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FOCUS TOPICS ONCOLOGY • SUBSTANCE USE DISORDER • PRACTICE MANAGEMENT • SENIOR HEALTH

Your Middle TN Source for Professional Healthcare News

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American Cancer Society, Meharry Team Up to Change the Narrative Addressing Outcomes, Workforce Disparities By MELANIE KILGORE-HILL

African Americans are more likely to die of cancer than any other ethnic group. Helping the medical community gain a better understanding of that reality is a monumental job, but it’s one the nation’s four historically Black medical schools are tackling thanks to a recently launched partnership under the American Cancer Society’s Diversity in Cancer Research Program (DICR) umbrella, which was announced earlier this year.

Hope Renewed

Renewal House Keeps Families Together For many women, family is everything. But for those with substance use disorders, keeping families whole through the treatment process can be a challenge ... 9

Tivity Health Keeps Seniors Engaged, Connected Actively aging happens to us all with each passing day, month and year. Aging actively is an entirely different proposition … 16

Tennessee Makes Major Changes to CON Process Tennessee healthcare providers now have a very different certificate of need (CON) law to consider when they plan new facilities or expand services ... 18

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Hefty Investment

The ACS is partnering with Meharry Medical College, Morehouse School of Medicine, Charles Drew Medical School and Howard University to improve diversity, equity and inclusion in the cancer research environment to help address health disparities. The inaugural initiatives of the overarching program include DICR Institutional Development Grants in a pilot program for 2021-2022. ACS has committed to a $12 million investment to fund a four-year program aimed to increase the pool of minority cancer researchers by identifying talented students and faculty from the four HBCU medical schools.

Partnering with Meharry

Samuel E. Adunyah, PhD, professor and chair of Biochemistry and Cancer Biology at Meharry Medical College, said ACS has long done a fantastic job of creating awareness through education (CONTINUED ON PAGE 6)

Managing Risk of Cyber Incidents Reaching Cybersecurity Maturity in the Healthcare Industry By GINA PRUITT, KraftCPAs

Cyber threats are here to stay — and they continue to be one of the topics keeping senior management up at night. With breaches and ransomware attacks still occurring at high rates, the healthcare industry continues to be significantly impacted. For the 11th year in a row, The Ponemon Institute 2021 Cost of a Data Breach Study (ponemon.org) commissioned by IBM Security listed the healthcare industry with the highest total cost per breach and the largest increase (29.5 percent from 2020 to 2021) of the 18 industries covered. Approximately 70 percent of records compromised included personally identifiable information (PII), which is why medical records are a hacker’s dream. Each record is worth at least 10 times the value of a stolen credit card. A company’s most important asset is its reputation. That said, management must determine their risk tolerance – or the level of risk the organization is willing to accept. Once risk tolerance is decided, there are several ways to mitigate risk. There are three key approaches an organization can implement to limit risk: • Manage risk within the organization, (CONTINUED ON PAGE 12)


Changing the Stigma of Lung Cancer

TriStar Centennial’s low dose CT scans a game changer in lung cancer outcomes Tennessee ranks third in the nation for lung cancer diagnoses, and fourth in deaths related to the disease. It’s a sobering reality attributed in part to stigmatisms surrounding outdated screening, treatment options and traditional outcomes.

The need for early diagnosis “Lung cancer kills more patients than breast, colon and prostate cancers combined, but people don’t discuss it as frequently as other cancers,” said Denis Gilmore, MD, a TriStar Centennial thoracic surgeon specializing in the treatment of lung cancer and lung disease. Gilmore said the tendency to overlook the disease also stems from historically low survival rates and limited treatment and screening options. “Before now, screening wasn’t performed consistently, so we waited until symptoms appeared, ” he explained. Unfortunately, because lung cancer does not have symptoms in its early stages, 70 percent of lung cancer patients aren’t diagnosed until stages three or four, when treatment options are limited. Unlike breast cancer with its 70 percent screening rate, cervical with 80 percent and prostate at 40, only two to four percent of eligible lung patients are currently being screened. It’s a staggering reality Gilmore hopes to change through awareness for providers and patients alike – particularly in the wake of a pandemic that cancelled elective screenings nationwide, lowering survival rates for countless undiagnosed patients.

oncology and radiation oncology options, Gilmore said. “In the old days of surgery, patients would go to the OR and come out with a large incision on their side, but today’s minimally-invasive robotic approach means a faster recovery with less pain and down time and increased survival,” he said. Another game changer, stereotactic body radiation Improving odds therapy, or SBRT, utilizes high intensity beams over four to six treatments completed in less Through low dose CT scans, specialists than two weeks, compared to contemporary are catching more cancers in their earliest, radiation. Chemotherapy most treatable stages: protocols also have Patients with a nodule one changed, with molecular centimeter or less have markers allowing for a 90 percent five-year more targeted treatments, survival rate, which drops including immunotherapy. roughly an additional Immunotherapy utilizes 10 percent with every the body’s own immune centimeter of growth. system to target tumor cells “Historically the five year as foreign and has had a survival for all lung cancer significant impact. “The patients is 18 percent, most exciting thing about driven by advanced disease lung cancer is that it’s not at presentation. Stage for just one facet of treatment stage, lung cancer has Dr. Denis Gilmore that’s’ changed - it’s all worse outcomes compared changed, and we’re working to all solid tumors, but we on all angles to improve the care of patients are changing this,” Gilmore said. “If we can with lung cancer,” Gilmore said. find lung cancer early, those rates will be greater than 70 percent.”

A game changer Low dose CT scans offer decreased radiation exposure (equivalent to two round trip flights) than traditional CT scans and far greater image quality than plain chest x-ray. Treatment also has progressed in all phases from a surgical perspective, medical

Updated guidelines Today, lung cancer screening is recommended for those ages 55 to 77 who have smoked an average of one pack a day for 30 years, including people who still smoke or have quit within the last 15 years. The guidelines are set to change within the next year to include a larger targeted population. New guidelines

will include patients ages 50-80 and those with a 20 pack year history. “Guidelines are changing to include more women and minorities, who tend to get lung cancer at earlier age than white men and with less smoking history,” Gilmore said. A surprising 20 percent of lung cancer patients have never smoked, while 60 percent are former smokers. The average age of diagnosis is 69, and women are at higher risk.

Challenges to providers As awareness for screening grows, Gilmore said overcoming the stigmatism of lung cancer along with easing requirements needed to obtain insurance approval for low dose lung cancer screening remain the biggest roadblocks for many patients and providers. “To qualify for low dose CT scans, doctors often have to document they’ve recommended smoking cessation, smoking history in packs per day and discussed health benefits, ” he explained. “We’re trying to make it easier for providers to order scans, but all of the logistics can be worked out.”

Changing minds Screenings are a quick process involving no need for invasive bowel prep, IV access, blood draws or undressing and uncomfortable exams as in other cancer screening

protocols– surprising but welcome news to most patients. “It’s by far the easiest screening of any you can get,” Gilmore said. TriStar Medical Group’s low dose CT scans are now offered in communities throughout Middle Tennessee, and the group utilizes a multidisciplinary approach involving surgeons, pulmonologists, radiologists, interventional pulmonologists, radiation oncologists, medical oncologists and nurse navigators. “We obtain everyone’s input and are very thoughtful in how we approach lung nodules. We aim to be as efficient as possible using minimally invasive techniques to obtain a diagnosis and stage of disease to help decide on treatment options,” he said, noting navigational bronchoscopy often used by pulmonologists. “A lung cancer diagnosis shouldn’t be considered a death sentence any more, and our lung cancer survival rates are improving five percent per year thanks to screenings and evolving treatment options on all fronts.” Still, Gilmore admits changing minds is a process. “Smokers have all known someone who’s had lung cancer that wasn’t diagnosed until late, leaving them few treatment options,” he said. “We’re trying to change education around lung cancer. We do have increasing options, but outcomes are much improved if we find it early. Screening can save lives, but only when screening is performed! Through advocacy and a multidisciplinary approach, we are making a difference in lung cancer.”

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Navigating Cancer Care

Thyme Care Creating Resources, Connections for Oncology Patients, Providers By MELANIE KILGORE-HILL Thyme Care is revolutionizing the cancer experience. The Nashville startup is transforming cancer navigation by connecting patients, caregivers, providers and payers with scalable, intuitive technology that generates actionable insights to help identify cancer patients earlier.

Identifying a Problem

Bobby Green, MD, Thyme Care’s co-founder and chief medical officer, said the company was born from a desire to level the cancer navigation playing field. “Anyone in oncology gets a lot of questions from people they know who’ve recently been diagnosed with cancer friends or acquaintances looking for connections and advice,” said Green, a board certified oncologist with 20-plus years of practice experience. “It’s a limbo period, and patients feel vulnerable. I get these calls all the time, and I’m able to answer questions and usually help point them in the right direction or expedite an appointment, all of which can have a big impact … but it didn’t seem fair that unless you know an insider, you’re just stuck out there.”

Addressing a Need

Dr. Bobby Green

social determinants like transportation to appointments, food insecurity and financial assistance: critical aspects that clinics don’t always have the time or resources to address.

Taking Root

In October 2020 Thyme Care was born, named for the herb that represents friendship and devotion. It was made possible by a $22 million funding round (led by Andreessen Horowitz, AlleyCorp, and Frist Cressey Ventures with participation from Casdin Capital, Bessemer). Green said Nashville was a natural choice

Partnering with Providers

The model also was designed to complement existing case management services offered by practices, many of which provide only short-term navigation during the diagnosis phase. “We don’t want to

step on toes, so we collaborate nicely and fill in gaps to help clinicians address barriers of care that clinics may not have the time or resources to address,” Green said. “Practice navigators can give us the stuff that’s hard or not a part of their core mission. If you’re an oncology-trained nurse, it’s probably not the best use of your time to arrange transportation, but someone needs to.” To date, Thyme Care has partnered with oncology practices primarily in the New Jersey market to support their Clover Health members and is establishing relationships with other oncologists, health plans and provider groups in the region. After partnering with a health plan, Thyme Care team members proactively reach out to members or are contacted by members themselves. Now with 50-plus employees, Thyme Care hopes to grow their geographic footprint with more partners in more locations and expanded its tech capabilities. “Cancer is really hard, and we’re certainly not lacking for amazing oncologists in both community and academic settings,” Green said. “If you fill gaps, you ultimately make it easier for clinicians to take care of patients; it’s hard to provide chemo if the patient can’t get a ride to the office. We’re hearing really exciting stories from interactions with members and are eager to see where we go from here.”

more control

He and colleague Robin Shah, founding member of Nashville-based OneOncology and Thyme Care founder and CEO, began brainstorming solutions to provide resources throughout the patient’s journey. “In general, there was a lack of comprehensive cancer navigation that broadly covered the needs of patients on a bigger scale,” said Green. Previously chief medical officer at Flatiron Health, Green helped develop a data-rich, cancer-specific EHR platform for better patient experiences while offering smarter research for clinical staff and cancer researchers. His new task: redesign cancer navigation. “It’s obvious that a cancer diagnosis is a really bad experience, so what does the business of improving that look like?” he asked. “Across the cancer continuum there’s not enough navigation, which leads to bad patient experiences and poor outcomes at a higher cost, so how do you create a company that can broadly and consistently provide high-touch services in a way that’s scalable?” For Shah and Green, the mission was to enable integrated cancer care leading to better results, higher value and aligned HEALTHCARE incentives – while also optimizing the patient experience and empowering clinicians. Achieving that meant addressing NASHVILLEMEDICALNEWS

for a home base. “It’s unbelievable what a healthcare tech hub Nashville has become,” he said. “There are so many great companies, and we’ve received advice and collaboration from clinicians and non-clinicians alike. Everyone’s been very welcoming. It’s a great place to found a company.” Green and Shah set out to hire tech experts and partner with health plans, placing a special emphasis on a glaringly absent component of most navigation platforms: clinician relationships. “Outside of a clinic, it’s hard to effectively build relationships without collaborating partnerships and buy-in from a clinical team,” Green noted. While technology is an integral component of their model, Green said it’s not sufficient to accomplish their mission. “Our high-tech approach isn’t possible without high touch points, or people engaging with patients,” he explained. “Our technology enables that personal connection and allows us to solve the problems we were seeing.”

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ONcology Rounds

News & Updates in Cancer Care New treatments, research, program innovations and leadership – there is a lot of exciting news both nationally and in Nashville when it comes to improving oncology care.

New AACR Report Highlights 50 Years of Progress

Last month, the American Association for Cancer Research (AACR) released the 11th edition of its annual Cancer Progress Report, which underscores how cancer research, largely supported by federal investments in the National Institutes of Health (NIH) and the National Cancer Institute (NCI), continues to drive progress for patients with cancer. The report chronicles advances in basic, translational, and clinical cancer research; features profiles of patients who have benefited from recently approved anticancer therapeutics; includes the latest information on cancer prevention, detection, and health disparities; and outlines policy recommendations. This year’s report highlights the enormous strides in cancer research and treatment since the National Cancer Act was signed into law by President Richard Nixon on Dec. 23, 1971. This groundbreaking legislation laid the foundation for a robust and innovative cancer research community, which has contributed to decades of progress for patients in the U.S. and around the world. A few highlights include: In the U.S., the overall age-adjusted cancer death rate has decreased by 31 percent from 1991 to 2018, a reduction that translates into 3.2 million lives saved. This reduction includes a record 2.4 percent decline between 2017 and 2018, the largest reduction ever seen in a single year. Successful efforts to reduce smoking rates among Americans have contributed to a 41 percent decline in lung cancerrelated deaths from 1991 to 2018. Fueled by discoveries made over the past 50 years, molecularly targeted therapeutics and immunotherapeutics have substantially increased the five-year survival rates for patients with formerly intractable cancers, like lung cancer and metastatic melanoma.

Biden Appoints Winkfield to National Cancer Advisory Board

President Joe Biden recently appointed Karen Winkfield, MD, PhD, to the National Cancer Advisory Board for a six-year term to help guide federal initiatives focused on cancer. Winkfield is the executive director of the Meharry-Vanderbilt Alliance, professor Dr. Karen Winkfield of Radiation Oncology and Ingram Professor of Cancer Research at Vanderbilt University Medi4

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cal Center and professor of Medicine at Meharry Medical College. “This is such an honor because the board helps shape the activities of the National Cancer Program,” said Winkfield. “For someone like me, who is focused on health equity and ensuring that everyone — regardless of their race, ethnicity, geographical location or socioeconomic background — has the same chance to survive cancer and survive it well, this is a golden opportunity.” She joins Scott Hiebert, PhD, professor of Biochemistry and Hortense B. Ingram Professor of Cancer Research at Vanderbilt, on the 18-member board.

Eng Named NCI Co-Chair of GI Steering Committee

Recently, Cathy Eng, MD, FACP, FASCO, was elected co-chair of the National Cancer Institute (NCI) Gastrointestinal Cancer Steering Committee, which is responsible for supervising clinical trials, including studies on neuroendocrine tumors, gastroesophageal carDr. Cathy Eng cinoma, rectal-anal and colon cancers, hepatocellular tumors and pancreatic cancer. “We help evaluate and prioritize NCI-sponsored studies involving the National Clinical Trials Network for all phase 2 and phase 3 trials that have more than 100 patients involved,” explained Eng, professor of Medicine, David H. Johnson Professor of Surgical and Medical Oncology and co-leader of the Gastrointestinal Cancer Research Program at Vanderbilt-Ingram Cancer Center, who began her three-year term on Aug. 23.

