FOCUS TOPICS ALZHEIMER’S & SENIOR HEALTH • TAX PLANNING
Your Middle TN Source for Professional Healthcare News
PHYSICIAN SPOTLIGHT PAGE 2
Robert Berkompas, ON ROUNDS
Vanderbilt Research Could Redefine Alzheimer’s Treatment
More than five million Americans are living with Alzheimer’s disease, a diagnosis that kills more people yearly than breast and prostate cancers combined. Fortunately there’s hope on the horizon, thanks to a number of studies and trials underway at Vanderbilt University Medical Center ... 3
Class of 2017 On Oct. 17, the Tennessee Health Care Hall of Fame recognized six industry luminaries – Dorothy Lavinia Brown, MD; Sen. William H. Frist, MD; Joel C. Gordon; Harry R. Jacobson, MD; Stanford Moore, PhD; and Donald P. Pinkel, MD ... 12
Follow us on Twitter
The State of Senior Health 2017 Rankings Show Progress, Challenges By CINDY SANDERS
November 2017 >> $5
With the holidays just around the corner, many families will enjoy multigenerational gatherings. Not nearly as many will take the opportunity to discuss expectations and plans for the most senior members of the family … but perhaps they should. Earlier this year, United Health Foundation released “America’s Health Rankings Senior Report 2017: A Call to Action for Individuals and Their Communities.” The report provided a mixed bag of good news and concerns facing the nation’s fastestgrowing population segment. “We continue to see improvements in clinical care,” said Rhonda Randall, DO, chief medical officer for UnitedHealthcare
Retiree Solutions. Now in its fifth year, Randall said the annual ranking allows providers, researchers, insurers and population health managers to begin to see trends over time for seniors. Since the first senior report was released in 2013, Randall said there have been decreases in hospital readmissions, deaths in the hospital, preventable hospitalizations, and less time in the intensive care unit during the last six months of life. Additionally, there has been an increase in the use of hospice care. Nationally, there was a 7 percent decrease in preventable hospitalizations (from 53.8 to 49.9 discharges per 1,000 Medicare enrollees) just in the past year. Since the first edition of the (CONTINUED ON PAGE 8)
Demystifying Year-End Tax Planning in Light of Proposed Changes Tune into any news channel, flip through a local paper, or scroll through your social media feed, and you’re almost sure to see these two words looming: “Tax reform.” The current administration is pushing for big changes, which has generated an even bigger buzz. As we near the end of 2017, the uncertainty around the timing and/or likelihood of these proposed changes going into effect could be causing you to second guess your approach to year-end tax planning. Though the president has expressed that he would prefer to have these changes finalized before the end of the year, even he has acknowledged that it is not likely. In fact, he recently alluded to the “years” it took for the last major tax code overhaul (CONTINUED ON PAGE 6)
By LUCY R. CARTER, CPA
ONLINE: NASHVILLE MEDICAL NEWS.COM PRINTED ON RECYCLED PAPER
PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357
A New Take on Hospice Care
Dr. Robert Berkompas Brings Hope, Compassion to End-of-Life Care that death has to be delayed at all cost, like it’s optional.”
By MELANIE KILGORE-HILL
Death is inevitable. That certain but often uncomfortable reality is the driving force behind the work of Robert Berkompas, MD, chief medical officer at Alive Hospice. A primary care provider for 25 years, Berkompas said the transition to fulltime hospice care seemed natural.
Redefining End-of-Life Options
Care Throughout the Journey
“I chose primary care because I wanted to care for patients over their lifespan and for multiple generations,” Berkompas said. “That includes understanding that you’re walking with patients through the end of their life journey. That was part of my commitment going into medicine from the beginning, and I wanted to do it well.” After receiving his undergraduate degree from Calvin College in Grand Rapids, Mich., the California native attended University of Texas Southwestern Medical School in Dallas. In 1986 he arrived in Nashville for internal medicine residencies at Vanderbilt University Medical Center and Nashville General Hospital. Berkompas soon began his primary care career at Saint Thomas Medical Group, a position he would hold until
2015. During this time he worked closely with Alive Hospice, which further peaked his interest in hospice and palliative care. “On one hand you’d think it would be a natural progression,” Berkompas said of the end-of-life role of physicians. “Still, more and more physicians are seen by patients as being there to fix and treat, without much understanding that it’s really about healing, which is much broader than physical. In medicine there’s a dichotomy
KraftCPAs PLLC & Kraft Healthcare Consulting, LLC present
Healthcare Helpings Don’t miss our upcoming series where we’ll serve up bites of knowledge — and breakfast! Join us for a series of presentations on a variety of hot topics affecting the healthcare industry. December – Compliance, Billing Fraud & False Claims – Oh My! January – What the H? HIPAA, HITECH, HITRUST
Today, Berkompas works with patients and providers to erase the stigma of endof-life care. “All patients one day are going to die, and we need to recognize when it’s imminent and help them focus on what’s important during those last days,” he said. Those conversations are tough and often overlooked by medical schools amid the flurry of academic and technological training. To that end, Alive Hospice has developed their SHARE communication and training program (NMN, Sept. 2017) to educate providers on how to have those difficult talks and to teach attendees to support families with honesty, autonomy, respect and empathy. “Even though a physician might understand a patient is approaching the end, many find it difficult to address, and we want to provide guidance for that,” Berkompas said. Alive Hospice is currently working with medical students at Meharry Medical College and Vanderbilt. The program is also open to additional providers. Training is offered one-on-one or in a group setting and includes simulation labs with trained actors.
Palliative Care vs. Hospice
Berkompas also helps medical professionals understand the difference between palliative and hospice care and dispels misconceptions related to each. “All hospice care is palliative, while palliative care is addressing symptoms no matter what stage the patient is,” he said. Another misconception is the belief
that hospice is only relevant in the last days, while it’s often the most beneficial weeks or months in advance. Another erroneous belief is that Medicare patients can only receive hospice care for six months. In reality, hospice staff closely monitor and re-certify Medicare patients as necessary. Patients can keep their existing attending physician while in hospice care and can leave the program if it’s determined to be in the patient’s best interest. Palliative care is beneficial whenever a patient has uncontrolled symptoms that keep them returning to the hospital. Diagnoses can range from lung or heart disease to rheumatoid arthritis. “Palliative care can be provided in an inpatient setting, but more and more we’re providing this through outpatient clinics so care can be delivered in a home setting,” Berkompas said.
Alive Hospice operates inpatient palliative care services at TriStar Summit Medical Center and TriStar Centennial Medical Center. Inpatient hospice services are available in Murfreesboro and Nashville. The innovative non-profit has also hired their own clinical pharmacist to address unique medication challenges faced by hospice patients, support clinical staff, and make home visits when necessary. Spanning 12 counties, Alive Hospice employs six physicians, five nurse practitioners and more than 300 employees to care for their 430 patients, the majority of which receive home care. “I want to combat the idea that when you’re nearing the end of life you give up all hope ... because there’s a lot of living left to be done, and you have to maximize that,” Berkompas said. “We want to emphasize that it’s about living and not dying.”
March – Practice Management Best Practices
Visit the events page of our website to stay up-to-date on information for our upcoming sessions! » » » » » » » »
physician practice consulting medical practice assessments outsourced accounting tax planning and preparation executive compensation consulting mergers and acquisitions assurance services wealth management services
» coding and documentation audits » Medicare/Medicaid cost reports and related services » CDM reviews and analysis » HIPAA, HITECH and meaningful use » RAC appeals and risk assessments » valuations » litigation support
Serving Nashville’s healthcare industry for more than 50 years.
