, VUMC has already been working closely with a number of top pharmaceutical and diagnostic companies including Pfizer, Celgene Corporation, Population Bio, and Goldfinch Bio. These projects, each of which aims to discover new treatments for patients in disease areas of interest for each partner, as well as multiple other ongoing efforts, will transition to the new company in the coming weeks. “We’ve only just started to scratch the surface of what is possible with genomics and informatics resources that can be coalesced for research in a comprehensive academic medical center,” said Gordon Bernard, MD, executive vice president for Research for VUMC. “Partnering with Nashville Biosciences will greatly expand the national and global reach of these resources.” nashvillemedicalnews

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Shelby McFadden Vice President Medical Private Banking ph: 615-514-6053 email: slmcfadden@ftb.com

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4/11/18 4:27 PM

May 2018 NMN  

Nashville Medical News May 2018

May 2018 NMN  

Nashville Medical News May 2018