Tennessee Oncology, BCBST Launch Value-Based Care Initiative

In October, Tennessee Oncology and BlueCross BlueShield of Tennessee announced an innovative, value-based cancer care program designed to improve treatment coordination. Launched for BlueCross networks P, S, and L, the new initiative is touted as being one of the most comprehensive value-based arrangements for cancer care in the country. “This program supports our members’ peace of mind by enabling access to the highest-quality, patient-centered care for their condition,” said Andrea Willis, MD, senior vice president and chief clinical Dr. Andrea Willis officer for BCBST. Developed through a comprehensive evaluation of the most effective features of other value-based cancer care programs in recent years, the program is designed

to support high-quality, cost-effective health care to patients. The initiative follows BlueCross members at all phases of the cancer journey from diagnosis through treatment and follow-up, and providers earn financial incentives or penalties based on how well members’ care is coordinated and documented. BlueCross and Tennessee Oncology will: • ensure best practices are followed in care planning and treatment, • analyze treatment data to make sure care guidelines are met and patients receive the right treatment at the right time, and • provide patient-centered care throughout the process. As the clinical partner in the Oncology Medical Home, Tennessee Oncology will maintain key quality designations including the Quality Oncology Practice Initiative (QOPI) Certification awarded by the American Society of Clinical Oncology (ASCO). “Our commitment to innovation and patient-centered care have always been core to the culture of Tennessee Oncology,” said Natalie Dickson, MD, president of Tennessee Oncology. “The current era of personalized medicine is especially encouraging for our patients and clinicians; how- Dr. Natalie Dickson ever, affordability will continue to be a major challenge. As evidenced by this program, the role of the health plans is becoming increasingly important to enable us to fulfil our mission. This value-based care initiative will serve as a model for how clinicians and health insurers can collaborate to benefit patients.”

Sarah Cannon Continues to Grow

Sarah Cannon has recently added several new physician-scientists to their renowned program. Navneet S. Majhail, MD, MS, FASTCT, recently joined Sarah Cannon as deputy physicianin-chief of Blood Cancers for the Sarah Cannon Transplant and Cellular Therapy Network. In addition to his work at Sarah Cannon, Majhail is also serving as Dr. Navneet program medical Majhail director for the Sarah Cannon Transplant and Cellular Therapy Program at TriStar Centennial Medical Center. Most recently, Majhail served as director of the Cleveland Clinic’s Blood and Marrow Transplant Program and also served as the vice chair for the Department of Hematology and Medical Oncology and a professor of Medicine

with the Cleveland Clinic Lerner College of Medicine. He is a past president of the American Society for Transplantation and Cellular Therapy (ASTCT) and has been recognized as a fellow for his contributions to the field of transplantation and cellular therapy. Meredith Pelster, MD, MSCI, joined Sarah Cannon as an investigator for Sarah Cannon Research Institute at Tennessee Oncology, specializing in gastrointestinal cancer, as well as head and neck cancer research. Pelster received her medical degree from Vanderbilt University Dr. Meredith Pelster School of Medicine. She completed her fellowship in hematology and medical oncology at MD Anderson Cancer Center and her residency and Master of Science in Clinical Investigation at Northwestern University. Benjamin Garmezy, MD, also joined Sarah Cannon this year as an investigator for Sarah Cannon Research Institute at Tennessee Oncology, specializing in genitourinary (GU) oncology research. In his role, Garmezy oversees investigational therapy trials for Dr. Benjamin GU cancers, including Garmezy prostate, kidney, and bladder cancers. He received his undergraduate degree from Amherst College and his medical degree from Baylor College of Medicine. Prior to joining Sarah Cannon, Garmezy completed his internal medicine residency at the University of Michigan and his fellowship in hematology/oncology at MD Anderson Cancer Center. (CONTINUED ON PAGE 5)

Mark Your Calendar AACR Annual Meeting April 8-13, 2022 • New Orleans Register by Dec. 17 to take advantage of early bird rates for the American Association for Cancer Research annual meeting. For event details or to register, go online to aacr.org.

ASCO Annual Meeting June 3-8 • Chicago Registration opens in December for the annual meeting of the American Society of Clinical Oncology. For details or to register, go online to conferences.asco.org/am.

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Funding Renewed for Local Partnership on Cancer Disparities

The Meharry Medical College/ Vanderbilt-Ingram Cancer Center/ Tennessee State University Partnership (MVTCP) recently received renewed funding for the next five years to continue long-standing collaborations to eliminate cancer health disparities. The National Cancer Institute, a division of the National Institutes of Health, awarded the grant through the U54 Comprehensive Partnerships to Advance Cancer Health Equity (CPACHE) program. The MVTCP is the longest-standing partnership in the United States through this program, beginning its 22nd consecutive year of funding this past September.

AACR Launches Two Career Development Awards to Encourage Diversity

In mid-October, the American Association for Cancer Research announced the creation of two career development awards (CDA) to further diversity, equity, and inclusion in cancer research. One is for basic, translational, or population sciences research with recipients receiving $300,000 over three years. The second is focused on clinical cancer research with applicants invited to submit proposed projects for the opportunity to receive $375,000 over three years. These new awards support earlycareer investigators from racial or ethnic groups that are underrepresented in cancer-related sciences. In coordination with the AACR’s Minorities in Cancer Research (MICR) constituency group, grantees will be provided opportunities to attend professional development sessions and to engage with colleagues and potential mentors. Applications for the two awards through Nov. 30, 2021. For more information on these and other funding opportunities, visit aacr.org/professionals/ research-funding.

Ascension Celebrates 3D Mobile Mammography

At the end of October, Ascension Saint Thomas held a ribbon-cutting for the state’s first 3D mammogram breast tomosynthesis bus at Green Hills Mall. The 44-foot coach is outfitted with an imaging test that combines multiple X-rays to create a three-dimensional picture of the breast. Set to serve 26 counties in the Middle Tennessee area, the goal of the coach is to contribute to early detection and a reduction in late-stage breast cancer and breast cancer mortality by providing crucial access to screening mammography. The new mobile mammography nashvillemedicalnews

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bus was made possible by the donors to the Ascension Saint Thomas Rutherford Foundation, The Ascension Saint Thomas Foundation, the Christy Houston Foundation, and through the Our Mission in Motion program, an Ascension Saint Thomas initiative to increase access to breast health services to underserved, uninsured, and low-income patients

VICC Trial Tests ATR Inhibitor in Difficult-to-Treat Cancers

A clinical trial recently has been launched to test a new targeted therapy in patients with advanced and difficult-totreat cancers. Satya Das, MD, MSCI, assistant professor of Medicine at Vanderbilt-Ingram Cancer Center (VICC), is the national principal investigator for the trial enrolling Dr. Satya Das people with metastatic small cell lung cancer, metastatic pancreatic cancer, metastatic neuroendocrine cancer and other types of advanced solid tumors. The phase 1 trial will evaluate a novel drug, elimusertib, in combination with standard chemotherapy. In preclinical studies, elimusertib has demonstrated tumor shrinkage. An ATR inhibitor, this promising class of new drugs target the ataxia telangiectasia mutated and Rad3related (ATR) kinase, which is involved in DNA damage repair. The drug inhibits the growth of tumor cells by limiting their ability to repair damaged DNA. ATR inhibitors work similarly to PARP inhibitors, which have already been approved by the U.S. Food and Drug Administration for ovarian cancer and breast cancer. “Unfortunately, PARP inhibitors have a pretty limited activity for patients with the types of cancers in this clinical trial,” Das explained. “ATR is a pathway that is actually activated by single strand DNA breaks. A lot of our chemotherapies induce DNA breaks. ATR is a very commonly activated pathway, so ATR inhibitors are being tested in multiple disease sites, mostly in early phase studies. What makes elimusertib quite interesting is that in preclinical models it seems to be the most potent. It induces the most tumor shrinkage across cancer types.”

trials at the earliest phases of research and was designed to meet the specialized needs of patients seeking advanced cancer treatment options. Also in September, Sarah Cannon Research Institute announced an expansion of their collaboration with American Oncology Network (AON) with the addition of AON partner practice Genesis Cancer and Blood Institute as a strategic research site in Arkansas. Genesis joins Hematology/Oncology Clinic in Baton Rouge, Messino Cancer Centers in Asheville, N.C., and Zangmeister Cancer Center in Columbus, Ohio as strategic research sites to enhance access to clinical trials.

Ascension Saint Thomas Uses ‘Hot Chemo’ in Ovarian Cancer Battle

Earlier this year, a Middle Tennessee teacher became the first in the state to receive an innovative treatment known as “hot chemotherapy.” When Cheatham County elementary school teacher Melissa Barr felt some stomach pains and bloating, she wasn’t overly worried. A healthy eater and yoga devotee, she brushed off any concerns, thinking it was safer to just ride it out as the first wave of the pandemic was underway. By December 2020, Barr knew she needed to seek care and was shocked to be diagnosed with stage 3 ovarian cancer. After receiving three rounds of traditional chemotherapy, Barr became the first ovarian cancer patient in Tennessee to receive Hyperthermic Intraperitoneal Chemotherapy (HIPEC), before completing another three rounds of tra-

ditional chemotherapy. HIPEC, also known as “hot chemotherapy” because it involves heating a standard dose of chemotherapy and applying it directly to the abdomen to increase penetration of cancerous tissues, has more frequently been used by surgical oncologists to manage cancers of the abdomen. However, gynecological oncologists Jason Barnett, MD, and Michael Stany, MD, led the charge in Tennessee by employing this technique in Barr’s treatment at Ascension Saint Thomas Hospital Midtown. Today, Barr’s cancer is in remission, she has returned to teaching and is enjoying life with her family and friends.

Nashville General Earns Cancer Reaccreditation for 80th Consecutive Year

This year, Nashville General Hospital earned reaccreditation from the American College of Surgeons Commission on Cancer (CoC) for an 80th consecutive year, making it the second-oldest accredited cancer program in Nashville. The CoC recognizes cancer care programs dedicated to improving survival and quality of life for cancer patients through standards that promote cancer prevention, research, education and monitoring of comprehensive quality care. To earn this accreditation, a cancer program must meet 34 CoC quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care. “We are thrilled to receive this accreditation for the 80th consecutive year,” said Joseph Webb, D.Sc., MSHA, FACHE, CEO at Nashville General Hospital. “This recognition is a significant reminder of the incredible work that our organization does to improve the quality of life for cancer patients in the Nashville community.”

Sarah Cannon Expands Collaborations

With a mission to bring cutting-edge care and clinical trials to communities across the country, Sarah Cannon has announced several additions to the network this fall. At the end of September, Sarah Cannon announced the opening of its newest drug development unit (DDU) in collaboration with Florida Cancer Specialists & Research Institute and the University of Central Florida College of Medicine in Lake Nona, Fla. The new unit is led by Cesar Augusto Perez, MD, a recognized expert in Phase 1 oncology research. The first of its kind in Lake Nona, the DDU focuses exclusively on oncology clinical

(L-R): Billy Ballard, MD, Pathology, Cancer Committee, Vice-Chair; Amine El Kadmiri, MD, Director of Medical Oncology NGH, Cancer Committee, Chair; Joseph Webb, DSc, MSHA, FACHE, Nashville General CEO; Faye Jornadal-Recinto, MSN, Manager, Robert E. Hardy Cancer Center; Richard Martin, III, MD, Ph.D., Hematology/Oncology; and Mark Brown, MHA, CRA, Nashville General COO. NOVEMBER/DECEMBER 2021

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Reducing Surgical Site Infections in Orthopedic & Other Surgeries By ROBERT M. HARRIS, MD, Hughston Clinic

During my long career as an orthopedic trauma surgeon for civilian and military patients, I’ve seen the significant negative impact of surgical site infections (SSIs) on patient outcomes and healthcare costs. For civilian patients, SSI rates can be up to 2 percent for Type 1 open fractures and up to 50 percent for Type 3. For military patients with trauma wounds, infection rates can be as high as 77 percent. These infections pose a substantial burden in terms of increased morbidity and mortality, as well as resource demand on the healthcare system. U.S. data from the Centers for Disease Control and Prevention (CDC) indicate an average of 1.5 million SSIs per year, with a mean direct cost per case of $20,785 and a total burden of some $3.3 billion annually. In the case of periprosthetic joint infection, per-case costs can rise in excess of $100,000. This SSI burden includes an additional 11.2 days of ICU care per case. Moreover, insurers have increasingly labelled SSIs as “never events,” meaning that the facility will receive reduced or no compensation for resolving these cases. The cost of treating the SSI comes directly out of a facility’s bottom line. Johns Hopkins conducted an analysis on 2007-10 data and found that preventing a single SSI could yield a net saving of over $34,000. Those analyses all occurred well before the COVID-19 pandemic began to overload and overwhelm healthcare systems worldwide. Clearly, this extra burden poses

a substantial risk to patients, caregivers and healthcare systems already under strain. It is critical to identify novel techniques and technologies to help alleviate the problem. Treatment options for SSIs are generally either pharmacologic (antibiotics) or invasive (surgical debridement, irrigation and stabilization), yet have widely varying degrees of success. Both risk factors and predictors of success are multivariate and include pathogen(s) present, patient comorbidities, patient socioeconomic status and timing to detection and intervention. No single factor can predict whether a patient will develop or recover from an SSI. Therefore, a multi-pronged approach is warranted. When pharmacotherapy alone is deemed insufficient, a common approach is open irrigation of the wound. The choice of irrigant has been hotly debated in scientific and clinical circles, and most traditional approaches include antibiotics (which biologically disrupt microflora) or antiseptics/detergents (which chemically or mechanically disrupt microflora). Each offers advantages and disadvantages; for example, antibiotics generally have lower host toxicity but offer differential impact on various microbiological species and risk formation of biological resistance. In 2020, the FDA requested voluntary market withdrawal of bacitracin for injection into irrigation solutions because of safety concerns and extremely limited use in pediatric pneumonia, its only approved indication. Antiseptics and detergents can offer broad spectrum coverage with low risk of resis-

tance but potentially damage host tissues. A more nuanced approach may be useful in both balancing microbial susceptibility and secondary tissue injury. One important factor in removing microbial contamination — and hence resolving infections — is whether the population has been able to form a biofilm in the site. Known since the 1970s, biofilms are now widely understood to form a protective niche for microbes in a wide variety of environments. In brief, microbes can accrete on a surface (ranging from a speck of dust to a biological surface to a petroleum pipeline) and synthesize extracellular polymeric substance (EPS) — a complex milieu of polysaccharides, proteins, lipids and nucleic acids, cross-linked by metal ions. This protective EPS layer defends the colony from immune, antibiotic and antiseptic attack. The challenges posed by biofilmbased SSIs, and the limitations of other treatment options, are why I’m excited to lead a U.S. clinical trial to test the efficacy of XPERIENCE™, a new no rinse antimicrobial solution that received FDA clearance in April. Developed by medical technology company Next Science, XPERIENCE is based upon Next Science’s proprietary XBIO™ Technology, which takes an innovative approach to solving the problem of bacterial biofilms. The unique, non-toxic technology attacks and deconstructs the structure of the biofilm by removing the metal ions that hold the EPS together. This exposes the bacteria within the biofilm, making them more

American Cancer Society, Meharry Team Up, continued from page 1 and prevention. “Having a partnership with medical schools is very important for what the ACS wants to do in addressing disparities,” he explained. “They want to invest in different respects of cancer Dr. Samuel prevention and address Adunyah health disparities.” For more than 100 years, Nashville’s Meharry Medical College has trained more African American physicians than any other school in the nation. Graduating about 100 students each year, 87 percent of the student body is Black. Nearly 90 percent of the Master of Public Health students and 92 percent of dental school graduates are African American. In fact, Meharry’s School of Dentistry produces 39 percent of the nation’s Black dental physicians.

By the Numbers

Data show African Americans and Black people, Hispanics and Latinos, indigenous people and native Hawaiians and other Pacific Islanders are underrepresented in grant funding. Fewer than 2 percent of applicants for the National Institute of Health’s principal grant program come from Black/ African Americans and fewer than 4 percent from Hispanic/Latino populations.  6

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The ACS partnership will boost cancer research and career development at minority-serving institutions such as Meharry, with grants designed to build capacity and enhance competitiveness of faculty at Minority Serving Institutions (MSIs) when applying for nationally competitive grant support and aid in faculty development and retention. The awards provided through the DICR program are unique in cancer research, providing a large amount of salary support for the four HBCU medical schools to select clinical faculty who need more dedicated time for their cancer research and scholarly activities. They also fund other students and postdoctoral programs and underpin the awards with career development funds and mentorship by established American Cancer Society professors. The goal of the grants is to build sustainability for both clinical and scientific cancerfocused careers, launching or sustaining the careers of 104 individuals by 2025.

Lowering Death Rates

The initiative will focus on pilot projects in the top five cancers: breast, colon, lung, prostate and ovarian. “Those five cancers are the ones with highest incidence as a nation but also have the highest death rates for African Americans,” Adunyah said. For example, while white women are more likely to receive a breast cancer diag-

nosis, the death rate among Black women is much higher. Similarly, Black men are more than twice as likely as white men to die from prostate cancer, and lung cancer has a higher incidence among Black men. “Research will focus on getting more information on why that’s the case and try to address it,” said Adunyah. “If you sum up those types of cancers, the bottom line is that in the last 20 to 25 years, overall death rates are going down in the U.S. as a whole; but when you break it down into racial groups, that decline is much slower in African Americans. We’re trying to understand that.”