Lucy Carter 615-346-2497
Scott Mertie 615-782-4292
Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. NEW IN NOVEMBER: Craig Hodges, CEO of CarePayment, discusses how offering seniors payment plan options helps providers increase revenue and enhance patient satisfaction and loyalty. Jim Shaub, a partner with Physicians Financial Partners, follows up his August Nashville Medical News article on ambulatory surgery center investment (“Considerations for Buying & Financing Ownership in an ASC”) with a second piece on the blog that delves into “What is a Fair Price and Value of an ASC Investment?” Al Thomas, owner of the iconic Sperry’s Restaurant, shares recollections and thoughts on having an ‘untraditional’ traditional holiday.
Fighting Alzheimer’s Head-on Vanderbilt Research Could Redefine Alzheimer’s Treatment By MELANIE KILGORE-HILL
More than five million Americans are living with Alzheimer’s disease, a diagnosis that kills more people yearly than breast and prostate cancers combined. Fortunately there’s hope on the horizon, thanks to a number of studies and trials underway at Vanderbilt University Medical Center. A potential new drug for Alzheimer’s and schizophrenia developed by Vanderbilt University scientists was recently administered to the first volunteer at Vanderbilt Institute for Clinical and Translational Research. Animal studies suggest that the compound, a small molecule called VU319, may have potential for reducing memory impairments in brain disorders.
A Long Time Coming
“There’s been an effort at Vander-
bilt to develop new molecules for neuropsychiatric illnesses for several years,” said Paul Newhouse, MD, director of the Vanderbilt Center for Cognitive Medicine. The molecule was discovered several years ago at the Vanderbilt Center for Neuroscience Drug Discovery through a Dr. Paul Newhouse team of scientists led by center director Jeffrey Conn, PhD, and co-director Craig W. Lindsley, PhD. “We realized this would be of particular interest for patients with Alzheimer’s and began collaboration with Drs. Conn and Lindsley to try to move this drug from discovery into human trials,” Newhouse said. “It’s one thing to discover a new molecule and test it in rats, but it’s another to get approval to put a new drug
into humans.” The molecule received FDA approval for human trials November 2016 and began the first-in-human Phase 1 clinical trial in July. “This is a novel achievement because we’re the first university to go from molecular discovery to testing in humans in the same university for a new potential Alzheimer’s disease treatment,” said Newhouse. Once a molecule is discovered, he explained, schools typically license it to a commercial entity to help defray development costs.
Enrollment is still open for the randomized double-blind, placebo-controlled study, which will be conducted in approximately 100 healthy adult volunteers over the next year. The single dose cohort, which concludes next spring, will help determine the compound’s safety, tolerability and bioavailability when taken
orally. Dosage will gradually be increased in participants until it reaches the highest level of exposure previously administered in animals. Trial participants undergo testing for brain effects using sophisticated computerized cognitive testing and EEG. While the molecule isn’t a cure for Alzheimer’s, it’s expected to enhance attention, memory and learning earlier than ever. “We’ve known for years that a certain chemical system is deficient in patients with Alzheimer’s so medications typically try to enhance that indirectly,” said Newhouse. The new molecule attempts to directly stimulate that system in a way that’s never been done and could be used independently or as a complimentary therapy. Newhouse also believes it could be administered at the onset of symptoms to help slow progression of the disease. (CONTINUED ON PAGE 4)
Alzheimer’s Association Mid South Chapter Offers Resources for Patients, Providers By MELANIE KILGORE-HILL
Alzheimer’s Facts & Figures
A diagnosis of Alzheimer’s can be devastating, but one group is making big strides in supporting patients, their caregivers and the medical community at large. Headquartered in Nashville, the Alzheimer’s Association, Mid South Chapter provides education and support to individuals in 36 counties within Tennessee and Alabama.
From Advocacy to Education
Tiffany Cloud-Mann, vice president of programs for the Mid South Chapter, said the group provides a variety of services for anyone touched by Alzheimer’s. “Our program centers around educational resources and support,” she noted. In addition to hosting fundraising Tiffany Cloud-Mann events, educational seminars and support groups, the chapter works with volunteers to lobby for Alzheimer’s funding. “We get a lot of direction from the national office in our work with both state and federal policy,” said Cloud-Mann. Their annual “Day on the Hill” allows ambassadors to meet with Tennessee legislators to advocate for the region’s growing Alzheimer’s population.
Alzheimer’s is a disease leaving few families untouched, due in large part to the aging baby boomer population. However, nashvillemedicalnews
#EndALZ - The Walk to End Alzheimer’s
that increased prevalence also has been key in breaking through the stigma previously tied to a diagnosis of Alzheimer’s. “Someone we know will be affected by the disease, and people are more willing to talk about it than ever before,” Cloud-Mann said. “People are also understanding more about Alzheimer’s and dementia, and they’re getting more facts on it as co-workers, friends and neighbors are touched by the disease. It’s created more awareness.” As figures increase, so does the need for caregiver support. “A lot of patients don’t fall into the financial bracket of receiving help, and those caregivers need ongoing respite,” she said. “We’re not sure what legislation will come up with, but we need more care and support on a state level.”
Help for Providers
The Nashville chapter also is working with local physicians to increase referrals. “Some doctors will tell patients to call the Alzheimer’s Association, while others don’t really know what we do or think they need us,” Cloud-Mann said. By partnering with physicians, the Alzheimer’s Association staff hopes to increase follow-up and provide more support and resources to patients and their families. Their ALZ.org/professionals link provides different tools for assessing, caregiving and diagnosing, while their Alzheimer’s Disease Pocketcard app, available at Clinicianapp.alz.org, provides access to clinical studies, pharmacology, assessment algorithms and more.
According to the 2017 Alzheimer’s Disease Facts and Figures report, an estimated 5.5 million Americans live with Alzheimer’s dementia with 110,000 living in Tennessee. Within the national population, 5.3 million with Alzheimer’s are age 65 and older, and approximately 200,000 have youngeronset Alzheimer’s. Other facts and figures from the most recent report, include: • Every 66 seconds, someone in the U.S. develops Alzheimer’s dementia. By mid-century, someone in the U.S. will develop the disease every 33 seconds. • Approximately 480,000 people age 65 or older will develop Alzheimer’s dementia in the U.S. before the end of 2017. • Two-thirds of Americans over age 65 with Alzheimer’s dementia (3.3 million) are women. • Alzheimer’s is the sixth-leading cause of death in the U.S. and the fifth-leading cause of death for those ages 65 and older. In Tennessee, 2,672 died with Alzheimer’s in 2014, the most recent figure available. • Alzheimer’s remains the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed.
A Better Continuum Means Better Care As healthcare providers, our paramount goal is always the health of our patients. With our population ages increasing in the United States and around the world, that means developing an ever-expanding range of services and new ways to deliver them to meet needs not even envisioned just a few years ago. By MIKE USSERY Today, we’re seeing more agerelated diseases, including many forms of dementia. Increasing life expectancies have produced new needs and have made us change the way we think about senior care. The results? More partnerships with acute care hospitals, which increase the value of the continuum of care, especially benefitting patients, physicians and hospitals themselves. Keeping care at one facility, or within one trusted network of care facilities, means better informed care. It helps assure that caregivers know their patients as individuals, as well as their medical histories, perhaps even from when they were in perfect health in a residential setting. As medical issues progress, or as new conditions develop, following patients along the continuum aids in efforts to manage cognitive conditions and improve medication adherence.