Minority Workforce

On the local front, funding also will help Meharry focus on cancer control and prevention, funding two Master of Public Health students each year for four years. Adunyah said training would directly reduce incidence of new cases through education around lifestyle changes, diet and activity. The project also will support postdoctorate fellows in biomedical sciences or public health to become independent cancer researchers following graduate studies. “There’s a big disparity of minorities and African Americans in cancer research and the workforce,” Adunyah said, pointing to a surprising 2-3 percent minority rate among oncologists. “Still, we know the extent to which that affects patients and

vulnerable to eradication. Bacteria that are enveloped within the XBIO Technology are then destroyed by the combination of a surfactant and high osmotic imbalance across the bacterial cell wall. XBIO Technology’s broad-spectrum efficacy helps defend from biofilm reformation, reducing the rate of reoccurrence by over 100X. Due to this unique mechanism of action, there is no known resistance to XBIO Technology. The trial, the TIFRAX (Tibial Fracture) Study, is a randomized, controlled, double-blinded, prospective study to evaluate the efficacy of XPERIENCE in helping decrease wound bioburden and surgical site infections. It will also evaluate whether XPERIENCE can improve post-operative outcomes when used as adjunct treatment to standard of care in patients undergoing tibial fracture repair. Enrolment in the 30-patient, 90-day study is already underway. Robert M. Harris, MD is a board-certified orthopedic surgeon based in Columbus, Ga., where he is program director for the Jack Hughston Memorial Hospital Orthopedic Residency Program and co-director of the Hughston Orthopedic Trauma Fellowship for the Hughston Clinic at Midtown Medical Center. Harris attended the COS annual meeting in Nashville from Nov. 3-6 as a guest of Next Science, for whose XPERIENCE product he is currently leading a U.S. clinical trial.

that ultimately this funding will move the dial a little and increase equality.”

A Promising Future

Adunyah said funding for research has been particularly difficult for the past decade, with grant funding from the National Institutes of Health virtually stalled. “When you have a private society like the ACS focused exclusively on cancer provide additional funding for training, it’s very important,” he said. Adunyah said the grant represents the first ACS funding of HBCUs. “The fact that the ACS is partnering with us is a very significant change, which will allow us to address disparities as a nation,” he said. “The more we impact the community and provide education, the more we’ll be able to stop some of these cancer deaths and impact not just African Americans but those who might be interested in working in the field of cancer. Given the high incidence of cancer among Blacks, this will play a pretty significant role in addressing those.” He added he also hopes the partnership will result in ACS support of non-medical HBCUs, such as those with thriving education programs. “Partnering with the ACS is an honor and blessing,” Adunyah concluded. “Given the great work the ACS is doing, it’s an honor for us to team up with them and enhance their ability to provide cancer information and control.” nashvillemedicalnews

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Fighting Addiction on All Fronts Substance use disorder knows no racial, economic, sexual orientation, age or gender boundaries. Fighting it requires a concerted effort on all fronts.

VUMC’s Firefly Lights a Path to Recovery

The opioid crisis — now one of the leading causes of maternal mortality — continues to rage in Tennessee. “There is a critical need to address access to care and provide comprehensive public health solutions for pregnant women and infants affected by the opioid crisis,” said Stephen Patrick, MD, MPH, MS, a neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “The stakes are Dr. Stephen Patrick high. For years we have been in the middle of an opioid overdose epidemic, but there are still far too many barriers to get treatment. Women are dying or losing their children to foster care as a result,” he continued. While VUMC has had clinical programming in place for many years dedicated to helping pregnant women with opioid use disorder and their infants, funding from the Centers for Medicare and Medicaid Innovation (CMMI), in conjunction with TennCare, will help to unite and expand these programs and provide additional resources. This new expanded program is called Firefly – lighting a path for moms in recovery and their infants. Patrick, who serves as executive director of Firefly, noted it is one of nine state programs funded by CMMI to test optimal models of care for mothers and their babies. This $5.3 million grant provides funding over a five-year period to combat the nation’s opioid crisis and address fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder. Each program is structured differently, with an aim to innovate and improve how care is administered to women and infants impacted by the opioid crisis, said Patrick. Vanderbilt’s model has been developed in collaboration with the departments of obstetrics, pediatrics and psychiatry. “We have to work to push through the system, break down barriers, enhance services and create resources to connect women,” he continued. “The ultimate goal for this new program is to support families and optimize care for pregnant women with opioid use disorder and for opioid-exposed infants.” The program’s recent launch is timely as Patrick noted families’ challenges have likely worsened during the COVID-19 pandemic. Firefly will be based in the Center for Women’s Health at One Hundred Oaks, where existing programs will continue to care for uninsured and privately insured pregnant and postpartum women with substance use disorders. Women in the new program nashvillemedicalnews

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will each be paired with a peer recovery specialist, a trained patient navigator and advocate with lived experience. In addition to five peer recovery specialists, the new Firefly program will also include social workers, an outpatient lactation consultant, obstetric, pediatric and psychiatric professionals and a clinical program manager to help provide wraparound services that are responsive to the needs of this patient population. For additional information about Firefly or to make an appointment go to fireflytn.org or call 615-421-8000.

Crush the Crisis: TriStar Collects 858 Pounds of Medication

TriStar Health facilities in Middle Tennessee and Southern Kentucky collected more than 850 pounds of medication during its “Crush the Crisis” opioid take-back events on Saturday, Oct. 23. The events took place at eight hospitals and one freestanding emergency room in partnership with local law enforcement and aligned with the Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day. “I would like to thank every individual who utilized our events to dispose of their unwanted and expired medication,” said Tama VanDecar, MD, chief medical officer for TriStar Health. “We were able to collect an incredible 858 pounds of medication, which is now out of people’s homes and is no longer at risk of being abused.” Events were held in local communities from Smyrna to Bowling Green. TriStar Horizon Medical Center in Dickson collected the most medication with 316 pounds, followed by TriStar StoneCrest Medical Center in Smyrna with 104 pounds.

New MAT Center for South Nashville

Adults in the Nashville area who have been struggling with addictions to heroin, prescription painkillers, or other opioids now have access to outpatient treatment with the September opening of South Nashville Comprehensive Treatment Center (CTC), which provides medication-assisted treatment (MAT) for adults ages 18 and older. “The staff at South Nashville Comprehensive Treatment Center is excited to have the opportunity to serve the community in the greater Nashville area,” said Regional Director Dustin Alvanas. “At South Nashville CTC, we are deeply passionate about helping adults achieve lasting recovery from opioid dependence.” Outpatient MAT at South Nashville CTC incorporates medication and counseling. Following assessment and consultation with one of the center’s doctors, patients may receive a prescription for methadone, buprenorphine, or Suboxone. When used as directed within the context of a licensed MAT program, these medications have allowed people to address their opioid use without experiencing the

powerful cravings and painful withdrawal symptoms that would otherwise occur. In addition to medication, South Nashville CTC patients also participate in individual and group counseling to help patients identify and address the many factors that may have contributed to their opioid use and other self-defeating behaviors. During counseling, patients work to develop the skills and strategies that will empower them to achieve long-term recovery from opioid addiction. The new center, located at 1420 Donelson Pike, is part of Franklin-headquartered Comprehensive Treatment Centers, which operates nearly 150 centers across the nation. For more information, go online to ctcprograms.com.

Spero Health Continues Aggressive Treatment Clinic Expansion

Brentwood-based Spero Health, a leading addiction treatment provider, opened four more clinics over the last few weeks with the latest being in the Ohio cities of Canton, Columbus and Sandusky, as well as Galax, Va. These latest clinics join a network of more than 60 Spero Health locations throughout Kentucky, Ohio, Tennessee, Indiana and Virginia. Company officials said these new openings are in-line with organizational plans to continue to expand regionally throughout the year to address commu-

nity needs for individuals to have local access to addiction treatment services close to home. “Overdose deaths in Ohio and the United States set a new record in 2020, and unintentional drug overdose is now one of the leading causes of injury death … surpassing motor vehicle crashes, said Steve Priest, CEO of Spero Health. “We’ve continued to see these numbers steadily increase across the country since the start of the pandemic. Initially people felt fearful and vulnerable with loss of social supports; that coupled with cheap access to deadly drugs, our communities were dealt a devastating blow causing many to lose their life. It is critical our communities have local resources and quick access to addiction treatment services, now more than ever, it’s simply a matter of life and death.” said Steve Priest, CEO of Spero Health. More than 93,000 Americans fatally overdosed in 2020, a 29 percent increase from the prior year.

ReVIDA Recovery Centers Expands Insurance Partnerships

At the beginning of November, Nashville-based ReVIDA Recovery Centers CEO Lee Dilworth announced that the company is now accepting Humana Behavioral Health – (CONTINUED ON PAGE 8)

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In an uncertain practice environment, it’s never been more important to have access to accurate, timely information. NMGMA keeps you up to date with monthly speakers addressing pressing practice issues. For information on upcoming events or to join, go online to www.NashvilleMGMA.org or email website@nashvillemgma.org NOVEMBER/DECEMBER 2021

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HealthStream Preps the Workforce to Battle the Opioid Epidemic By CINDY SANDERS

With the world’s attention understandably focused on a global pandemic, the deadly opioid epidemic has been bumped from the headlines over the past two years. Yet, it’s front-page replacement has acted as an accelerant to the physical and emotional pain driving opioid use disorder (OUD) to new heights. According to the Centers for Disease Control and Prevention, of the nearly 71,000 drug overdose deaths in 2019, more than 70 percent involved an opioid. Those numbers have increased at an alarming pace with recently released CDC preliminary data showing a record high 93,000 overdose deaths in 2020. While opioid overdoses were already on the rise pre-pandemic, the CDC released an official Health Alert Network Advisory at the end of 2020 warning of substantial increases in drug overdose deaths involving synthetic opioids. The alert noted the largest increase in fatalities was recorded from March to May 2020, coinciding with national lockdowns associated with the initial wave of the pandemic. Observing a perfect storm of conditions fueling this rise, Nashville-based HealthStream has expanded their approach to opioids to focus on creating

a culture of safety, rather than a singular focus on compliance. A leading source of workforce and provider solutions across the nation, HealthStream is leaning into education, stewardship and health equity to offer healthcare executives and leaders a different perspective on increasing opioid awareness and training. While it remains critical to comply with prescribing guidelines and evidence-based treatment protocols, the hope is taking a broader view of the pervasive epidemic crossing all population segments will lead to new understanding, compassion and solutions. “HealthStream has been around for over 30 years. Our vision has been to improve the quality of healthcare by developing those who deliver care,” noted Trisha Coady, senior vice president and general manager for Workforce Development Solutions Trisha Coady at HealthStream. Addressing the rise in opioid-related fatalities, Coady added, “As we look at what’s happened in healthcare across the country, our focus is really on helping frontline staff.” Partnering with the National Qual-

ity Forum and Just Health Collective, HealthStream is working on programming that creates a structured approach to opioid stewardship while also drilling down to look at healthcare access … and just as importantly, to upstream issues and solutions. In August, just ahead of International Overdose Awareness Day, the group hosted a national conversation on opioids. Experts in quality, equity and the judicial system discussed the impact of the opioid crisis across all sectors of society and looked at collaborative opportunities, equity, inclusion, resources and innovative concepts to help save lives. “Education is one of the least expensive tools in the toolbox that has one of the most broad-reaching impacts,” noted Coady, a nurse and national thought leader on professional development. She added, education needs run the gamut from enhanced awareness of OUD, implicit bias and microaggressions to guidelines for adhering to evidence-based prescribing and the deployment of community education around Narcan. However, Coady is quick to point out complex issues like OUD require a multipronged approach to finding effective, long-term solutions. “People come to the ER and are sent out without a treatment plan. We don’t have enough places for

people to recover,” she said of the need for more physical resources. Breaking down silos is another important step to comprehensive care, Coady continued. Pointing to diabetes care, she noted there is a strong emphasis on prevention, care coordination and patient education. “We’re not yet connected as a system with opioids the way we are with diabetes,” she said, adding OUD requires the same mindset. “It really is a chronic condition, and we need to treat it that way.” In addition to the physical toll, the cost of OUD in terms of providing care and lost productivity is in the billions and continues to rise each year. While there have been positive steps for both opioid stewardship and addressing barriers to care, Coady said the pandemic exacerbated underlying issues and shone a light on how much more work remains to be done when it comes to achieving health equity. “As the pandemic stabilizes at some point, we’re going to be left with issues that need to be tackled. There will be such a hill to climb,” said Coady. Education alone won’t resolve the opioid epidemic, she continued, but it’s a foundational platform for launching initiatives within healthcare and community settings to begin to scale that mountain.

Fighting Addiction on All Fronts, continued from page 7 Commercial and Medicare Advantage plans at all seven of its locations in East Tennessee and Southwest Virginia. This is the latest addition to ReVIDA’s growing list of commercial, Medicare Advantage, and Medicaid partnerships to lower the cost of treatment for individuals living with opioid use disorder. “Not too long ago, state Medicaid programs and commercial insurers were not willing to insure recovery treatment for substance use disorder, creating steep barriers for individuals in need of treatment,” said Lee Dilworth. “That’s why we’ve worked Lee Dilworth hard to contract with additional insurance plans who believe in evidence-based treatment like we do.” Additionally, ReVIDA is accredited with all three MCOs for TennCare and accepts commercial and Medicare Advantage patients for Blue Cross Blue Shield of Tennessee and UnitedHealth in Tennessee. According to the National Center on Addiction and Substance Abuse, only one in 10 people struggling with opioid use disorder receives treatment due to barriers, including a lack of insurance or high out-of-pocket costs. 8

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AI Predicts Opioid Overdose in Tennessee

Researchers at Vanderbilt University Medical Center and the Tennessee Department of Health (TDH) have developed 30-day predictive models for fatal and non-fatal opioid-related overdose among patients receiving opioid prescriptions in the state. The team applied machine learning techniques to statewide data sources that included details on 2,574 fatal and 8,455 non-fatal opioid-related overdoses occurring within 30 days of an opioid prescription. In all, the data involved just over 3 million patients and more than 71 million prescriptions for controlled substances. The team’s report appeared Oct. 19 in the Journal of the American Medical Informatics Association. According to TDOH, there were 3,032 overdose deaths in Tennessee in 2020, a 45 percent increase from 2019. Opioids, both illicit and prescribed, were involved in 79 percent of the state’s overdose deaths in 2020, and 19 percent of Tennesseans who died of a drug overdose in 2020 had an opioid prescription in the 60 days before death. To assess and engage the opioid overdose crisis, public health authorities in Tennessee have relied solely on current and retrospective descriptive data, without prognostication. According to the report’s senior author, Colin Walsh, MD, MA,

associate professor of Biomedical Informatics, Medicine, and Psychiatry and Behavioral Sciences, TDH will continue to study the predictive models with an eye to their potential deployment in the public heath response to the ongoing crisis. The new models are not designed to guide interventions at the patient level. By predicting risk at the prescription level, the models are instead designed to allow aggregation of risk to practices and healthcare organizations, pharmacies, localities and counties. “With these predictive models, Tennessee might bolster overdose prevention through better understanding of systems, communities and regions at highest risk before overdoses have occurred,” Walsh explained. “If this were to prove useful in Tennessee, the tools Dr. Colin Walsh and methods we’ve used could potentially be adapted by other states to support more targeted prevention.”

Substance Use and Pain Care Task Force Urges Action

Task Force Updates Focus, Seeks Public Policy Changes The American Medical Association (AMA) issued a report in late September

showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade, including a 6.9 percent decrease from 2019-2020. Along with the sharp decreases in opioid prescriptions, new AMA data also show physicians and other healthcare professionals used the state prescription drug monitoring programs (PDMPs) more than 910 million times in 2020. The report also highlighted more than 104,000 physicians and other healthcare professionals have an “X-waiver” to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80 to 90 percent of people with a substance use disorder receive no treatment. Despite these moves, the nation continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, according to the U.S. Centers for Disease Control and Prevention. In addition, state public health, media and other reports compiled by the AMA show that the drug-related overdose and death have worsened across the nation. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration, and Indian Health Service underscore the continued challenges and inequities for Black, Latinx and American Indian/ (CONTINUED ON PAGE 14)

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HEALTHCARE ENTERPRISE

Hope Renewed

Renewal House Keeping Families Together During Addiction Treatment By MELANIE KILGORE-HILL

will provide an additional 34 apartments, along with meeting rooms and office space. Completion is expected early 2022.