This streamlined system is especially helpful when acute care hospitals partner with post-acute partners to transition patients within a known and trusted network. Tracking patients throughout their care ensures the comprehensive exchange of information so nothing gets lost in a move from care center to hospital or vice versa. The seamless transitions keep patients’ health at the forefront, minimizing administrative background noise that might distract from their care. Trusted partnerships and known pathways of communication allow caregivers on both sides of the relationship to focus on the patient’s health rather than the logistics of a complicated move, which minimizes incidents of readmission for the same conditions. Reducing these rates of readmission benefits patients and hospitals, in turn reducing penalties resulting from the Hospital Readmissions Reduction Program. Providing ongoing follow-up care can be difficult for individual providers. That’s why partnerships between acute care hospitals, post-acute care facilities and home care services are so effective. These partnerships ultimately lead to better outcomes — these outcomes are physical, but they are also mental and emotional. Continuing care within a trusted network makes patients feel more at ease during health challenges. Easing this stress for patients and their families creates a better experience and, in turn, a better environment for recovery and care. The environment and the actual con-
tinuum of care is expanding. Today, with more than one million adults in the U.S. diagnosed annually with a chronic brain disease or disorder, the need for Memory Care is growing at a steady rate. That’s why over the past two years NHC has built three new facilities around Middle Tennessee specifically for those who struggle with cognitive impairment. We see these facilities as investments in patients’ futures — a way to prepare for whatever issues might arise. Together as a healthcare community, we can take steps like these together to improve overall health in and around our city, strengthening the relationships within the continuum of care to improve patient outcomes. We’ve seen the results in our affiliated centers across the state — the expanded continuum of care is reducing hospital readmissions, keeping costs down and even helping to keep some people safely in their own homes with assistance from our range of home care services. As senior care continues to evolve, what was once exceptional in our industry has become standard practice, and facilities across the nation will need to adjust in order to meet the needs of our growing senior population. Mike Ussery serves as president and chief operating officer for National HealthCare Corporation. He has been with NHC since 1980 and has served as COO since 2009. In January of this year, he was named president of the Murfreesboro-based long-term care provider. For more information, go online to nhccare.com
Laser Cataract Surgery, Newer Lenses Help Turn Back Time As people age, many are bothered by cataracts, a clouding of the lens that results in symptoms including blurred vision, glare from lights, trouble seeing in dim light and poor contrast. Cataracts can make it more difficult to drive safely, participate in hobbies, perform household activities, and live independently. The develop- By MING WANG, ment of cataracts MD, PhD is a normal part of the aging process, affecting everyone to different degrees in the later phases of life. However, cataracts can also occur in younger patients related to genetic factors or other health conditions such as diabetes. The only treatment for visually significant cataracts is removal with surgery. Cataracts are the most common cause of blindness in the world, where not all have easy access to quality surgical care or treatment. While traditional cataract surgery is performed with a blade, Wang Vision Institute was the first center in 4
the state to perform laser cataract surgery. The laser cataract system utilizes an advanced, ultra-short-pulsed femtosecond laser to improve the precision of cataract surgery. The surgeon uses the laser to customize the surgery to the exact specifications of each individual patient, and a computerized laser imaging system guides the laser beam. Real-time, high-resolution images of the eye are projected onto a computer screen, which allows the surgeon to perform the surgery and laser astigmatism correction with precision that far surpasses that of a traditional manual blade. Wang Vision Institute was among the first nationally to implant several of these advanced presbyopic lenses, sometimes referred to as the “Forever Young Lenses™” as a group because of the improved visual acuity achieved. This new generation of lenses gives patients a wide range of vision and reduces their dependence on glasses for both distance and near sight. For years, traditional cataract surgery has been performed with standard monofocal lenses, which provide focus at only one distance. When these monofocal lenses are used, patients nearly always still need to wear glasses for reading vision, distance
vision, or both as these lenses do not provide any focus range. Cataract surgery can now be completed with modern, customized lenses that can correct for vision more completely than ever before. The introduction of the laser for cataract surgery has made surgery less invasive, safer and helped patients to recover quicker. An increasing array of lens types for vision correction has provided patients with the ability to do more with their vision without glasses after surgery. Patients with cataracts now have more options than ever for surgical correction. By choosing a surgeon that offers the full range of technology for cataracts, patients will have the opportunity to not only have their cataracts removed, but also in many cases achieve a significant improvement in vision for distance, near, or both without glasses. Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is the CEO of Aier-USA, director of Wang Vision 3D Cataract & LASIK Center, and one of the few laser eye surgeons to hold a doctorate degree in laser physics. He has performed more than 55,000 procedures, including on over 4,000 doctors. For more information, email email@example.com or go online to wangcataractLASIK.com.
continued from page 3 Alzheimer’s Treatment Past & Present
Historically, innovation in Alzheimer’s therapies has been remarkably slow, with a failure rate of over 99 percent. In fact, the last FDA approved Alzheimer’s drug was introduced some 15 years ago. “There’s still a lot we don’t know about Alzheimer’s, and that’s disconcerting to us,” said Newhouse. “We thought we understood the biology, but it’s more complex than we thought.” That’s because while the predominant theory of what’s causing the illness might be true … changing those proteins doesn’t necessarily alter symptoms. Still, researchers are hopeful about the molecule’s cognitive benefits due to promising evidence from preclinical studies. VU319 isn’t the only potential gamechanger coming out of Vanderbilt. “We’re doing a lot here in terms of clinical trials in Alzheimer’s patients with new therapies, including collaborating with pharmaceutical companies,” he said. “We’re focused on early stage, as well as prevention.” Newhouse also is the national lead investigator for a 27-site study through the National Institute on Aging. The Memory Improvement Through Nicotine Dosing study uses transdermal nicotine patches to try to slow early memory loss. The MIND study is a collaboration between Vanderbilt and the University of Southern California’s Alzheimer’s Therapeutic Research Institute. Another NIA study, the Alzheimer’s Disease Neuroimaging Initiative, looks at history, biomarkers and symptoms to better distinguish between dementia and Alzheimer’s. Participants receive specialized scans and spinal fluid analysis not available to the general public. “Not every dementia is Alzheimer’s, and it’s important for any family to make sure they get an accurate diagnosis,” Newhouse said. “Seniors are living longer, and brain health is becoming ever more critical. The sad reality is that the percentage of patients diagnosed is increasing, although it’s better recognized than it used to be.”