For many women, family is everything. But for those with substance use disorders, keeping family together through the treatment process can be a challenge that delays or prevents women from seeking help. One Nashville agency understands the importance of keeping children close while moms receive help. Each year, more than 500 women and children get a new start at Renewal House.

Overcoming Stigma

Doing it Right

“What makes Renewal House so unique is a woman can participate in addiction treatment while living independently in her own apartment with her children,” said Renewal House CEO Pamela Sessions. Since 1996, Renewal House has treated more than 7,000 women and children through its Pamela Sessions residential and outpatient programs. The north Nashville campus welcomes mothers with children newborn to age 10. While moms are in treatment during the day, their children attend a local school or daycare. Women are encouraged to stay as long as they’re working on treatment goals. “We want them to take their time and do it right,” Sessions explained. While most recovery programs maintain a 42 percent success rate, 60 to 70 percent of clients at Renewal House are successful in treatment, meaning they become sober, improve parenting skills, identify a vocational track and find stable housing.

Life at Renewal House

Clients at Renewal House find a welcoming, yet structured, environment. During the week, women adhere to a schedule of morning meditation, therapeutic groups, 12-step meetings, case management sessions and life skills development. Weekends are reserved for family time on the playground, engaging in activities with their children, doing homework and managing their own apartments. “Being in this environment allows families to create structure in their life, which is so important as many of them have not had that previously,” Sessions said. “Many of our moms have never lived independently or parented before coming to Renewal House.”

COVID-19 & Addiction

Like many treatment centers, Renewal House has seen an uptick throughout the COVID-19 pandemic, nashvillemedicalnews

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with 60 women currently on a waiting list. Pre-pandemic, it wasn’t uncommon for women to have some sobriety upon admission. Now, many arrive having used the same day. “The acuity level is a lot higher than it was prior to the pandemic,” said Savak Millis, LPC-MHSP, director of programs at Renewal House. “The frequency in which clients are using Savak Millis substances, along with the amount used, has sharply increased, causing the need for more intensive services.”

Meeting Demand

To better meet needs, Renewal House is undergoing an expansion to accommodate 100 residential clients a year – double their current capacity. The three-story, 30,000-square-foot facility

While a lot has changed during Renewal House’s 25 years of operation, Millis said the stigma surrounding pregnancy and addiction is still tough to overcome. “There’s not a more stigmatized population than a pregnant woman injecting a substance,” she said, noting that many don’t associate a woman who has recently given birth with someone at risk of overdose: a reality responsible for a staggering 33 percent of maternal deaths in Tennessee associated with substance use. “Renewal House stands in the gap between what could be death for these ladies and/or a fulfilling life with their child,” said Millis. “As primary caregivers, women are often more likely than men to have to choose between treatment and their children,” added Sessions. “This is not a choice that Renewal House ever wants a woman to have to make. Our clients are proof that mothers with substance use disorders love their children and make great sacrifices to keep the family intact.”

No Judgment Zone

Renewal House staff utilizes a judgment-free approach – one that medical providers can adopt when working with those at-risk. “My hope is that the medical community will keep substance use in mind and ask the uncomfortable

questions while remembering that there’s not one profile of what a person with a substance use disorder may look like,” Sessions said. That means asking questions with kindness and empathy rather than judgment. “When women feel judged, they shut down,” Millis noted, adding providers are sometimes afraid of having these conversations because they can be biased by their own personal feelings. Reframing these discussions often means changing the language from “addiction” to “substance use disorder,” and focusing on the disease. This shift puts medical professionals back in their comfort zone of treating a disease and not a choice.

Funding

Renewal House receives most of its funding through state grants, private foundations and individual donors. Their signature event, A Renewal House Thanksgiving, raises awareness of substance use disorders while generating funds to support the agency. Millis said individuals with substance use disorders are frequent consumers in the TennCare system, spending more dollars on care than someone who is healthy. “That’s why supporters believe in investing in solutions rather than perpetuating a negative cycle,” she said. Renewal House challenges the notion that women with substance use disorders aren’t anyone else’s problem. “It’s everyone’s problem,” Sessions said. “The problem of addiction has an impact on our entire community, from foster care to the legal and healthcare systems. Investing in resources to create a healthier community is so important. These are your tax dollars at work. What do you want to do with them?”

LET’S DO THIS TOGETHER 615.377.4600 www.LBMC.com/healthcare

The team is stronger when experts work together. LBMC Advisory Services offers expertise in Data Insights, Risk, Healthcare Consulting, Transaction Advisory & Compensation Valuation

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America’s Health Rankings: Women & Children Defining Health Strengths, Opportunities for Tennessee By CINDY SANDERS

For three decades, United Health Foundation has worked to quantify areas of challenge and opportunity for states in addressing health outcomes through America’s Health Rankings®. Last year, the philanthropic foundation of UnitedHealth Group adopted a new model focused on health at the intersection of the four key drivers – physical environment, social and economic factors, clinical care and behaviors. In October, the organization released America’s Health Rankings 2021 Health of Women and Children, which impacts the overall health of the nation. The report looks at the health of more than 58 million women of reproductive age and 73 million children nationwide with data points specific to each state. “There are 118 measures and 35 data sources,” explained UnitedHealthcare Regional Chief Medical Officer Arethusa S. Kirk, MD. “It’s America’s data.” She noted this most recent release is the fifth report on the health of women and children. “The data primarily represents pre-pandemic and early pandemic timing,” she added as a caveat, noting the pandemic has likely exacerbated some issues.

“Now, in this stage of the pandemic, we’re seeing an increase in overall mental health conditions for children. This is reflected nationwide,” Kirk continued. “Just today, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a Dr. Arethusa Kirk national emergency in children’s mental health,” she noted of the mid-October announcement (see sidebar). On the plus side, the report found Tennessee had lower rates of anxiety and depression for children. Another positive for youth is a lower rate of illicit drug use in Tennessee compared to much of the nation. Teen suicide, however, was slightly above the national average with the state measuring at a rate of 12.0 compared to a national rate of 11.2. Kirk again stressed the information outlined in the most recent rankings was largely collected pre-pandemic. “There is significant evidence of mental health stress for women, children and others,” she said of more recent reporting. “It’s estimated more than 150,000 children have lost a

TDH Announces Temporary Increase in WIC Benefit The Tennessee Department of Health recently announced a temporary increase to the Women, Infants and Children (WIC) Program’s Cash-Value Benefit (CVB) for fruit and vegetable purchases. Through Dec. 31, 2021, increased benefits are available in varying amounts for children, pregnant and postpartum women, breastfeeding mothers and those exclusively breastfeeding with multiples. The authority to increase the amount of the CVB was approved recently by the federal agency and terminates on Dec. 31, 2021. The enhanced CVB will be automatically added for participants scheduled to receive benefits in November and December. For those who received their three-month benefits in October, TDH said they are working with its vendor to make sure WIC participants receive the additional benefit amounts for November and December. If participants have questions regarding their benefits, they should contact their local WIC clinic or call 1-800-DIAL-WIC.

Fisk, Galen Create New Pathway to Nursing Fisk University and Galen College of Nursing have announced an articulation agreement to create a new pathway in nursing for Fisk students. Filling an unmet need for students enrolled in science programs who wish to explore nursing, the agreement allows for Fisk degree coursework credits to transfer to Galen College of Nursing so students may go directly into Galen’s Bachelor of Science in Nursing (BSN) program. “The articulation agreement marries our university’s rich tradition of scholarly excellence with a new opportunity to receive an unparalleled nursing education from Galen College of Nursing - helping drive diversity and leadership in the nursing field,” said Fisk University President Vann Newkirk Sr., PhD. Prospective students must first be granted admission into undergraduate degree programs in Biochemistry and Molecular Biology or in Biology at Fisk University. Upon successful completion of the degree, a student will be granted admission to the BSN program at Galen College of Nursing, which can then be completed in as little as two years.

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America’s Health Rankings® uses the World Health Organization’s definition of health: “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”

primary or secondary caregiver during the pandemic.” Tennessee saw a number of positives including a high prevalence of exercise among women and a decrease in teen births for females ages 15-19, dropping from 34.8 to 23.7 per 1,000 births over a six-year period. For women ages 18-44, there was an 11 percent decrease in poverty between 2018 and 2019. However, at a rate of 16.9 percent, that figure is still above the national average of 15.2 percent and gives Tennessee a rank of 37 in the nation. The story is worse for children, with the state ranking 41st at 19.7 percent compared to a national value of 16.8 percent. Other issues to be addressed include a high mortality rate among women ages 20 to 44, a high prevalence of multiple chronic conditions among women and a 61 percent increase in excessive drinking for women between the ages of 18 and 44 when comparing the years 2014-15 to 2018-19. “That’s concerning, as well as drug deaths increasing by 33 percent,” noted Kirk. Despite ranking in the middle of the pack for number of pediatricians and above average for adequate insurance, Tennessee ranks last for WIC coverage among eligible children ages one to four. Similarly, the state ranks highly for high school graduation rates (6th in the country) but poorly for early childhood education (41st nationally). “Look at these measures that seem like they are in contradiction and really drill down to see where the gap may be,” advised Kirk. For example, she continued, the low WIC usage “may be a marker of parental misunderstanding of WIC availability and how to access the resource.” She added the point of the annual rankings is a call to action. “One of the key messages is to highlight with the data strengths and opportunities for improvement,” said Kirk. “Another key message is for everyone who is invested in health and wellness to drill down into our nation’s data to understand for their own communities and state what the trends are and to help determine where resources should be allocated to address challenges.” For more detailed information on national and state findings, go online to AmericasHealthRankings.org. State summaries are available to download from the report’s homepage.

National Child Mental Health Emergency On Oct. 19, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP) and Children’s Hospital Association declared a national emergency in children’s mental health, citing the toll of the COVID-19 pandemic on top of other existing challenges. Noting much of the focus has been on physical health during the pandemic, AAP President Lee Savio Beers, MD, FAAP, stated escalating mental health issues demand action. “Today’s declaration is an urgent call to policymakers at all levels of government – we must treat this mental health crisis like the emergency it is.” Prior to the pandemic, suicide had become the second leading cause of death for youths ages 10-24. With the pandemic came the added burdens of fear, physical isolation and grief as caregivers and family members were lost to COVID. The Centers for Disease Control and Prevention has issued several reports to quantify the toll on mental health, including a 24 percent increase in emergency department visits for mental health emergencies for children ages five to 11 and a 31 percent increase for those ages 12 to 17 between the months of March and October 2020. The three organizations are calling on policymakers to take several definitive steps including: • increase federal funding to ensure all access to mental health services, • improve access to telemedicine, • support effective schoolbased mental health models, • accelerate the integration of mental health services in primary care pediatric settings, and • fully fund community-based systems of care that connect families to evidence-based interventions. “We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness and suicidality that will have lasting impacts on them, their families, their communities and all of our futures,” said AACAP President Gabrielle A. Carlson, MD. “We cannot sit idly by. This is a national emergency, and the time for swift and deliberate action is now.”

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Managing Risk of Cyber Incidents, continued from page 1 • Transfer risk outside the organization, and • Avoid risk as an integral part of decision making.

Common Types of Healthcare Breaches

Several types of data breaches commonly occur within the healthcare industry: • Social Engineering: coming in the form of both logical and physical means. A logical social engineering attack could be either a phishing email which includes a link to ransomware, business email compromises for which a third-party has taken over an executive’s system, or credential loggers to capture passwords and other key user data. • Third-party Software Vulnerabilities – which are often caused by vulnerabilities in programming of the software and require the organization or their network support provider to install timely software updates to resolve the vulnerability. • Accidental or Intentional Compromise or Loss of Data – this could be a lost device, a malicious insider, system errors, or even system misconfigurations. Ransomware attacks continue to be on the top of the list for healthcare and most other industries as well.

Managing Cyber Risk Within the Organization – A Dynamic Process

Healthcare entities have a responsibility to comply with the privacy and security laws outlined in the Health Insurance Por-

tability and Accountability Act (HIPAA). Risk assessment is the first step to ensure compliance. Once the assessment is complete and the organization has identified key controls and filled any gaps in those control, the risk management process should be a continuous, dynamic process. The same basic tenets of a HIPAA risk assessment can be applied to the process of performing a cybersecurity risk assessment to identify threats and vulnerabilities, then determine the likelihood of occurrence, as well as the potential impact of an occurrence in a specific organization. The next critical step is to identify and implement necessary controls to mitigate those risks and reduce the likelihood of occurrence. For this process to be successful, it requires leadership within the organization, as well as input and commitment throughout the organization to ensure all business components and information assets are identified, and that is an ever-changing inventory. Suggested steps of the process should include, but may not be limited to: • Identify and Classify Information Assets It is important to identify and classify sensitive, critical information assets that need to be managed. Information assets include various categories of data (both automated and non-automated), including, but not limited to, data contained in records, files, and databases. Healthcare entities are responsible for protecting the privacy, confidentiality, integrity, and availability of their patient’s

When it comes to data security, you can’t be too safe. Partnering with our team of audit, technology and security experts allows you to leverage our methodologies, technology, knowledge, and expertise to proactively address security matters so you can continue to focus on what matters most: providing excellent patient care.

Network & Cyber Security • HIPAA, HITECH & HITRUST Practice Management • Operations • Compliance 615-242-7353 ext. 184 • krafthealthcare.com

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protected health information (PHI) and personally identifiable information (PII), as well as other information assets. Generally speaking, information assets are critical systems, third-party interfaces (such as those used for payer processing), automated tools and source code, proprietary systems, and confidential records. Classification is a designation given to the information asset based on sensitivity and criticality to the organization. • Identify Threats A threat can be a person, organization, or even an act of nature that could compromise information security or privacy of PHI or PII. Threats can be malicious, intentional, unintentional, natural disasters, hardware failures, or viruses, among other things. The nature of threats, their capabilities, and resources must be considered to determine the likelihood of their occurrence. For this purpose, assess risk and threats in terms of the probability of an attack or breach. Threat intelligence, such as that provided by The Ponemon Study, plays a key role in developing and maintaining a cybersecurity risk management program. • Identify Vulnerabilities Vulnerabilities could be weaknesses in a network, a particular system, lack of segregation of duties within an application, inadequate physical security and other issues that could potentially be exploited. Vulnerabilities should be assessed based on the type of weakness and the information asset(s) that would be impacted. • Analyze Risk There are inherent risks for any process. Information security and data privacy have more inherent risks and, therefore, require more controls. Healthcare’s valuable information is highly sought after by threat actors, hackers and even unethical employees. There is also the potential for unintentional and accidental breaches. Analyzing risk based on the impact or criticality to the organization is key. Risk can generally be determined using the following equation: Likelihood of a threat against the asset x Value of the asset = Risk Based on this equation, the higher the likelihood of occurrence and the higher the value of the asset to the organization, the higher the risk level – and the cost to an organization of a successful breach.

Integrating a Dynamic Cybersecurity Program

Cybersecurity touches almost all aspects of the organization and is an ongoing process. Cyber risk management requires organizations to address those threats identified in the risk assessment, as well as new threats identified or caused by ongoing changes in hardware, software, third parties, etc. Redefining the controls, tools, and other mitigating factors affecting the processes and programs within the organization should become second nature. Other critical areas a cybersecurity program ties to and may require periodic changes include the organization’s privacy policy and program, information security

program, business continuity and disaster recovery plans, incident response and crisis management plans and third-party vendor management program. A cybersecurity program should be weaved throughout the organization. Although not an exhaustive list, it is critically important to ensure that the following are addressed: Protecting Patient Data: A documented data protection program such as logging and monitoring probable attacks, quarantining systems, encrypting data intransit and at rest, as well as managing third parties who impact the organization’s systems and data. Backups and Recovery: Minimize loss and downtime through recovery time objectives (RTOs) for backups and testing backups for fast and efficient recovery. In addition, tests for cybersecurity incident response scenarios as part of regular business continuity and disaster recovery testing. Backups are key to recovering from ransomware attacks. Upgrades and Patches: A consistent process to maintain systems with the most current upgrades and patches in a timely and consistent manner. Anti-virus and Malware Detection: Ensure the most current anti-virus and malware detection software are on both servers and employee workstations. Threat Intelligence: Gather and manage threat intelligence, identifying specific threats to the organization. Detection and Incident Response: Detail how your organization identifies and responds to breach attempts, including who will be involved, what steps will be taken and in what order. Continuous Monitoring: Identifying and alerting key personnel when a possible attack or breach is indicated and providing a means for monitoring logs and reports in a timely, consistent manner. Periodic Network Assessments and Social Engineering: Independent, third-party network vulnerability assessment, social engineering, and internal and external network penetration tests. These can also be done on your behalf if you use a network support provider. (Note that scanning is helpful, but a full penetration test should be performed at least every 12 months.) Training and Education: Annual employee security training is a requirement of HIPAA, but training should be customized with various scenarios to address specific threats to your organization. Train employees about their responsibilities for privacy, security, and confidentiality of data, the ways the organization will hold them accountable, potential HIPAA fines, and then having the employee sign an annual acknowledgement for their personnel file.

Transfer Risk: Cyber Liability and Insurance

Traditionally, we think of insurance as a means to transfer risk to a third party. Cybersecurity risk is somewhat different. We must portion and partition off pieces of risk. Cyber insurance is one element of transferring risk. Other elements might (CONTINUED ON PAGE 19)

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NMGMA: Providing Support for Practice Managers By CINDY SANDERS

What makes healthcare exciting also makes it challenging. For those on the administrative end, wearing a lot of hats – from marketing and human resources to revenue cycle management and logistics – comes with the territory. Add in a constantly changing regulatory landscape and tight workforce market, and it’s easy to see why both new and seasoned professionals rely on organizations like the Nashville Medical Group Management Association (NMGMA) to provide critical educational and professional development resources. Recently, Nashville Medical News had the opportunity to chat with local leadership to discuss the value of the organization to practices across all specialties and sizes. Hayden Cook, director of Payor Contracting with Bon Secours Mercy Health, was installed as NMGMA presi-

dent in October. Kathi Carney, CPC, CPMA, CPC-I, CHC, director of Physician Business Solutions with LBMC, is NMGMA immediate past-president.

NMN: You both have busy jobs, yet you give your time and talent to NMGMA. What does this organization provide to practice administrators? Cook: NMGMA is an opportunity to join a wonderful organization and meet and network with individuals in a variety of roles in medical groups across Middle Tennessee. We also offer invaluable resources such as ways Hayden Cook to obtain CMPE credits, monthly member meetings with speakers and topics from

wide sectors of the industry, and social events, as well. Carney: NMGMA has been a constant in my career. It helps build bonds with other practice managers that last a lifetime. Having other professionals and peers to bounce ideas and issues off of is invaluable. I also feel new Kathi Carney administrators can find mentors that will always be there for them as they learn and grow in their careers.

NMN: What is one challenge and silver lining practices have faced while providing care during a pandemic? Carney: Practices definitely are facing staffing shortages, which can cause burn out. To combat this, we as leaders,

need to be cognizant of how our employees are doing. We need to make every effort to ensure that team members can get some down time to decompress. Thinking of silver linings, I think healthcare has had to reimagine what an office visit looks like. (Practices) have had to become creative in order to make a telehealth appointment feel like an in-person visit, which I feel has led to more of a connection with the patients. NMN: What’s the best piece of work advice you’ve received or given? Cook: The best piece of work advice I have been given is don’t be afraid to fail and to put yourself out there. Carney: Everyone is human, and we all can make mistakes. It is what we learn from those mistakes that helps us grow. For more information on member benefits and upcoming meetings, go online to nahvillemgma.org.

ACHEMT Appoints 2022 Board The American College of Healthcare Executives Middle Tennessee recently announced board members for 2022. Vikram Bollu, MS, MHA, FACHE will serve as president and Jonathan Puncochar, MBA, FACHE will serve as president-elect of the organization, which counts more than 700 area industry executives among its chapter membership. Bollu is Director of Analytics, Capital Deployment for HCA Healthcare, and Puncochar serves as Parallon Project Vikram Bollu Director, Strategy and Innovation for HCA Healthcare. Officers include: Immediate PastPresident: Laurie Babin, BrightSpring Health Services, Vice President: Brian Raybourne, AngelEye, Jonathan Puncochar Secretary: Susan Nance, Omni Community Health, Treasurer: Renee Burnham, Clarivate, Treasurer-Elect: Manjunath Subbaiah, Community Health Systems,

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Immediate Past-Treasurer: Chris Dooney, CenterPointe Behavioral Health, and Regent: Trent Beach of UNC Health. Other board members, including committee chairs and chair-elects, include: Colleen Vetere of Vizient, Inc.; Reed Smith of Jarrard Phillips Cate & Hancock; Charles Jones and Wes Crawford of Vanderbilt University Medical Centr;

Gerd Peters of naviHealth; Olivia Velasquez of TriStar Hendersonville Medical Center; Jim Mitchell and Nate Comstock of Optum; Donita Brown of Lipscomb University College of Business; and Amit Parmar of TriStar Southern Hills Medical Center. ACHEMT members-at-large include: Patrice Mayo, Tennessee Hospital Asso-

ciation; Commissioner Lisa Piercey, MD, Tennessee Department of Health; Troy Chisolm, Vanderbilt Psychiatric Hospital; and Tama VanDecar, HCA TriStar Health. For information on upcoming educational, networking and professional development opportunities, go online to achemt.org or email info@achemt.org.

Fighting Addiction on All Fronts, continued from page 8 Native Alaskan populations. “The nation’s drug overdose and death epidemic has never just been about prescription opioids,” said AMA President Gerald E. Harmon, MD. “Physicians, have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidencebased care.” To address the country’s worsening overdose epidemic, the AMA’s new Substance Use and Pain Care Task Force, which includes more than 27 national and state organizations, released recommendations to promote evidence-based policy measures. The recommendations are focused on actions that physicians can take, as well as public policy changes, that would ease the epidemic. Steps include broad efforts to remove barriers and improve access to evidencebased care for patients with pain, a substance use disorder (SUD) or mental illness, as well as to increase access to harm-reduction strategies. The new task

force also pledged to work more directly to address the changing drug overdose epidemic, focus on removing racial, gender, sexual orientation and other healthrelated inequities. The new task force combines the AMA’s Opioid Task Force and Pain Care Task Force. The new name and recommendations reflect a broader approach to the problem. “The name may have changed, but this task force continues the work of promoting policies that will improve outcomes and save lives. No single recommendation is a panacea, but taken as a whole, they would move our country in the right direction,” said AMA Board Chair and Task Force Chair Bobby Mukkamala, MD. “Removing barriers requires policymakers to join us in establishing a more effective and humane approach. Failure to adopt these policies will prolong the epidemic and our patients’ suffering.” Highlights of the recommendations include: • Support patients with pain, mental illness or SUD by building an evidencebased, sustainable and resilient infrastructure and health care workforce rather than continuing a crisis-driven approach that has led to multiple unintended negative consequences, including one-size-

fits-all strategies, continued stigma and widespread gaps in data, evidence-based treatment, and prevention efforts. • Support coverage for, access to, and payment of comprehensive, multidisciplinary, multi-modal evidencebased treatment for patients with pain, a substance use disorder or mental illness. Additionally, coverage, access and payment should directly address racial, gender, sexual orientation, ethnic and economic inequities as well as social determinants of health. This includes removing barriers to evidence-based treatment for SUDs, co-occurring mental illness and pain. • Broaden public health and harm reduction strategies to save lives from overdose, limit the spread of infectious disease, eliminate stigma and reduce harms for people who use drugs and other substances. This includes increased support for naloxone and sterile needle and syringe exchange services. • Improve stakeholder and multisector collaboration to ensure that the patients, policymakers, employers, and communities benefit from evidence-based decisions. The full task force recommendations are available at end-overdose-epidemic.org. nashvillemedicalnews

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NAM Celebrates 200 Years By REBECCA LESLIE, NAM

This has been a year of celebration for the organization, includThe Nashville ing recognition by the Medical Society was the Tennessee Senate and first medical association the Tennessee Mediin Tennessee, founded cal Association. On on March 5, 1821, by Saturday, Oct. 2, the seven physicians: Drs. bicentennial celebration Felix Robertson (presiculminated with a gala dent), James Roane benefiting the Medical (secretary), Boyd Foundation of Nashville McNairy, Adam Gibbs at the Schermerhorn Goodlett, James OverSymphony Center. The ton, John Waters, and halls were adorned with R.A. Higginbotham. medical memorabilia, The goals of the sociphotos, manuscripts, ety that would become and historical archives. The Nashville Academy of Medicine and Medical Foundation of Nashville board and staff at the gala bicentennial celebration in October. the Nashville Academy NAM Board Chair of Medicine included Robin Williams, MD; establishing a society for doctors trained NAM President Nicole Schlechter, MD; 1857: Dr. Paul Eve became the first of eight Nashville physicians elected in medical schools and improving the MFN Board Chair Ralph Atkinson, MD; president of the American Medical Association. Nashville has provided more health of Middle Tennessee. The newly and MFN Board Vice-Chair Christopher presidents to the AMA than any other city in the United States. formed society instituted agreed-upon Ott, MD, shared the history and accomEve was also president of the Tennessee Medical Association in 1871-1872. fees for various services including in-town plishments of the organization with the He was the first professor of operative and clinical surgery at the newly opened visits ($1), country travel ($1 per mile), and audience and led the evening’s celebraVanderbilt University and was noted as performing the first successful hysterectomy night visits ($5). tions. Guests danced to the songs of the in the nation. Nine years later, these doctors led renowned Jimmy Church Band and His sons inherited their father’s dedication to organized medicine with Dr. Duncan the formation of a statewide society which toasted the history and the future of the Eve serving as TMA president from 1889-1890, and Dr. Paul Eve, Jr. taking on the would become the Tennessee Medical Nashville Academy of Medicine and its role of TMA president from 1904-1905. Association, with Nashville physician, physician members. Dr. James Roane, as president. In 1853, Learn more about the organization the Davidson County Medical Society The Academy’s services have had a yellow fever quarantine, after conditions and its impact on our community, includformed; and in 1893, merged with the lasting impact on physicians and the comhad improved. ing a timeline outlining two centuries of Nashville Academy of Medicine to unite munity, including: 1950 – NAM encouraged schools to service, at NashvilleMedicine.org. all local physicians. The organization was 1823 – Members funded The Hospiban soda-pop and candy bars. Rebecca Leslie, MBA, serves chartered by Tennessee on Sept. 4, 1906. tal of the State of Tennessee, serving those 1958 – NAM collaborated with fire as chief executive officer for Today, academy members represent in poverty with weekly care ranging from departments to offer free diabetes screenboth the Nashville Academy 70 fields of practice, all local hospital staffs, $2.50 - $7. ings. of Medicine and Medical Foundation of Nashville, leadfaculties and administration of Nashville’s 1832 –Members pushed for the 1962 – NAM leaders fought polio ing the staff in support of the three medical schools, local and city’s first public health meawith events and vaccination information. 2,300 physician members and state health departments sures to address a cholera 1968 – The organization co-sponvolunteers. and boards and numerepidemic. sored a health career fair for 90,000 stuous health organiza1866 – The orgadents, highlighting 35 different medical Sen. William H. Frist, MD, has tions. Members have nization created its careers. been a member of the Nashville been U.S. senaown board of 1975 – NAM launched a nationwide Academy of Medicine for more than tors, mayors, health to overprogram that provided brief recordings 30 years. In the book, “Nashville: The decorated war see hygiene, concerning a variety of health topics. South’s New Metropolis,” by Karl heroes, and leadendemic diseases 1990s – NAM and Leadership Dean and Michael Cass, Frist shared ers of state and and sanitation, Nashville matched business leaders with these reflections on NAM: national medical resulting in a commedical professionals in a mini-internship “Over the past 50 years, Nashville societies. They influprehensive sewage sysprogram. and Middle Tennessee have earned enced the founding of tem, a pure water supply 2005 – NAM and the Safety Net the now nationally recognized status every hospital in the Nashand clean streets. In 1873, Consortium of Middle Tennessee creof being the ‘Silicon Valley of the ville region and created numera permanent Board of Health was ated Bridges to Care Plus, which became health services sector’ in America. This ous companies, medical practices and established, after years of encouragement Project Access Nashville Specialty Care, reputation in large part has its roots nonprofits. Membership has grown from from physicians. to provide specialty healthcare for those in the remarkable, living legacy of the 7 members in 1821, to 900 in the 1970s, 1888 – NAM “formally condemned” who could not afford it. Beginning with oldest medical society in the state, the to 2,300 members today, including eight cigarette smoking following the findings of 260 physician volunteers, today this proNashville Academy of Medicine, which presidents of the American Medical Assoits committee that explored the effects of gram has over 1,500 physician volunteers, has consistently for 200 years been ciation and 47 presidents of the Tennessee tobacco products. six hospital partners, and $50 million in THE voice of Nashville physicians. And Medical Association. 1897 – NAM called for the end of the donated care. it is these physicians, bound together 2018 – NAM launched the Mediin the fabric of the Academy, who have cal Foundation of Nashville, a 501(c)3 been the backbone of ensuring the 1876: Samuel Meharry and his four brothers (Alexander, David, Hugh and to empower our community by supporthealth and well-being of our mid-state Jesse) funded Central Tennessee College’s medical department, now known as ing health access through Project Access community. Meharry Medical College. The motive for the gift was an act of kindness by an Nashville, promoting healthy lifestyles, “Nashville today, thanks to the unnamed black family who helped Samuel move his wagon of salt that had become and championing health and medical contributions and devotion of those stuck in a muddy ditch. The family had recently been freed from slavery and risked education. who have been and are the Nashville that freedom to help Samuel at a time when slave hunters were paid to find and 2020 – NAM members fought CovidAcademy of Medicine, is a rich return slaves. Samuel was so moved by their actions he vowed, “I have no money 19 by volunteering at vaccination sites, amalgam of medical excellence and now, but when I am able, I shall do something for your race.” Today, Meharry working endless hours caring for patients, state-of-the-art patient care.” Medical College is renowned as both an educational and research institution and as hosting meetings for area doctors to learn – Sen. William H. Frist, MD a leader in the quest for health equity. about the disease and more. nashvillemedicalnews

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Tivity Health Takes Meaningful Steps to Keep Seniors Engaged, Connected By CINDY SANDERS

Actively aging happens to us all with each passing day, month and year. Aging actively is an entirely different proposition. It’s a dedication to the latter that drives Tivity Health to connect nearly 75 million eligible members nationwide to programming that supports living longer by living well. Richard Ashworth, PharmD, MBA, joined Tivity Health in June 2020 as president, chief executive officer and a member of the company’s board of directors. Although fairly new to Tivity Health, Ashworth spent nearly 30 years with Walgreens, beginning on the front lines as a pharmacist. Richard Ashworth “Whenever you spend a lot of your time at the eyeball level with clients, it starts to give you a real appreciation of the human impact your company decisions make,” he said of that invaluable early experience. “As a pharmacist, I spent the major-

ity of my career helping people when they were sick. Quite a bit of what I saw was people not living their lives in a way they could or should,” he explained. “I wanted to try to get in front of that to help people before they need medications,” Ashworth added of the critical importance an active lifestyle and social engagement play on health and well-being. Tivity Health has three core brands focused on that mission. Prime® Fitness connects employees to approximately 12,000 fitness facilities across the country to support a commitment to regular exercise. WholeHealth Living® is a managed network of chiropractic, physical therapy, therapeutic massage, acupuncture and complementary alternative medicine providers to reduce pain. Perhaps the most famous, SilverSneakers® has become the country’s premier community fitness program for older adults.