Protecting the Brain
Newhouse also wants to dispel common myths related to aging. “There’s a belief that as you get older memory inevitably becomes worse, but that’s not true,” Newhouse said. “The brain is not immune to age-related changes, but brain function overall should not decline.” To that end, lifestyle choices are now recognized as an increasingly important aspect of protecting brain function during aging. “There’s no question that paying attention to lifestyle will make a significant dent in dementia outcomes,” Newhouse said. “We can’t prevent it, but we know we can do a lot to reduce risk; and we’re beginning to think about ways we can help younger and middle age people reduce their risk earlier in life. Identifying those at increased risk is something I’m quite passionate about, and it’s being seen as a new approach to treating this disease.” nashvillemedicalnews
HoneyCo Homes: Using Smart Technology to Help Seniors Age in Place By CINDY SANDERS
An oft-cited survey by AARP found nearly 90 percent of seniors intended to continue living in their homes … and more than 80 percent were confident in their ability to maintain their independence. That confidence, however, began to wane as people aged. Among those 70 and older, only 43 percent found it “very easy” to live independently and nearly 20 percent either found it difficult or impossible to do so without help. Enter HoneyCo Homes. The Nashville-based startup has developed a platform, part of the Internet of Caring Things (IoCT), used in combination with smart home technology to better enable seniors to age in place. The technology, which provides a non-invasive ‘view’ of the home, passively collects and analyzes data to determine deviations in patterns and then notifies caregivers of irregularities. Zachary Watson, founder and CEO of HoneyCo Homes, said there are two looming concerns for America’s aging population. “One of them is coordination and communication of affordable care. The other is what we’re going to do with what some call the ‘longevity bonus.’” Zachary Watson Watson believes a big part of the solution is to enable more seniors to age in place with assistance. Despite rapid innovations with smart home technology, he noted many of those products aren’t being directed in a meaningful way to help care for older Americans. He said technology, in combination with human interaction, had great potential to allow seniors to realize their desires of staying in their own homes longer. Watson noted HoneyCo’s initial emphasis has been on working with the home care industry, now expanding to discharge planners and the post-acute care industry, as well.
How it Works
“We place sensors throughout the house very similar to an alarm system,” Watson explained, adding most are easily installed with hook and loop fasteners. He added options include motion sensors and contact sensors such as a bed sensor or toilet flush sensor. A remote kill switch for the stove or smart locks on the front door can also be installed. What is not used is video. “There’s no image capture at all,” nashvillemedicalnews
he stressed of respecting seniors’ privacy. The sensors capture data surrounding normal daily activity. “There’s no behavioral change required,” Watson said of the ease for residents, adding there are no wearables, buttons to push or devices to charge. Clients lease or buy the equipment in a basic package and pay a monthly fee for monitoring and support. Premium add-ons include the smart locks or stove kill switch, and packages are fully customizable. When irregularities in patterns emerge, key contacts are alerted. Recently, a client fell in the bathroom. Because of the alert, Watson noted, “Mom didn’t spend all day … or multiple days … on the floor because the caregiver had the information she needed.” Similarly, if the oven kill switch was selected as part of the service package, the appliance could be remotely turned off if a smoke detector activated or if the stove was accidentally left on while the resident was away. The alert could also be cleared without taking any action if leaving the stove on for hours was intentional. “The last thing we want to do is ruin Thanksgiving dinner,” Watson said with a laugh. “It’s an early warning detection system, really,” he continued. The overarching goal, he said, is for care constituents to have actionable information to make more informed decisions – whether that’s hitting on the right level of assistive care in the home or seeing trends over time that indicate aging in place is no longer feasible. “We’re building a platform to coordinate care with better information. When everything starts to work together, the whole is greater than the sum of its parts.”
tor of a hospital readmission is a hospital admission … so how can we intervene before an acute event?” If, for example, a senior has a history of urinary tract infections or kidney disease and the number of toilet flushes decline over several days, that might be an early indicator for a nurse navigator or wellness coach to check in with the client. Similarly, he said the sensors help home health agencies with consistency. “In-home care suffers from 60 percent turnover of caregivers each year so they’re constantly training,” Watson pointed out. “To date, the organizations have had very few options to address the quality and consistency of the care they’re providing without having to add staff. The right solution is finding a scalable way to improve the care without having to spend more cost per hour.” If a patient is supposed to be turned over every two hours to prevent sores, the bed sensor technology automatically logs
The Industry Value Proposition
While the value of such information is clear for seniors and their loved ones, Watson said there is also a larger value proposition for the healthcare industry. “Insurance agencies are interested in the wellness trends of their constituents,” Watson pointed out. “The greatest predic-
that action … or lack thereof … to alert the agency. “When you’re presented this data, you can deliver higher quality care,” he said of addressing problems quickly.
Watson, who relocated from Manhattan, said the choice to start HoneyCo in Nashville was very intentional. “I looked at 150 MSAs, and narrowed it down to six that I thought had the best ecosystem for our mission,” he noted. After a due diligence trip to Middle Tennessee, he said he walked away believing there was “no better place to do a healthcare startup than in Nashville.” In addition to the healthcare infrastructure, Watson said he believed the support system and collegial atmosphere would foster innovation and growth. That belief seems to have been well placed. HoneyCo Homes launched their first product last November, beginning with two organizations. A year later, Watson said they are on an adoption path with a national organization and in the midst of expanding to Michigan and California. “The path forward is very bright,” he concluded.
WE CARE about the FUTURE of HEALTH CARE
Proud founding partner of the Tennessee Health Care Hall of Fame
At Belmont University we are thoughtfully and strategically educating the next generation of practitioners, researchers, innovators, entrepreneurs and executives for the future healthcare marketplace. Learn more about our leading edge programs at belmont.edu/healthcare.
Learn more about the Health Care Hall of Fame at TNHEALTHCAREHALL.COM NOVEMBER 2017
Don’t fear the FBAR Report Your Offshore Accounts If you are a taxpayer with offshore financial accounts, you could be in trouble with the IRS and not even know it. The Bank Secrecy Act was passed in 1970 to fight overseas money laundering. It requires that certain financial accounts based in foreign countries be reported to the IRS through a By LARRY SACKS, document called CPA, PFS the Foreign Bank Account Report (FBAR) if these accounts have a total value exceeding $10,000 at any time during a calendar year (not the average balance for the year). This includes
money in any savings or checking accounts in a foreign financial institution, as well as equity accounts such as mutual funds. While the law is certainly well-intentioned, it unfortunately snares innocent foreigners like physicians who legitimately made their money outside the U.S. Unlike the United States, most countries do not tax the income their citizens make beyond their borders so it might not occur to new American citizens, resident aliens … or even their accountants … that they have to report these assets to the IRS. (Few CPAs delve into foreign tax issues, but being an immigrant myself from South Africa and having numerous foreign clients, it behooves me to stay abreast of the latest regulations.) Unfortunately, ignorance of the law probably won’t prevent the IRS from imposing stiff penalties for not filing a FBAR. A willful failure to file could carry criminal prosecution, as well as criminal
or civil penalties. So what can taxpayers with foreign accounts do to avoid potential penalties? First, come clean. You can run but you can’t hide — banks readily share information with each other so it’s fairly certain the IRS will discover any undisclosed foreign accounts. If you willfully failed to report foreign accounts in the past but the IRS has yet to discover it, you could still avoid the stiffest penalties and prosecution by participating in the Offshore Voluntary Disclosure Program (OVDP), which is specifically designed to provide protection from criminal liability and terms for resolving your civil tax and penalty obligations. In recent years, the U.S. expanded the OVDP to include the Streamlined Filing Compliance Procedures (known as the Streamlined Program) for non-willful
foreign account holders. Penalties could be as little as 5 percent of the maximum undisclosed amount. Although the Bank Secrecy Act might seem to unfairly target foreign doctors and other professionals, it is nevertheless routinely enforced. Find an advisor who understands this specific area of the tax code to ensure that the FBAR and other paperwork are filed in a timely manner. Report offshore financial accounts before the IRS finds out about them. Otherwise, you could be out of good options. Larry Sacks, CPA, is a principal at Snow Creek Wealth Management in Nashville, which helps clients build, preserve and manage wealth through financial planning, accounting and investment management. For more information, email lsacks@ snowcreekwealth.com or go online to snowcreekwealth.com.
Demystifying Year-End Tax Planning, continued from page 1 to be finalized under former President Reagan. That was 1986, when gas cost about 90 cents a gallon, stamps were 22 cents apiece, and the tax code was around 30,000 pages. Obviously much has changed in 30 years, including the tax code more than doubling in length (it now exceeds 74,000 pages) despite the lack of major tax reform. Thus, if history is any indicator, there is a good chance that the tax code will change in the near future – though we don’t yet know when or to what extent. For 2017, smart tax planning means sticking to the basics … but keeping a close watch on what could be.
In the proposed tax reform, some of the deductions available to individuals under the current law may be reduced or eliminated. These areas are important to consider for year-end tax planning: Sales tax: Under the current law, Tennesseans may deduct either sales tax based on the table provided by the IRS or the actual sales tax paid during the year. And the sales tax spent on a motor vehicle, aircraft, boat, or a home (either a motor home or the materials to build a home) or substantial addition or renovation of a home can be added to the table deduction. If you are planning on making any of these purchases in the near future, doing so before the end of 2017 may allow you to deduct sales tax. Property tax: Currently, property taxes are deductible in the year they are actually paid. Prepaying for 2017 could help you ensure deductibility. Standard deduction: Under the proposed tax reform, the standard deduction would be increased for joint filers to $24,000 from the current $12,600; single filers would have a $12,000 standard deduction, up from $6,300. Although mortgage interest and charitable contributions are not on the chopping block, the 6
increased standard deduction amounts may exceed the amount most taxpayers pay for interest and donations, rendering them essentially non-deductible. Charitable giving: With the potential increase in the standard deduction, consideration should be given to maximizing charitable gifts in 2017. With the surge in the stock market, consideration could be given to gifting appreciated stock to charity. It’s the best of both worlds – no tax on the gain and deduction for the fair market value of the stock. Many of the investment funds provide access to donor advised funds – a tax-effective way to consolidate, accrue, and grant assets to charity. Retirement savings: The best way to save on taxes is to maximize your retirement plan funding. Although there are no proposed changes regarding retirement savings, funding for retirement is like the adage of eating an apple a day – it’s just good medicine. Make certain you are maximizing your deferrals, and consider additional funding that might be available for contract revenue through a SEP or SIMPLE plan. Even funding a nondeductible IRA makes sense for income deferral. Health savings accounts (HSA): An HSA is used with a high-deductible healthcare plan to help save for qualified medical expenses. For 2017, a family can contribute up to $6,750 and individuals up to $3,400 (plus a $1,000 catch-up contribution for taxpayers over 55) of pre-tax income to an HSA. There are two other changes included in the tax proposal that could have a positive result for individual taxpayers: The end of alternative minimum tax and the elimination of the estate tax. How these changes will affect other provisions (i.e., the carryover of alternative tax paid in previous years and the step-up in basis for property passed through an estate) remains to be seen.
Changes proposed for businesses are basically a reduction in the tax brackets. The proposal calls for a maximum tax rate of 25 percent for partnerships and S corporations, which is puzzling because both of these entity types are classified as “passthrough,” and currently there is no entity tax. The proposal also includes reducing the corporate tax rate to 20 percent, which is good news for personal service corporations (i.e., incorporated physician practices) that are currently taxed at a flat rate of 35 percent. Business tax planning for 2017 is more of the same. If you practice in a C corporation that is classified as a personal service corporation, make certain that you are not retaining profit when the countdown to 2018 ends. Otherwise, you may be looking at 35 percent federal tax plus another 6.5
percent excise tax in Tennessee. Although there are no proposed changes to the current depreciation rules (i.e., the first-year Section 179 expense and bonus depreciation), there is also no guarantee that they will continue as-is. But if you’re planning to purchase equipment, it would be best to consider doing so in 2017 while the current depreciation rules are certain. For now, we recommend basing your tax planning approach on the current law for 2017, staying in touch with your CPA or tax advisor, and monitoring any changes that could be on the horizon. Lucy Carter, CPA, is a member (owner) in KraftCPAs PLLC and practice leader of the firm’s healthcare industry team. You may contact her via email at lcarter@ kraftcpas.com. For more information, visit kraftcpas.com/healthcare.htm.
Saint Thomas Health Opens City’s First In-Hospital Birthing Center Last month, Saint Thomas Health opened The Birthing Center at Saint Thomas Midtown Hospital. The Birthing Center is Nashville’s first in-hospital natural birthing center, providing expectant families both the comfort of a homelike environment while also having the security of specialized clinical staff in the same building. The new center includes three birthing suites with fullsized beds where expectant families can experience a home-like birth. In addition to personalized lighting and music, the in-room amenities include spacious labor tubs, refrigerators, large flat-screen televisions, essential oil diffusers, and additional features to ensure comfort and relaxation. The Birthing Center is staffed by physicians, midwives and nurses who help families develop a birthing plan to create their own personalized experience. The service is designed for low-risk moms and healthy babies, and consent from the patient’s physician and pediatrician is required.
Surgical Innovations By CINDY SANDERS
Tryton Side Branch Stent
Myers said the side branch stent allows for total accommodation of the anatomy of the bifurcation without blocking the blood flow to the smaller vessels with an end result of more predictable patient outcomes and less likelihood of artery plaque shifting into larger side branches after a stent implantation. The Tryton Side Branch Stent is a cobalt chromium stent based on TriZONE® technology engineered to provide complete lesion coverage. It is deployed in the side branch artery using a standard single wire balloon-expandable stent delivery system. A conventional drug eluting stent is then placed in the main vessel. In February 2017, the Tryton Side Branch Stent became the first dedicated
bifurcation stent to receive regulatory approval in the United States.