More than Movement

About 18 million seniors are eligible for SilverSneakers, which utilizes more than 15,000 facilities across the country for interactive classes. “Moving is such an important component of longevity and

Keeping Cognitively Fit, Too Tivity Health® will offer GetSetUp, a virtual learning platform designed specifically for seniors to provide mental enrichment activities, to SilverSneakers® members in participating Medicare Advantage plans starting in January of 2022. The strategic relationship with GetSetUp will expand opportunities for SilverSneakers members to learn new skills, combat social isolation and unlock new life experiences. Tivity Health has been granted the exclusive right to offer GetSetUp to Medicare Advantage plans and their members. SilverSneakers members in participating plans will have unlimited access to the platform at no additional cost to the member. GetSetUp is a live, secure, interactive platform developed to support mental enrichment and cognitive health in older adults. It not only features instructors but also enables seniors to become instructors to share their skills and knowledge with their peers. GetSetUp offers a wide range of classes (over 2,000 hours/week), through a senior-specific video platform optimized for ease of activation, user engagement and social connection. “At Tivity Health, we’ve always believed that fitness means more than just physical activity – it is also important to stay mentally, intellectually and socially engaged,” said Richard Ashworth, president and CEO, Tivity Health. “GetSetUp is the perfect solution to provide engaging, relevant content and an accessible platform designed specifically for seniors. This solution, along with our social engagement program, SilverSneakers Connect, are the most recent additions to our engagement platform, expanding beyond our industry-leading senior fitness options to provide a more holistic approach to healthy aging.” Eighty-seven percent of people 65 and over experience cognitive changes associated with normal aging. Physical activity is proven to improve cognitive function as people age through neuroplasticity, which allows the brain to compensate for injury and disease and to adjust in response to new situations. Lifelong learning and mental enrichment are increasingly viewed as a protective strategy against commonly observed cognitive decline in the older population. “Mental enrichment activities increase our enjoyment of life through the stimulation of learning and connecting with others, and they are also important to maintain brain health,” said Kelly O’Brien, executive director, Brain Health Partnership for UsAgainstAlzheimers. “Research is increasingly pointing to the importance of strengthening brain health, maintaining cognitive function, and delaying or preventing the onset of Alzheimer’s and dementia. Providing seniors with opportunities to engage their brains is an important part of healthy aging.”

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living well,” noted Ashworth. “We want people to live the last third of their lives in the best shape they’ve ever been in.” However, he’s quick to add the program is about so much more than movement. The classes also provide participants with social connection and engagement. “It’s a very simple program, but I think a very powerful one,” Ashworth stated. “I love that our program is not only fun and accessible but that it actually works,” he continued. Ashworth pointed to a recent independent study by Avalere Health that found participating in SilverSneakers reduced healthcare costs by 16 percent. He noted the average out-ofpocket Medicare cost for individuals is about $5,300 per year. Participants in the Tivity program saw that average drop to $4,460.

Pandemic Pivot

During the early days of the pandemic with so much fear and uncertainty, the company recognized a need to keep seniors moving and find an outlet with some sense of normalcy and engagement. “We knew the business model was going to have some pressure. A lot of gyms were temporarily closed,” said Ashworth. The result was to create virtual programming. The fun, interactive classes not only answered a need for loyal SilverSneakers participants they also opened the door to a much larger audience. “We’re seeing a lot of new people engaging in physical activity now who historically have not,” noted Ashworth, adding digital engagement has doubled participation.

Although most gyms are now reopened, he said company research has shown 84 percent of people using the digital product will continue to do so even after adding in-person classes back into the mix. “We’ve given people an opportunity to maximize fitness on their own terms.” In addition to convenience, Ashworth adds the classes are interactive and engaging. “I do these workouts online with our trainers, and they’re a ton of fun,” he says with a laugh. “There’s an inherent social element to that.” Building off this digital success, Tivity is rolling out SilverSneakers Connect at the beginning of 2022. “We are launching a national social platform that has nothing to do with fitness but is all about connecting people with similar interests,” he explained. The pandemic underscored the importance of human connection to an overall sense of well-being. Ashworth said Tivity conducts an ongoing healthy living survey for older adults. “Just last week, we did a survey and asked about COVID isolation … 39 percent of seniors had experienced social isolation in the last week,” he stressed of findings more than 18 months into the pandemic. Building off a successful pilot program, Ashworth said reaction to the new platform has been incredibly positive. Finding someone who shares your enthusiasm for college sports, swapping recipes or discussing books provides a reason to get up and get engaged each morning. And that, he pointed out, is key to living well longer.

PopHealthCare Launches Emcara for In-Home Solutions Franklin-headquartered PopHealthCare, specializing in home-based care and risk adjustment services, has expanded its suite of services with the launch of Emcara Health – a value-based national medical group offering solutions to insurers and managed care organizations throughout the country, including 24/7 Home-Based Advanced Primary Care (HBAPC), for vulnerable seniors and adults. Backed by support from GuideWell Mutual Holding Corporation, PopHealthCare’s parent company, Emcara Health seeks to be a leader for in-home care through a range of solutions provided by clinical teams delivering quality care while reducing the total cost of care for vulnerable populations by 10 to 20 percent. Serving health insurance segments – including Medicare Advantage, ACA, Managed Medicaid and Managed Medicare – Emcara’s solutions include advanced primary care, advanced sup-

portive care and short-term care solutions ranging from in-home assessments and SDOH assessments to transition of care, ER diversion and in-home palliative care. “The COVID-19 pandemic has accelerated the recognition that home-based care solutions maximize patient engagement and deliver better health outcomes for vulnerable populations,” said Kirk Stanley, president of PopHealthCare. “Having conducted more than 500,000 membermonths of in-home/facility clinical management and 250,000+ patient home visits during the past seven years through our CareSight offering, we have seen firsthand how care in the home can deliver a higher quality care at a lower cost.” Stanley concluded, “With Emcara Health, we are reimagining how healthcare is delivered by making a patient’s home, including assisted living facilities and other institutional settings, the primary point of care.” nashvillemedicalnews

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Survey Says: Senior Housing Faces Workforce Crisis

AHCA/NCAL Responds to Vaccine Mandates

At the end of September, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 skilled nursing and long term care facilities across the country, released a survey of nursing home and assisted living providers across the U.S. Results from the survey highlight an urgent need for Congress to address the labor shortage facing the long term care industry. Key findings include: 86 percent of nursing homes and 77 percent of assisted living providers said their workforce situation has gotten worse over the last three months. Nearly every nursing home (99 percent) and assisted living facility (96 percent) in the U.S. is facing a staffing shortage, with 59 percent of nursing homes and nearly one-third of assisted living providers experiencing a high level of staffing shortages. More than seven out of 10 nursing homes and assisted living communities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff. Due to these shortages, nearly every nursing home and assisted living community is asking staff to work overtime or extra shifts. Nearly 70 percent of nursing homes are having to hire agency staff, and 58 percent of nursing homes are limiting new admissions.

78 percent of nursing homes and 71 percent of assisted living facilities are concerned workforce challenges might force them to close. More than one-third of nursing homes are very concerned about having to shut down their facility or facilities. “The survey demonstrates the severe workforce challenges long term care providers are facing due to the COVID-19 pandemic. Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents,” said Mark Parkinson, president and CEO of AHCA/NCAL. Since the survey was released, the workforce crisis has only deepened. At the beginning of November, AHCA/NCAL Mark Parkinson officials released an alert citing data from the Bureau of Labor showing skilled nursing facilities attribute a loss of more than 380,000 employees to the pandemic. The issue also causes a ripple effect with staffing shortages forcing facilities to turn away new residents and temporary rehab occupants, making it difficult for overwhelmed hospitals to discharge patients to nearby skilled nursing facilities.

Following the recent release of the CMS regulation on COVID-19 vaccination requirements for healthcare workers, Mark Parkinson, president and CEO of AHCA/NCAL released the following statement. “Once again, we appreciate the Biden Administration’s efforts to ensure that as many workers as possible in all health care settings are vaccinated. Nursing home providers have dedicated themselves to increasing staff vaccination rates, and as a result, three-quarters of employees are fully vaccinated today. We are committed to forging ahead and encouraging all staff members to get these safe and effective COVID-19 vaccines. “While we support the overall intent of this CMS policy, we are concerned that the execution will exacerbate an already dire workforce crisis in long term care. A hard deadline with no resources for providers or glide path for unvaccinated workers is likely to push too many out the door and ultimately, threaten residents’ access to long term care. “Even a small percentage of staff members leaving their jobs due to this mandate would have a disastrous impact on vulnerable seniors who need around-the-clock care. Across the country, access to long term care is becoming strained as providers have no choice but to limit admissions or even close their doors due to workforce shortages. We hope to continue working with the Administration to make the federal vaccine mandate successful while supporting our residents and caregivers.”

AHCA/NCAL officials also said lower occupancy rates create a lack of resources to enable facilities to provider higher wages and better benefits to attract new workers and incentivize those already on staff to stay. The national organization recently sent a letter to the Federal Trade Commission Chairwoman Lina Khan, asking the FTC investigate price gouging among some staffing agencies. AHCA/NCAL alleges some agencies are charging anywhere from double to quadruple what providers pay their staff. Parkinson said facilities cannot solve

these ‘perfect storm’ problems on their own. “Lawmakers across the country must prioritize long term care and that begins with providing resources to address workforce challenges. When facilities have the means to offer competitive wages and training programs, workers will follow. We have laid out key proposals in our Care for Our Seniors Act, which will allow us to boost our workforce, but without the help from Congress and state legislators, this will not be possible,” he stated. For more information, a link to Care for Seniors Act is available with this story online at NashvilleMedicalNews.com.

Healthpilot Creates New Medicare Shopping, Enrollment Experience By CINDY SANDERS

Nashville-based Healthpilot recently launched an intuitive, online shopping and enrollment experience for individuals searching for the best Medicare option to suit their personal needs. “The large and growing senior population in the U.S. has been poorly served by the healthcare market to solve for one of the most basic and important life decisions they face in retirement – making sure they have the right Medicare insurance coverage for their health and economic needs,” explained David Francis, Healthpilot’s CEO. “The Healthpilot platform is built with each individual customer at the center of our mission – to make healthcare easy, efficient and effective for every consumer.” The all-digital comparison, recommendation and enrollment platform transforms the research process without being overwhelming to maneuver. “We have seen seniors embrace digital technology in rapidly increasing fashion in recent years, accelerated further by the impact of Covid on their daily lives. Beyond being the fastest growing users of apps like Facebook, over 90 percent of seniors are regular users nashvillemedicalnews

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of the internet; and they are the fastest growing consumers of online shopping and other digital services,” explained Francis. “The challenge for us at Healthpilot has been to make our experience Amazon-like in its simplicity and confidence-inspiring

in its insurance recommendations so that seniors are delighted by the experience and enroll online.” He added customers who have questions can reach out to “our licensed service ‘co-pilots’ either by phone, chat or email. Our service is designed to be ‘white glove’ in nature, meeting every need of our senior customer.” The platform compares a full complement of Medicare options, including Medicare Advantage Plans, Medicare Supplement Insurance and Prescription Drug plans. Customers provide demographic information and answer a few questions about how they utilize healthcare. Healthpilot uses that data to search thousands of health insurance claims to find people who use healthcare in a similar way. Healthpilot then predicts what coverage the customer would get from each available plan and what it would cost before delivering highly personalized recommendations for plans offering the best coverage for the customer’s needs. Customers can compare plans side-by-side and enroll right then. However, there is no obligation to enroll, and services provided to customers are free.

In estimating costs, Healthpilot not only factors in copays and premiums but also considers deductibles, coinsurance and prescriptions to present a more accurate cost profile. Even after selecting a plan for the year, the platform will alert users if a different plan becomes available that might be a better option so that appropriate consideration can be given during the next open enrollment period. “Our leadership team has vast experience in serving the healthcare and health insurance needs of seniors and in building unique technology solutions for consumers,” said Francis. “We have seen for decades how underserved the senior population is in finding the right help to find the best Medicare insurance for their particular needs, and in accessing the healthcare market with knowledge and confidence to get what they need,” he continued of the impetus behind launching the company. “Our mantra – Customer first … Always – speaks to this commitment,” Francis concluded. “Our goal is to transform the health insurance and healthcare experience for millions of seniors across the country. We believe that our platform and tools are of unique value to every single one of the 65 million seniors in the U.S.” NOVEMBER/DECEMBER 2021

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Tennessee Makes Major Changes to CON with Tennessee Health Services & Planning Act of 2021 By CHRISTOPHER PURI, Bradley

Tennessee healthcare providers now have a very different certificate of need (CON) law to consider when they plan new facilities or expand services. Tennessee’s legislature and governor recently enacted the Health Services and Planning Act of 2021 (Public Chapter 557 or “the Act”), which became fully effective Oct. 1, 2021. The Act changes the substantive requirements for CON approval, as well as the application process to obtain a CON. It also sets in motion a process to consolidate the Health Service & Development Agency (HSDA) and Tennessee Department of Health (TDH) licensure into a new single agency.

Substantive Changes

The Act enacts several changes to the state’s CON law for impacted providers and services, which was most recently revised its CON law in 2016. General Criteria for Approving a CON: For more than a decade, the HSDA granted CONs based on four criteria: need, orderly development, economic feasibility and adequate quality. The Act keeps the need and appropriate quality standards criteria. However, the Act eliminates the “economic feasibility” standard and reframes “orderly development” as “consumer advantage.” Under the “consumer advantage standard “the effects attributed to competition or duplication [must] be positive for the consumers.” Mental Health Hospitals/Psychiatric Services: The Act effectively removes all mental health services from the CON law’s ambit by deleting mental health hospitals and the initiation of psychiatric services from CON requirements. As a result, obtaining a CON is no longer required to establish a mental health hospital or other facility to provide psychiatric services, nor to initiate psychiatric services at an existing provider. Nursing Homes: The Act aligns incremental increases in nursing home beds with the existing process for hospitals by reinstating the so-called “10 Bed, 10 Percent Rule.” This will permit a nursing home to increase its total number of licensed beds by the lesser of 10 beds or 10 percent of its licensed capacity without obtaining a CON. A nursing home must request the bed increase in writing from the HSDA prior to submitting its request to the Board for Licensing Health Care Facilities (BLHCF) to modify its bed count. An increase cannot be requested within one year after initial licensure, nor more often than once every three years. Rural and Economically Distressed Counties: In addition to the hospital revival provision, under the Act, a CON is not required for any action that would otherwise require a CON in counties designated as “distressed eligible” by the state Department of Economic and Community Development as 18

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of Jan. 1, 2021, where there is no actively licensed hospital. Additionally, a closed hospital in a rural or distressed county may now reopen without applying for CON so long as it operated within the previous 15 years. Relocation of Existing Healthcare Facilities: The Act delegates authority to the HSDA’s executive director when providers wish to relocate their facilities. Under the new law, the executive director may issue an exemption from the CON requirement to relocate a healthcare facility if (a) at least 75 percent of the patients to be served following relocation are reasonably expected to reside in the same zip codes as the facility’s existing patient base and (b) relocation would not reduce access to consumers, particularly those who live in underserved or economically distressed communities, who are uninsured or underinsured, on TennCare, or women and/or members of racial or ethnic minorities. Also, the relocation of the principal office of a home care agency within its licensed service area does not require CON approval. “Use It or Lose It” Provision: The Act also ensures that applicants promptly implement the CONs they receive. A CON will now become void “if the actions it authorizes have not been performed for a continuous period of one year after its implementation.” For home care organizations, this provision applies to each county where they are licensed. The provision permits the HSDA to revoke a CON unilaterally, and there is no hearing prior to revocation. Once a CON becomes void, the state cannot issue or renew licenses for the facility or activity. The HSDA executive director may issue temporary exemptions to the provision This provision does not affect existing licensed healthcare facilities with an active or inactive license. Home Health and Hospice (Home Care Agencies): The new law relaxes some restrictions on new home care agencies (i.e., home health agencies and hospices). A CON is no longer required to establish limited-purpose agencies that provide (a) services under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA), (b) pediatric home care services, or (c) hospice services to patients under the care of a healthcare research institution. Any license issued by the TDH for such providers must be limited to the provision of those particular services. Additionally, any home care agency providing services without a CON must be accredited by the Joint Commission, the Community Health Accreditation Partner, or the Accreditation Commission for Health Care and submit proof of such accreditation to the HSDA within two years of the initiation of service or face licensure discipline. Hospital-Operated Nonresidential SubstitutionBased Treatment Centers: Under the new Act, if a treatment center is (or will be) located on

the same campus as a licensed, operating mental health and substance-abuse-related hospital, a CON is not required to initiate treatment or establish a facility. PET and MRI Services in Urban Counties: Public Chapter 557 relaxes CON requirements regarding the establishment of institutions and rendering of services in urban counties with higher populations. Tennessee’s 2016 revision to the CON law set a population threshold of 250,000 for several provisions, which the Act lowers to 175,000. Consequently, some CON requirements will be loosened for Davidson, Hamilton, Knox, Rutherford, Shelby, and Williamson counties. Among other provisions, providers in these counties will no longer be required to obtain CON approval prior to initiating positron emission tomography (PET) services, provided they receive accreditation within two (2) years of licensure. Additionally in these counties, a CON for initiation of magnetic resonance imaging (MRI) services for adult patients is no longer required; a CON will still be needed for pediatric MRI services. In rural counties with populations below 175,000, a provider will still need to obtain a CON for these activities. Also, certain types of providers may still need to seek a CON for an outpatient diagnostic center, even if the equipment in the center does not require a CON. Medical Equipment: Under the new law, providers will no longer need to obtain the HSDA’s approval to replace or relocate medical equipment that originally required a CON.