In late October, TriStar Centennial Outpatient Lumbar Fusion Medical Center announced completion of Juris Shibayama, MD, an orthopaeMiddle Tennessee’s first procedure utilizdic surgeon with Tennessee Orthopaedic ing the Tryton Side Branch Stent to treat Alliance in Smyrna, a coronary bifurcation lesion involving a recently performed large side branch 2.5 mm or greater. The minimally invasive, procedure was performed at TriStar Censame-day, outpatient tennial Heart and Vascular Center led by lumbar surgery. Paul Myers, MD, in collaboration with Jef“The minimally frey Webber, MD, who are both interveninvasive transforamitional cardiologists with Centennial Heart. nal lumbar interbody “This innovative and comprehenfusion (MIS TLIF) sive approach allows us to treat patients is all about reducing Dr. Juris Shibayama with complex and high-risk blockages the collateral damage that involve arteries with done to the tissues during important larger branches surgery,” said Shibayama. off the main heart artery,” “Rather than stripping said Myers. and burning the muscles Approximately 20-30 off the spine in a tradipercent of patients undertional open approach, going percutaneous corodoing it this way prenary intervention (PCI) to serves the muscles and open blocked arteries have ligaments. The procedure a bifurcation lesion. While is done by dilating the provisional stenting of the muscles; therefore, there main branch is the curis no trauma to the musrent standard of care, the cles and ligaments to the side branch is not stented spine during the surgery.” in many cases and can be Shibayama has been compromised by shift of perfecting the spinal plaque from the main vesfusion procedure for the sel into the side branch. The TriStar Centennial team including Dr. Webber (center) and Dr. Myers (far right, first row). last eight years. Tradi-
tional open surgery typically requires a hospital stay of two to three days. Shibayama had already reduced hospitalization to an overnight stay for observation before moving to an ambulatory setting this fall. “Spine surgery today is where sports medicine was 50 years ago,” said Shibayama. “That was when arthroscopy was just becoming popular.” He noted at the time, many surgeons thought the newer technique wouldn’t take off, as it would prove to be inferior to open surgery. Instead, he said, “Doing the surgery arthroscopically allowed surgeons to have great visualization and perform an excellent surgery without causing collateral damage.” Recognizing most spine surgeons have similar hesitation over minimally invasive procedures, Shibayama noted, “I have never had a deep infection with this surgery, nor have I ever had to return the patient to the operating room for repair of a dural tear. That reduction in complication rate alone is a massive advantage … but in addition to that, the post-operative pain is much less to the point where the surgery can be done as an outpatient.” Other advantages, he continued, are a much abbreviated recovery time and faster return to work and normal activities. “There is no doubt in my mind that this is where spine surgery is headed, and I’m excited to be able to bring these advances to Middle Tennessee,” Shibayama concluded.
It’s time to get back to your bucket list. F
or more than 45 years, NHC has provided quality, rehabilitative care to people of all ages. With skilled therapists and decades of experience providing compassionate post-surgical care in locations close to home, you can get back to what’s important to you. So what’s first on your list?
Discover NHC and get back to life. Visit NHCcare.com to learn more about our rehabilitative care services, to explore our full range of services and to find the NHC nearest you. To learn more about our homecare services, visit MyNHChomecare.com.
NHCcare.com ©2017 NHC 23664
CONTINUING CARE • REHABILITATION • ASSISTED LIVING • HOMECARE • RESIDENTIAL LIVING HOSPICE • LONG TERM CARE INSURANCE
The State of Senior Health, continued from page 1 senior rankings in 2013, there has been a 7 percent decrease in hospital readmissions, a 30 percent decrease in hospital deaths, a 21 percent decline in hip fracture hospitalizations, and a 9 percent drop in ICU use at the end of life in the Medicare population. However, Randall continued, “We continue to see challenges in our lifestyle – in the choices we make around our health.” Despite receiving good clinical care once the system is accessed, a growing issue is the volume of individuals who require that access. “Not only are we seeing a higher Dr. Rhonda Randall percentage of people turning 65 with a chronic condition, but we’re also seeing more people over age 65,” Randall said of the country’s demographic shift. In 2011, baby boomers began turning 65, and an average of 10,000 boomers celebrate the milestone birthday every day. By the time the last of the boomers hit retirement age in 2029, Pew Research Center projects 18 percent of the American population will be 65 or older. While the sheer volume of seniors could strain the delivery system, Randall said social determinants of health add to that burden. In creating the annual “America’s Health Rankings®” and subsequent senior report, United Health
Foundation uses the World Health Organization definition of health: “Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.” Therefore, the United Health reports consider 34 measures including the impact of behaviors, policy, and community and environment, in addition to clinical care, to assess health outcomes. “Obesity increased by 9 percent from the 2013 edition,” Randall said of the 27.6 percent of adults 65 and older who now fit the criteria. “Food insecurity increased by 16 percent over the last five years.” Additionally, she noted, data from the U.S. Department of Agriculture shows there has been a decrease in SNAP reach, which has gone down by 7 percent over the last two years for adults 60 and older living in poverty. Similar to other health rankings, the Southeast was once again well represented at the bottom with Georgia (41), Alabama (43), Tennessee (44), Arkansas (46), Louisiana (47), Kentucky (49) and Mississippi (50) making up seven of the last 10. Higher rates of physical inactivity and smoking were a common thread among states at the bottom. On the other end of the scale, the five healthiest states for seniors were Minnesota, Utah, Hawaii, Colorado and New Hampshire. Randall was quick to say, “Every state, no matter where it’s ranked, has areas it should be proud of and areas where there is room for improvement.”
IHEALTHCARE NCHARGE 2018 COMING IN DECEMBER! THIS HIGHLY ANTICIPATED RESOURCE is used throughout the year, making it a terrific medium for your message. For advertising information, email sales@nashville medicalnews.com or call Cindy Sanders, 615.397.2836
She noted, “There’s no silver bullet to being ranked high on this list, but I can tell you the states that tend to rank highest on the list have a tendency to also rank very high in individual behaviors.” In addition to behavioral factors, environment and policy supports also have a major impact in how well seniors fare. Within the category of community and environment, the report looked at six key measures, including giving back. “We look at volunteerism,” Randall said. “It’s a proxy for purpose. We know that has a lot of positive effects on aging,” she continued of staying plugged into the community. Research has shown seniors with a reason to get up and do good typically have fewer depressive symptoms, better cognitive performance, higher activity levels and better mental wellbeing. Higher rates of volunteerism have also been associated with lower rates of mortality and heart disease. “Another call to action, I think, is
around home-delivered meals,” Randall said of a measure where the large majority of states have room to improve. “That can be a significant benefit to the senior community,” she continued, adding a stable source of nutrition is a key factor in being able to age in place. The 2017 report stated that increasing the number of seniors receiving home-delivered meals by 1 percent in each state has a projected cost savings of $109 million to Medicaid programs. Randall said the annual report is intended to be put to use by providers, policymakers and community representatives at a local, state and national level. “It’s definitely meant to be a call to action,” she said. Randall encouraged stakeholders to go online to americashealthrankings.org and click on the 2017 senior report to take a deeper dive on specific measures to foster dialogue about what is working and where there is need to improve on behalf seniors.
Tennessee by the Numbers
The “Needs Improvement” – National Ranking
Overall Rank: 44 (down one slot from 2016)
Physical Inactivity (% of adults 65+ in fair or better health): 44
Determinants Rank: 42
Smoking (% of adults 65+): 50
Outcomes Rank: 44
Home-delivered Meals (% of adults 60+ w/ independent living difficulty): 50
The Good – National Ranking
Community Support (dollars per adult 60+ living in poverty): 43
Excessive Drinking (% of adults 65+): 2
Geriatrician Shortfall (% of needed geriatricians): 45
Low-care Nursing Home Residents (% of residents): 5
Home Health Care (number of workers per 1,000 adults 75+): 45
Healthcare-associated Infection Policies (% of policies in place): 8
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees): 44
Prescription Drug Coverage (% of adults 65+): 8 Diabetes Management (% of Medicare enrollees aged 65-75): 9
Hip Fractures (hospitalizations per 1,000 Medicare enrollees): 46 Depression (% of adults 65+): 45 Teeth Extractions (% of adults 65+): 46 Premature Death (deaths per 100,000 adults 65-74): 44
Cumberland Pharmaceuticals Launches Totect®
Nashville-based Cumberland Pharmaceuticals Inc. and Clinigen Group plc, based in the U.K., recently announced the promotional launch of Totect® (dexrazoxane hydrochloride), in the United States. Totect is an FDA-approved, hospital-based emergency oncology intervention drug, indicated to treat the toxic effects of anthracycline chemotherapy in case of extravasation, which occurs when an injected medicine escapes from the blood vessels and circulates into surrounding tissues in the body. Extravasation can cause severe damage and serious complications. Totect can limit such damage without the need for additional surgeries and procedures and enable patients to continue their essential anti-cancer treatment. “This is a significant next step for Cumberland as we build our position in oncology supportive care, while improving the quality of care for patients in the U.S.,” said CumberA.J. Kazimi land Pharmaceuticals CEO A.J. Kazimi.