Procedural Changes

In addition to changing many of the substantive requirements for CON approval, the Act also streamlines the CON process and reduces the burden on providers. Independent Review: The Act changes the review process for CON applications. Currently, two agencies review a CON application – the HSDA reviews a CON application and declares it complete, and then the applicable licensing agency also does an evaluation. Under the new Act, the HSDA will now complete the entire review of the CON application. Additionally, the HSDA may not deem a CON application complete under the new process until it has overseen an independent review and verified all the information submitted. This independent review will verify objective data such as the existing provider capacity within a region, occupancy rates, regional demographics, and utilization (i.e., number of procedures performed). Opposition to CON Applications Restricted: Under the Act, a healthcare institution may oppose a CON application only if the opponent is located within 35 miles of the proposed project, which significantly limits

who can oppose a CON. For home care applications, the opposing healthcare institution must have served patients in one of the counties in the applicant’s proposed service area within two years prior to CON application. Opponents now also have more stringent requirements that apply to presenting their opposition. Changes in Ownership or Control: The Act removes a longstanding requirement for a provider to notify the HSDA of ownership changes occurring within two years of a healthcare institution’s initial licensure. It also creates a process allowing the HSDA to permit CON transfers for as-yetunimplemented CONs where the agency determines the new CON holder would provide healthcare that meets appropriate quality standards and the transfer would not reduce access to consumers, especially those in underserved communities, those who are uninsured or underinsured, women and racial and ethnic minorities, TennCare or Medicaid recipients and low income groups. Emergency CON Process: Public Chapter 557 also codifies existing regulatory provisions authorizing HSDA to issue temporary emergency CONs, which are generally valid for 120 days. An emergency CON can be issued at a scheduled meeting, or the HSDA’s chair or vice-chair can act immediately if not doing so would lead to an interruption in services. Reporting Provisions: The new law requires providers of cardiac catherization, open heart surgery, organ transplants, burn unit operations, neonatal intensive care unit operations, home health services, or hospice services to file an annual report with HSDA that includes utilization data sorted by payment source and patient zip codes. Schedule of Fees: Public Chapter 557 eliminates the per-application fee in favor of a new, annual fee process. To fund the HSDA, the ACT establishes annual licensure fees for all licensed providers by category. This reflects a policy decision that that licensed facilities who benefit from a CON should also fund the CON process.

Future of Healthcare Facility Regulation in Tennessee

This new statute also reflects the Legislature’s longstanding goal to make healthcare services and facility licensure more efficient by creating a single agency to oversee healthcare facilities and services from initial planning through ongoing operation. The Act also directs the HSDA executive director to create a plan that will ultimately combine the functions of licensure (currently under the Board for Licensing Health Care Facilities) and CON approval (under the HSDA) into a new, independent Health Facilities Commission. The Act continues the reliance on (CONTINUED ON PAGE 20)

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Health Care Council Looks to Future of Industry By CINDY SANDERS

Nearly two years into battling a global pandemic, there’s no question healthcare providers and facilities have faced difficult headwinds. Emotional and physical exhaustion, overcrowding, supply chain issues, frustration over vaccine misinformation, disruption in services … it would be easy to paint a bleak picture of healthcare in 2021. Yet, COVID also created a space where innovation and collaboration offered new solutions to address problems that extend beyond the immediate pandemic, including building vaccines on a different platform and increasing access to care through telehealth. Social justice also took center stage over the past two years with a spotlight that laid bare the health inequities impacting people of color. Piercing the national consciousness, a will to address health disparities in a meaningful way has resulted in new programs, grants and initiatives to both address root causes and increase diversity among providers, researchers and clinical trial participants. Stepping into this climate of real concern mixed with real hope, the Nashville Health Care Council hosted the panel “Health Care Next” last month to explore the pandemic’s impact on the industry and forecast for the future. The panel marked the final event in a series celebrating the Council’s 25th anniversary. The esteemed panel included experts spanning primary and acute care, behavioral health, academic medicine, home health, hospice and health equity. Moderator Hayley Hovious, president of the Nashville Health Care Council, introduced Sam Hazen, CEO of HCA Healthcare; James E.K. Hildreth, PhD, MD, president and CEO of Meharry Medical College; Paul Kusserow, CEO and chairman of Amedisys; and Debbie Osteen, CEO of Acadia Healthcare.

Economic Starting Point

Hovious began by sharing the Council’s recently released impact study, created in collaboration with economist Murat Arik, PhD, associate director of the Business and Economic Research Center at Middle Tennessee State University’s Jennings A. Jones College of Business. The report showed Middle Tennessee’s healthcare ecosystem represents $66.89 billion of the state’s business revenue or approximately 9.23 percent of Tennessee’s total business revenue and 25.77 percent of the Nashville metropolitan area’s total business revenue in 2019. Primarily focused on economic impact between 2014 and 2019, the report also showed a total of 602 new core healthcare establishments emerged in Nashville, bringing the total to 3,731. Nashville’s healthcare industry cluster was responsible for more than one-third of the Nashville metropolitan area’s total personal income in 2019, and one in every eight new jobs between 2018 and 2028 is projected to be in healthcare in Tennessee. The report also found Nashville’s healthcare industry was responsible for 328,598 jobs in 2019, which is 25 percent of the total nonfarm employment within the Nashville MSA. Globally, Middle Tennessee’s 18 publicly traded companies account for nearly 499,434 jobs and more than $95 billion in revenues.

And Then Came COVID

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demic came along to shine a light on critical issues. Hazen shared that HCA Healthcare, similar to other health systems across the U.S. and globally, has struggled with employee burnout. “Never in my Sam Hazen almost 40 years have I seen this level of anxiety and uncertainty for their own safety and the flood of patients. It’s been emotionally, spiritually and physically taxing. Everyone from leadership to clinical employees are affected and that can compromise care delivery,” he said. “We’re focused on employee assistance programs, stress education and training, advanced chaplaincy programs and more. It all comes together to deal with capacity constraint. We are in a long-run battle in our workforce.”

And a Spirit of Innovation

In addition to revealing challenges, the pandemic also accelerated healthcare innovation and improvement. The panelists agreed telehealth and digital tools introduced during the pandemic will remain and have advanced care delivery and access, but the industry has more work to do to ensure health equity. “This crisis has greatly impacted the underserved. We talk about the right care in the right place and at the right time, and some of these populations are not getting that. Telehealth is a helpful mechanism but not everyone has the technology to make it work,” Osteen said. “We’re thinking about Debbie Osteen how to promote access and reach patients. The Department of Health and Human Services and Substance Abuse and Mental Health

Services Administration have allocated funds for mobile methadone clinics that can go into communities to support those who can’t come to us.” The pandemic shone a bright light on disparities and renewed energy around addressing these inequities. For Middle Tennesseans, healthcare organizations didn’t have to look far for expertise and guidance with Meharry Medical College making health equity a priority since its founding in 1876. “Meharry was originally created because there was nowhere for Black people to learn about healthcare,” said Hildreth. “COVID-19 underscored the technology and equity gap – when providers quickly pivoted to telemedicine to continue offering care, we had a challenging time because many of James E.K. our patients don’t have Hildreth access to that technology. We had to scramble for other resources and methodologies. We have to find ways to ensure tech and access to care for everyone, equally, and that’s what we’re focused on now.” Hildreth pointed to Meharry’s new School of Applied Computational Sciences, which will educate the next generation of physicians to use data science to address health disparities and support underserved populations.

And Rethinking the Delivery System

Kusserow explained how the pandemic shifted patients’ priorities and confirmed the Amedisys commitment to meeting patients where they are with home-based care. “We saw tremendous demand for care at home,” he said. “COVID-19 gave people – especially baby boomers – a definitive understanding of home-based care, and now patients and their families are

fighting to be at home. It even impacted the way skilled nursing and senior living facilities refer patients to us. As a company, we’re trying to shift even more toward home-based care and ensure we can provide a low cost, highPaul Kusserow touch environment and the highest quality of care.”

The Next Decade

Hovious asked the group to identify investment areas that will have the greatest impact for the next five to 10 years. Osteen said Acadia is focused on partnerships to share expertise and resources and help holistically care for patients. Currently, Acadia has seven active partnerships and has announced six more. Amedisys is experiencing increases in demand for services and is investing time and resources into recruitment, retention and productivity. Alongside home-based care coordination, Kusserow plans for the organization to build a digital platform to ensure care continuity. Meharry Medical College has embarked on Meharry 2026, a 10-year strategic plan in conjunction with the college’s 150th anniversary, to transform Meharry into a self-sustaining, economically diverse institution. The school has also recently launched a number of exciting partnerships and initiatives to improve equity among providers, researchers and patients. Hazen aims to continue developing HCA Healthcare’s ambulatory network and focus on the professional growth of its workforce. HCA’s physician graduate programs host approximately 5,000 residents, and Hazen expects within five years of expanding their nursing school, HCA will become one of the largest nurse educators in the U.S.

Managing Risk of Cyber Incidents, continued from page 12 include utilizing third party vendors (as long as the organization performs adequate due diligence in selecting vendors, clearly outlines expectations and responsibilities of the vendor, and has a consistent and thorough vendor management program) and obtaining other insurance policies related to physical structures, equipment, and so on. As for cyber liability insurance coverage, there are approximately 50 major insurance providers that provide some level of liability policy, but these policies vary widely. Policies tend to need to be custom designed, and companies are not sure what their policy should cover. There will often still be coverage gaps, so coordination of coverage is important. In some cases where the cyber liability policy does not cover an area, professional liability insurance, which should include directors and officers (D&O) and errors and omissions (E&O), may address the risk. Finally, a fidelity bond, which protects the company against acts of individual employees, whether intentional or negligent, may cover certain aspects of a

cyber incident. Four main types of cyber liability coverage include: • Data breach and privacy management coverage, • Multimedia liability coverage, • Extortion liability coverage, and • Network security liability. Regardless of type, the better your organization has implemented risk management processes and procedures, the lower the premiums should be. Insurance companies will need to see these processes and procedures in action, and policies includes clauses that limit or waive coverage if certain controls and procedures are not in place and limit liability for breaches or losses caused by third parties.

Integrate Risk Avoidance into Day-to-Day Decision Making

Some of us are natural risk takers; others avoid risk at all cost. Avoiding risk in business is important, but there must be balance. The discernment required for risk management is developed over time,

which is why most organizations limit critical decision making to experienced management personnel. Even then, the most critical and potentially costly decisions are made by multiple parties. Continuous vigilance, monitoring, and training are essential. Leading by example at the senior management level and sharing how employees can help the organization avoid and limit risk will ingrain these concepts. Finally, employee training, education, and knowledge sharing is a must. Getting employee buy-in and involvement, as well as encouraging them to identify risks, will help make them an extension of your risk avoidance model. Gina Pruitt, CPA, CITP, CGMA, CRISC, CHFP, CCSFP, CISA, is the member-in-charge of the risk assurance & advisory service at KraftCPAs and a member of the firm’s healthcare industry team. Contact her at (615) 782-4207 or gpruitt@ kraftcpas.com. To learn more, visit kraftcpas.com.

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Health Care Hall of Fame Two New Classes Inducted at Belmont After postponing the annual Tennessee Health Care Hall of Fame induction ceremony last year due to the pandemic, the industry celebrated the outstanding leaders in both the 2020 and 2021 classes at a gala luncheon last month held in Belmont University’s newly opened Fisher Center for the Performing Arts. The dual-year class recognizes 10 healthcare leaders and legends from across the state. “Over the course of the past year and a half, the COVID-19 pandemic has refocused the spotlight on the healthcare industry and the important role healthcare professionals play in each of our lives,” said Belmont President Greg Jones, PhD. “Now more than ever, we want to honor the leaders in this vital field — individuals who demonstrate the character, compassion and strength of purpose that quite literally transforms lives on a daily basis.”

2020 Inductees

Monroe Dunaway “M.D.” Anderson: Healthcare philanthropist; former treasurer, president and CFO for Anderson, Clayton and Co. He is the namesake for the renowned M.D. Anderson Cancer Center. Governor Phil Bredesen: Entrepreneur who started HealthAmerica and other prominent healthcare companies; former mayor of Nashville (1991—1999)

Tennessee Makes Major Changes, continued from page 18

using quality standards to regulate facilities and services and ensure accountability. The plan is not due until Jan. 1, 2023, but discussions are already ongoing regarding how this new commission will operate. Overall, the new Act reflects the Tennessee Legislature’s intent to create healthcare oversight that emphasizes competition, rather than regulation, by applying CON requirements to only those facilities and services where attention is most needed. The Act simultaneously relaxes CON requirements for some facilities and services, while retaining or even tightening requirements on others. Obviously, providers must still meet all other licensure requirements imposed by state and federal agencies. As with any new law, providers will have to examine these provisions as they plan strategically for the future. Christopher C. Puri is a nationally recognized healthcare attorney with vast experience in regulatory matters, specifically representing clients in post-acute care. His deep industry knowledge allows him to provide comprehensive representation on a full array of legal issues facing providers. Contact Chris at cpuri@ bradley.com.

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and governor of Tennessee. Bredesen redesigned TennCare to become a model managed-care Medicaid program widely studied and replicated by other states. Kathryn M. Edwards, MD: The Sarah H. Sell and Cornelius Vanderbilt Endowed Chair in Pediatrics and a professor of Pediatrics at Vanderbilt University School of Medicine. Her work has focused on the evaluation of vaccines for the prevention of infectious disease. She has contributed to vaccine development for Haemophilus influenza type B, pertussis, influenza, avian influenza, Streptococcus pneumoniae, smallpox, rotavirus, malaria and others. Donald S. MacNaughton: Former CEO and chairman of HCA Healthcare; chairman of the executive committee at HealthTrust; and mentor to numerous healthcare providers and leaders. G. Scott Morris, MD: Founder and CEO of Memphis’s Church Health who developed a model for whole person healthcare and led Church Health to become the largest faith-based, privately funded health clinic in the country. Morris is also a popular speaker on community and faithbased healthcare

2021 Inductees

Tom Cigarran: Cofounder, former chairman, director, president and CEO of Healthways (now Tivity Health), the largest chronic disease management company and well-being provider in the nation. Cigarran was also co-founder, former chairman, director, president and CEO of AmSurg, Corp (now Envision); a two-time former chairman of the Nashville Health Care Council and an active community leader. Autry O.V. “Pete” Debusk: Founder and chairman of DeRoyal Industries, Inc., a world-wide medical device manufacturer and member of the Medicare Payment Advisory Commission (MedPAC) to Congress. Debusk also serves as chairman of the Board of Trustees at Lincoln Memorial University, where he has helped launch multiple healthcare graduate and professional degree programs. William E. Evans, PharmD: Former CEO of St. Jude Children’s Research Hospital who led the hospital to consis-

tent national rankings and increased cure rates for the most common pediatric cancers from 50 percent in 1975 to more than 90 percent in 2021. Evans is author of more than 450 scientific publications, an elected member of the Institute of Medicine of the U.S. National Academy of Sciences (2002) and the U.S. National Academy of Medicine (2015). James E.K. Hildreth, PhD, MD: President and CEO of Meharry Medical College who catapulted the institution to the national stage. Hildreth is an acclaimed immunologist, virologist, researcher and healthcare educator and is an advisor to the local, state and national government on infectious diseases. He is also a renowned advocate for minority communities and a leader in fight for health equity. Robert Sanders, MD: Former chairman of the Accident Prevention Committee of the Tennessee Chapter of the American Academy of Pediatrics. Sanders was a successful advocate and lobbyist of the Child Passenger Protection Act, leading to his name “Dr. Seat Belt.” He is also a former director of the Rutherford County Health Department. The Hall of Fame was created by Belmont University, Belmont’s McWhorter Society and the Nashville Health Care Council to recognize Tennessee’s most influential health and healthcare leaders. Additionally, the Hall of Fame serves as an on-going educational resource to document the rich history that has contributed to Tennessee’s position as a leader for national healthcare initiatives. Sponsors of the induction ceremony contribute to not only the long-term viability of the Hall of Fame, but also to the McWhorter Society Scholarship Fund, which benefits students pursuing careers in the health sciences. Since the inception of the McWhorter Society and the Tennessee Health Care Hall of Fame, more than $3.7 million has been raised to support McWhorter Society Endowed Scholarships, and there have been more than 160 scholarship recipients since 2014. “The inductees of the 2020 and 2021 classes of the Hall of Fame have helped shape and advance the industry, paving the way for future healthcare leaders,” said Jones. “I can think of no better way to solidify the hope we have for our healthcare students than by honoring the heroes and heroines we want them to emulate.”

Nominations Open for Class of 2022 The nominations are now open for the next distinguished class. A nomination form, along with information on eligibility and requirements, judging criteria and required materials, are available online at tnhealthcarehall.com/nominations. The deadline to submit candidates for consideration is Feb. 22, 2022.

GRAND ROUNDS

HCA Healthcare Names Cuffe Chief Clinical Officer In late October, HCA Healthcare, Inc. announced Michael Cuffe, MD, MBA, will become executive vice president and chief clinical officer of the organization effective Jan. 1, 2022. In his new role, Cuffe will be responsible for the company’s Dr. Michael Cuffe clinical agenda, leading multiple areas including clinical quality, nursing, care transformation, and clinical informatics. He will also continue his existing responsibilities of leading physician services, which includes urgent care operations, graduate medical education (GME), laboratory services and more than 13,000 employed and managed physicians. Cuffe joined HCA Healthcare in 2011 as president and CEO of physician services. Previously, he served as vice president for Ambulatory Services and chief medical officer for Duke University Health System. Prior to that, he served as vice president medical affairs of Duke University Health System and vice dean for the Duke University School of Medicine. Cuffe is a graduate of MIT and received his MD and MBA degree from Duke University where he completed his residency in internal medicine and fellowship in cardiology. He takes over the role from Jonathan Perlin, MD, Ph.D., who is leaving to become the president of The Joint Commission.

LifePoint Health Names Wang Chief of Staff In November, LifePoint Health® announced the appointment of Charles Wang to the role of chief of staff where he will work closely with LifePoint Health’s president and CEO David Dill, as well as the organization’s senior leadership, to provide strategic guidance, coorCharles Wang dination and support for company initiatives and priorities. Wang joins LifePoint Health from Optum, where he served as vice president, strategy and operations. Prior to that role, he served as a senior associate at McKinsey and Company. He holds a master’s degree in health science from Johns Hopkins Bloomberg School of Public Health and a bachelor’s degree in biomedical engineering from Johns Hopkins University.

Key Joins ReVIDA in Leadership Role Nashville-based ReVIDA Recovery Centers has welcomed Lindsay Key, NCC, LPC-MHSP as the organization’s new senior vice president of Revenue and Clinical Operations. Previously, she served as the vice president of Revenue Cycle for Constellation Behavioral continued on page 21

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GRAND ROUNDS Health, with a career focus on helping treatment centers integrate clinical and financial operations. In her new role, Key will oversee ReVIDA’s Lindsay Key seven clinics spanning East Tennessee and Southwest Virginia. A Licensed Professional Counselor with over a decade of experience, she is a graduate of Belmont University, where she received a Bachelor of Arts in Religion. She later received her Master of Arts in Counseling from Trevecca Nazarene University.

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

Vanderbilt University Medical Center has been named a National Organization for Rare Disorders (NORD) Center of Excellence, joining 31 medical centers as part of an innovative collaborative. The Vanderbilt Undiagnosed Diseases Program (VUDP), which accepts patients with undiagnosed and rare diseases, will be part of a unique network of institutions dedicated to the outstanding treatment of rare disease patients and collaboration to improve standards of care, advance research and increase awareness about rare diseases in the broader medical and patient communities. Ascension Saint Thomas Hospital West has received the Mitral Valve Repair Reference Center Award from the American Heart Association and the Mitral Foundation for a demonstrated record of superior clinical outcomes resulting from evidence-based, guideline-directed degenerative mitral valve repair. The hospital also was recognized on the Target Stroke Advanced Therapy Honor Roll. Additionally, all three Ascension Saint Thomas Middle Tennessee campuses won national recognition by the AHA with four achievement awards for implementing successful quality improvement measures to ensure cardiovascular and neurology patients receive efficient, effective, coordinated care. Bone and Joint Institute of Tennessee was named the 2021 Practice of the Year and CEO Darren Harris named Practice Executive of the Year by the American Alliance of Orthopaedic Executives (AAOE). The annual awards recognize orthopaedic practices that have gone above and beyond, representing some of the best in the industry

nationwide. “We are honored to receive two of the top distinctions from AAOE, recognizing our practice as an industry leader in innovation, quality and service,” said Harris. KraftCPAs has been named one of the “Best Accounting Firms to Work For” based on an annual survey by Accounting Today. Kraft’s appearance on the national list of 100 best places of employment in the accounting industry marks the local firm’s eighth appearance since the survey launched 13 years ago. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) has recognized 90 of an eligible 607 hospitals participating in the adult program for achieving meritorious outcomes for surgical patient care in 2020. Middle Tennessee’s TriStar NorthCrest Medical Center and Vanderbilt University Hospital were both honored. Provision’s Culture of CARE is once again garnering national recognition. For the second year in a row, Provision CARES Proton Therapy Nashville has won the distinguished Press Ganey 2021 Guardian of Excellence Award®. Matthew Walker Comprehensive Health Center was recently recognized as a 2021 Health Center Quality Leader by the Health Resources and Services Administration. Additionally, MWCHC was one of the honorees recognized in October during the AgeWell Middle Tennessee Sage Awards. Making the grade – the following Middle Tennessee hospitals received an ‘A’ from Leapfrog in safety grades for fall 2021: Lincoln Medical Center, Maury Regional Hospital, TriStar Centennial Medical Center, TriStar Hendersonville Medical Center, TriStar Horizon Medical Center, TriStar Skyline Medical Center, TriStar Southern Hills Medical Center, TriStar StoneCrest Medical Center, TriStar Summit Medical Center and Vanderbilt University Hospital.

TwelveStone Health Partners has been named a 2020 Top 10 Performer in URAC’s Leaders in Performance Measurement Recognition Awards.

THA Honors Leaders at 2021 Annual Meeting During the Tennessee Hospital Association’s 2021 Annual Meeting in October, association leadership and the board of directors honored superlative hospital and health system executives across the state. Several of this year’s honorees hail from Middle Tennessee, including: Senior Executive of Distinction: Angela Beard, vice president and COO/CNO at TriStar NorthCrest Medical Center, Springfield; Clinical Nurse of Distinction: Mark Allen, a registered nurse in the ICU at TriStar Horizon Medical Center, Dickson; Patient Safety Leadership: Gail Fraine, system infection prevention director at Ascension Saint Thomas, Nashville; and Diversity Champion: Joseph Webb, DSc, CEO at Nashville General Hospital. The full list of honorees is available online at NashvilleMedicalNews.com.

Nabaweesi Joins Meharry as Endowed Chair Rosemary Nabaweesi, DrPH, MBChB, has been named the Robert Wood Johnson Foundation endowed chair of health policy in the Center for Health Policy at Meharry Medical College. A health services research expert, Nabaweesi will support the Meharry’s expanded efforts to use health policy, implementation and community-engaged research to address African American injury-related childhood disparities and education inequities. With more than 25 years’ experience in injury research addressing health disparities in urban and rural communities, her work will aim to improve the inequitable built (physical) and social environments of under-

served African American communities. As an associate professor, she will teach a course centered on leadership and population health change. Nabaweesi comes to Meharry from the University of Arkansas for Medical Sciences where she was an assistant professor and senior director for research and evaluation in the Division of Diversity, Equity and Inclusion. She earned a medical degree from Uganda’s Makerere University School of Medicine, and a Master of Public Health with a concentration in reproductive and population health and a doctorate in health policy management, both from the Johns Hopkins Bloomberg School of Public Health.

Waldrop Launches New National Healthcare Network Franklin-based healthcare entrepreneur Hays Waldrop – founder of the Institute of Healthcare Executives and Suppliers, Council of Supply Chain Executives and Council of Pharmacy Executives and Suppliers – is launching a new national network for healthcare founders and CEOs of companies that sell products, services and solutions to hospitals and healthcare systems. Those selected will meet eight times a year, with one in-person Hays Waldrop meeting, to share ideas and best practices across the many operational areas critical to running and growing a healthcare company. A unique peer advisory group specific to the healthcare industry, the network provides a place for execs to discuss operational challenges in a moderated discussion with Hays and other industry experts. For information, contact Hays@ IHESLLC.com.

Bone and Joint CEO Darren Harris (R) accepts award at the annual AAOE conference.

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GRAND ROUNDS In October, senior living community Blakeford at Green Hills celebrated their 25th anniversary. Residents and staff safely gathered outdoors for refreshments and a performance from the Nashville Symphony, as well as remarks by Blakeford President and CEO Brian Barnes and Board Chair Barbara Cannon marking the quarter century since the community’s founding in 1996. In addition to hosting the resident event, Blakeford is celebrating the future with a $75 million expansion project to their campus.

Ascension Midtown Celebrates Construction Progress At the end of October, Ascension Saint Thomas Hospital Midtown hosted a “topping out” celebration for the new Surgery and Critical Care Tower and the ongoing construction progress of the Rehabilitation Hospital in partnership with Kindred Healthcare. Midtown physicians and associates were invited to sign the final steel beam that will sit atop the Surgery and Critical Care Tower. These projects are part of “Midtown Modernization,” an overall campus transformation encompassing more than $300 million in investments. In creating the hospital of the future, priorities have included ease of access, enhanced wayfinding, boutique retail experiences, dedicated underground parking for each new building and technology-enabled communication zones.

Byrd Joins TOA J.W. Thomas Byrd, MD, a third-generation physician to serve the Nashville community has joined Tennessee Orthopaedic Alliance (TOA), Tennessee’s largest orthopedic surgery group. Byrd pioneered many of the surgical techniques for hip arthroscopy com- Dr. J.W. Thomas Byrd monly employed throughout the orthopedic world and invented numerous instruments that have revolutionized aspects of orthopedic surgery. He has been one of the leaders of defining and developing the role of less invasive arthroscopic techniques in and around the hip and travels the world as a visiting surgeon, invited professor and lecturer. Byrd has authored a number of textbooks and hundreds of clinical publications. Byrd is team physician for the Tennessee Titans alongside fellow TOA physician Damon Petty, MD. Byrd is a consulting surgeon for numerous professional sports franchises from the NFL, NHL, NBA, WNBA, and MLB, as well as the ATP professional tennis tour; and he sits on the board of the Titleist Performance Institute.

Nashville Healthcare Veteran Named Everly Health COO Nashville healthcare executive Cindy Kent has been appointed chief operating officer of Austin, Texasbased Everly Health, a digital health company at the forefront of virtual diagnostics-driven care.

Ascension Building in Rutherford County, Too

This fall, Ascension Saint Thomas Rutherford officials announced plans for an additional $110 million facility development of the hospital campus starting before year’s end with completion in 2024. The project will bring the hospital’s bed count from 358 to 416 and includes an addition of 16 Critical Care Unit beds, a build-out of 36 medical beds in shelled space in the West Tower, development of a higher level NICU with six bassinets, reconfiguration of the second floor to support expanded operating rooms and addition of more than 1,000 new parking spaces. Additionally, Ascension hosted a groundbreaking ceremony in late September for Tennessee’s first neighborhood hospital on Veterans Parkway off Interstate 840. Ascension Saint Thomas Rutherford Westlawn Hospital will include eight private inpatient medical beds, an emergency department with eight treatment rooms, diagnostic imaging and laboratory services and a second story with convenient outpatient services. Work is already underway on the adjacent Westlawn Surgery Center with partners USPI and Tennessee Orthopaedic Alliance.

TriStar Hendersonville Completes Renovation

At the beginning of November, TriStar Hendersonville Medical Center announced completion of a $16.5 million renovation and construction project of the hospital’s Surgical Services Department. The project, which impacted more than 23,000 square-feet of the hospital, included the addition of two new operating rooms, new PACU (postanesthesia care unit) bays and a new prep/recovery room. More than 17,000 square-feet of perioperative space was renovated, with 6,000 square-feet of new construction added to the space. Post-renovation the space now includes a total of 10 operating rooms, 10 PACU bays and 21 pre- and post-op recovery rooms.

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Kent brings decades of operational leadership experience Cindy Kent to Everly Health, most recently serving as part of the senior leadership team at Brookdale Senior Living. Before that, she served as president and general manager of 3M’s global infection prevention division, where she led business growth and improved performance for a $1.7 billion division across 170 countries. Prior experience also includes leadership roles with Medtronic and Eli Lilly & Co. Kent serves on the board for cloud-based personalized healthcare provider Accolade (NASDAQ: ACCD), is a Henry Crown Fellow of The Aspen Institute and sits on the Board of Trust for her alma mater, Vanderbilt University.

PatientPop Expands Practice Platform

In November, PatientPop announced expansion of its comprehensive practice growth platform to give doctors even more ways to attract, acquire, engage, and retain patients with less administrative work across the entire patient journey. Noting the pandemic permanently changed the way American access healthcare, with 88 percent planning to continue using telehealth for non-urgent consulta-

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PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Pam Harris MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Dr. Robert M. Harris Melanie Kilgore-Hill Rebecca Leslie Gina Pruitt Christopher Puri Cindy Sanders CIRCULATION subscribe@nashvillemedicalnews.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 (FAX) 615.673.8819 or e-mailed to: subscribe@nashvillemedicalnews.com Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.

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More Grand Rounds Online Details on these and other announcements online at NashvilleMedicalNews.com

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GRAND ROUNDS

tions, the expanded platform matches consumer expectations for a mor modern healthcare experience across all touchpoints. New features include easier communication, online payments, EMR reconciliation, customizable intake forms, enhanced scheduling and a mobile app that allows physicians to see practice details in in real-time.

Denise and Milton Johnson

Milton & Denise Johnson Donate $10 Million to New Med School In late October, Belmont Board of Trustees Chair, alumnus and retired HCA Healthcare Chairman and CEO Milton Johnson and his wife Denice announced a $10 million gift to Belmont’s newly established Thomas F. Frist, Jr. College of Medicine. The donation is made in honor of Dr. Thomas F. Frist, Jr., the college’s namesake and HCA Healthcare co-founder, and Johnson’s many years of work with HCA Healthcare. The gift will name the Milton and Denice Johnson Lobby of the college’s new building, construction of which is currently underway.

WGU Tennessee Unveils New FNP Program Online, nonprofit WGU Tennessee, an affiliate of Western Governors University, has introduced a new Family Nurse Practitioner (FNP) program and a Rural Healthcare Scholarship to support nursing students across rural Tennessee and to help address clinical shortages in a growing number of healthcare deserts in Tennessee. WGU Tennessee is simultaneously launching a Rural Healthcare Scholarship valued at $5,000. The online university commits to awarding $100,000 in scholarships to qualified applicants seeking BSN, MSN or FNP degrees.

Corizon Announces Grant, Renewals The USDA has awarded Corizon Health a $967,356 grant to expand distance learning and telemedicine services to rural areas. Telehealth is a key strategy Corizon has employed successfully for nearly 20 years. In the correctional environment, telehealth facilitates collaboration across the healthcare ecosystem, regardless of where healthcare providers are located. In other news, the company also recently announced a number of contract renewals including with Calhoun County Detention Center in Battle Creek, Mich., for an additional three years and with the Wyoming Department of Corrections for another five years. NASHVILLEMEDICALNEWS

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Introducing

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