A Plan to Address COPD By CINDY SANDERS
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death and fourth leading cause of disability in America, according to the National Institutes of Health. The umbrella term encompasses a number of progressive lung diseases including emphysema, chronic bronchitis and refractory asthma. While the National Heart, Lung, and Blood Institute (NHLBI) identifies 16 million Americans as being diagnosed with COPD, that figure only tells part of the story. The American Lung Association and COPD Foundation both estimate closer to 25-30 million Americans are impacted by COPD … but millions are unaware they have the disease.
The Diagnosis Issue
Jamie Sullivan, MPH, vice president of Public Policy and Advocacy for the COPD Foundation, said one reason people go undiagnosed is because symptoms often aren’t noticeable in the earliest stages. Even when individuals begin to experience increased breathlessness and coughing, it’s easy to pass it off as a cold, allergies or simJamie Sullivan ply part of the aging process and to change behaviors, like avoiding stairs, to mask the problem. Another issue, she added, is that physicians aren’t necessarily asking probing questions during routine visits when the disease might be caught in the early stages. Sullivan noted most diagnoses occur when symptoms have become so severe patients can no longer ignore them. The CAPTURE Study, she added, found
most people aren’t diagnosed with COPD until they have already lost half their lung function. Primarily seen as a smoker’s disease, Sullivan said there is also a “shame and blame” element surrounding COPD. However, she noted, there is an increasing understanding that other factors including environment, prematurity, and genetics also add to the burden of the disease. “Our founder John Walsh, who unfortunately passed away earlier this year, saw there was this huge hole in support for COPD patients,” said Sullivan. “He really put out a call to action to the patient and scientific community to come together and find solutions to support the community.”
Mounting a National Response
It has only been since 2013 that COPD rates across all 50 states have been available with the data put forth from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance Survey (BRFSS). Further complicating the issue, there haven’t been national screening parameters, a coordinated action plan, or funding for COPD research at the level of other diseases. However, the hope is all of that might be about to change with the release of the COPD National Action Plan earlier this year. “Prior to the release of the federal action plan in May, there hadn’t been a coordinated federal response,” said Sullivan. Now, she continued, “Here’s a blueprint of how we, as a country, can tackle COPD.” Sullivan said the COPD community had advocated for this type of coordinated response for years. She noted many stakeholders, including the COPD Foundation, had a voice in creating the collaborative plan. Following interagency work groups
Quick Takes & Updates
at the federal level in 2014 and 2015 and a letter from Congress urging next steps in late 2015, Sullivan said NHLBI hosted a town hall meeting in February 2016 open to physicians, patients, researchers and COPD organizations. “That was a great chance for the community to come together to talk about what are the major issues the plan should address and to prioritize goals,” Sullivan noted. Following the town hall meeting and period for public comment, the finalized COPD National Action Plan outlines five key goals: • Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD. • Improve the diagnosis, prevention, treatment and management of COPD by improving the quality of care delivered across the healthcare continuum. • Collect, analyze, report and disseminate COPD-related public health data that drive change and track progress. • Increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment and management of COPD. • Translate national policy, educational, and program recommendations into research and public health actions. The next steps, Sullivan said, are to move forward with implementation of the plan.
What’s Happening Now
In the meantime, Sullivan said there are a number of immediate steps to improve care including an emphasis on ensuring everyone is diagnosed properly and on time, enhancing patient education efforts, instituting a personalized treatment regimen to meet a patient’s specific needs, and where appropriate, utilizing pulmonary rehab. “These are all things
Late last month, TriStar StoneCrest Medical Center broke ground on a $10.5 million Emergency Room expansion. This project will include a behavioral health unit and a clinical decision unit. Saint Thomas Health and insurance startup Oscar have signed a collaboration agreement effective Jan. 1, 2018. Middle Tennesseans who purchase their 2018 coverage from the Marketplace, both on and off exchange, and choose Oscar for healthcare coverage will have access to receive their care from Saint Thomas Health and Saint Thomas Medical Partners. The open enrollment period begins Nov. 1, 2017. Patrick Ryan, MD, FACS, founder of Nashville Vascular & Vein Institute recently announced he will expand the practice’s reach by traveling to Pleasant View one day a month to see patients, improving convenience for those north of Nashville. More than 22,000 Greater Nashville residents came together on Oct. 21 at Nissan Stadium for the American Cancer Society Making Strides Against Breast Cancer walk and raised approximately $700,000 for a world without breast cancer. Also last month, the 25th annual Greater Nashville Healthy For Good Heart Walk, sponsored by Vanderbilt Heart Dr. Patrick Ryan and Delta Dental, raised over $1.7 million for the American Heart Association. Monroe Carell Jr. Children’s Hospital at Vanderbilt has launched a telemedicine initiative to serve Kentucky schools. In a first of its kind collaboration for both parties, schools in Allen County, Ky., are joining with Monroe Carell so that sick children can receive a more comprehensive array of healthcare services while attending school through virtual visits with Vanderbilt clinicians. Middle Tennessee School of Anesthesia recently announced it is expanding efforts to educate certified registered nurse anesthetists (CRNAs) on treatment options that reduce or eliminate the need for opioids during and after surgery. MTSA will be accepting a second cohort for its Acute Surgical Pain Management (ASPM) Fellowship, in partnership with the American Association of Nurse Anesthetists (AANA). The application period is open through Dec. 1, with classes beginning in January 2018.
we don’t need new treatments to do,” she said of deploying an evidence-based approach. Sullivan added the COPD Foundation and others have long advocated for broader use of primary pulmonary rehab, a non-pharmacologic management option. “Think of it as physical therapy for your lungs with the added benefit of education and support,” she said. Reimbursable at low levels that Sullivan said aren’t sustainable, pulmonary rehab therapy is typically offered only though hospital-based programs. Without enough programs, Sullivan said it’s been hard to gain traction among patients and physicians. Another issue is the time commitment, which entails two hours of education and exercise plus travel time. “To get adherence and compliance with someone, that takes a major commitment,” she noted. “But for the people who do, nearly everyone you talk to will say it changes their life.” While the therapy is evidence-based, Sullivan said more research is needed to grow awareness and improve reimbursement rates. However, she noted, research funding has been another ongoing issue. “It goes back to the federal response to COPD, which is around $100 million per year gets spent on federal research … which is pennies compared to the impact of the disease,” she said. Sullivan added that while a great deal of progress has been made in understanding COPD and its genetic basis, additional research funding could really accelerate that work. “This coordinated action plan could be the tipping point,” she said. “It has the potential to be if the community rallies around it,” she concluded.
Hutcheson Named LifePoint Chief of Staff
Brentwood-based LifePoint Health recently appointed Sam Hutcheson to the role of chief of staff. Hutcheson replaces Osei Mevs, who has been appointed to a new position as senior director, provider onboarding and retention with the Physician Services team at LifePoint. In the chief of staff role, Hutcheson will work closely with LifePoint Chairman & CEO Bill Carpenter to ensure proper coordination and effective Sam Hutcheson communication of key issues, activities, projects and staff resources related to the company’s top strategic priorities. Hutcheson, who joined LifePoint in 2008, previously worked as a management consultant for AIM Healthcare, where he advised hospital and payer clients in the New York Metropolitan area on strategic projects. He earned his undergraduate degree from the University of Tennessee and his MBA from Vanderbilt’s Owen Graduate School of Management.
Tennessee Joins Medical Licensing Compact Earlier this year, the Tennessee General Assembly approved legislation that paves the way for state participation in the Interstate Medical Licensure Compact (Compact), a nationwide streamlined process for physician licensing. Public Chapter 365, signed by Governor Bill Haslam on May 11, 2017, is based on model By J. MATTHEW language created KROPLIN by the Federation of State Medical Boards (FSMB) in an attempt to improve licensing efficiency for physicians and increase patient access to care. The Compact creates a pathway for streamlined physician licensing across state borders without federal regulation and within the purview of existing state medical boards. The Compact is administered and governed by the Interstate Medical Licensure Compact Commission (Commission), which consists of two voting representatives from each member state. The Commission also promulgates rules and procedures and reports back to member states. Currently, 22 states have joined the Compact, five of which have delayed implementation dates, and relevant legislation has been introduced in four additional states. The legislation passed both houses of the Tennessee General Assembly with broad, bipartisan support. The only amendment attached to the legislation delays implementation until January 1, 2019, during which time the legislation’s sponsors anticipate that the Commission will continue to develop the regulations and procedures for licensing among member states.
Once Tennessee’s membership in the Compact is effective, Tennessee physicians can obtain full, unrestricted licenses from other Compact states if they meet agreed-upon eligibility requirements. Physicians will submit application materials to the Commission and indicate which state licenses are sought, and the Commission will collect fees, verify eligibility, and forward the physician’s information to the requested states to issue the licenses. An estimated 80 percent of licensed physicians in the United States will be eligible to participate once their states join the Compact. To be eligible, a physician must: • Possess a full, unrestricted medical license in a Compact member state, which is either - the physician’s primary residence, - where at least 25 percent of the physician’s practice of medicine occurs, - where the physician’s employer is located, or - the physician’s state of residence for U.S. federal income tax purposes; • Have graduated from an accredited medical school, or a school listed in the International Medical Education Directory; • Have successfully completed Accreditation Council for Graduate Medical Education (ACGME) or American Oseopathic Association (AOA) accredited graduate medical education; • Have passed each component of the United States Medical Licensing Examination (USMLE), Comprehensive Osteopathic Medical Licensing Examination-USA (COMPLEX-USA), or equivalent, in no more than three attempts; • Hold a current specialty certification or time-unlimited certification by an American Board of Medical Specialties (ABMS) or American Osteopathic Association Board of Osteopathic Specialists (AOABOS);
• Not have any history of disciplinary actions or controlled substance actions toward the physician’s medical license; • Not have any criminal history; and • Not currently be under investigation. According to the sponsors of the Tennessee legislation, joining the Compact is consistent with the General Assembly’s focus on the developing field of telehealth and on increasing access to care for Tennesseans, especially those in rural and underserved areas. It also logically follows the state’s recent approval of streamlined licensing procedures for nurses and physical therapists. Senate sponsor Bo Watson (R-Hixson) explained, “This is an example of where states are working cooperatively and collaboratively together to create these types of systems that create more efficiencies, particularly in the delivery of healthcare.” Approximately two-thirds of Tennessee counties are designated, in whole or in part, Health Professional Shortage Areas (HPSAs) for primary care by the U.S. Department of Health and Human Services. When looking solely at behavioral health, all but five counties are designated HPSAs. According to a recent study by Avalere Health, there are more than 111 areas in Tennessee with primary care physician shortages, encompassing almost one-fifth of the Tennessee population. Although this shortage extends across Tennessee (and nationwide, for that matter), the effects of physician shortage are often most pronounced in rural areas. Among the beneficiaries of Tennessee’s joining the Compact are Tennessee’s rural clinics, where physician recruitment has been challenging. According to Humayun Chaudhry, president and CEO of FSMB, “The launch of the Compact will empower interested and eligible physicians to deliver high-quality care
Let’s Give Them Something to Talk About! Awards, Honors, Achievements
The Children’s Hospital at TriStar Centennial has received accreditation from the Foundation for the Accreditation of Cellular Therapy (FACT) for its Blood and Marrow Transplant Program. The Children’s Hospital received the accreditation for autologous transplantation, and allogenic transplantation, and immune effector cellular therapy, marrow and peripheral blood cellular therapy product collection and cellular therapy product processing with minimal manipulation. Last month, Vanderbilt University Medical Center performed its 2,000th liver transplant, another milestone for one of the largest liver transplant programs in the Southeast. Launched in 1991, VUMC joins 11 programs in the United States that have performed more than 2,000 liver transplants. Scott R. Mertie and Katie Reid of Kraft Healthcare Consulting, LLC (KHC) were selected by the German American Chamber of Commerce® of the Midwest, Inc., which is headquartered in Chicago, to join an international delegation to Germany last month. Only 15 U.S. healthcare and medical technology professionals were chosen for participation. Mertie is president of KHC, and Reid serves as director of reimbursement and Scott R. Mertie operations in the advisory services practice of KHC. Home Care Solutions has been named a top agency of the 2017 HomeCare Elite®, a recognition of the top-performing home health agencies in the United States. For 12 years, HomeCare Elite has annually identified the top 25 percent of Medicare-certified agencies and highlights the top 100 and top 500 agencies overall. Home Care Solutions, a local provider of home health services in Nashville, is part of LHC Group, a national provider of post-acute care services with over 14,000 employees operating more than 400 locations in 27 states. Chris Redhage, co-founder of Nashville-based healthcare software company ProviderTrust, has been named to the inaugural class of Leadership Connect, a small business initiative of the Nashville Area Chamber of Commerce. Nashville-based Premise Health, a leading employer-sponsored health center and wellness provider, has been named an honoree of International Data Group’s CSO50 Award for 2018. The award is given to a select group of organizations that have demonstrated their security initiatives have created outstanding busiChris Redhage ness value and thought leadership for their companies.
across state lines to reach more patients in rural and underserved communities. This is a major win for patient safety and an achievement that will lessen the burden being felt nationwide as a result of our country’s physician shortage.” The Compact has been endorsed by, among other medical groups, the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. J. Matthew Kroplin is a partner in Burr & Forman’s healthcare and business litigation sections. His experience includes the representation of healthcare companies and providers, product manufacturers, and other business entities and individuals. For more information, email firstname.lastname@example.org or go online to burr.com.
Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S
PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Maggie Bond, Pam Harris, Jennifer Trsinar MANAGING EDITOR Cindy Sanders email@example.com CREATIVE DIRECTOR Susan Graham firstname.lastname@example.org CONTRIBUTING WRITERS Lucy Carter, Melanie Kilgore-Hill, Matthew Kroplin, Larry Sacks, Cindy Sanders, Mike Ussery, Dr. Ming Wang CIRCULATION email@example.com —— All editorial submissions and press releases should be emailed to: firstname.lastname@example.org —— 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: email@example.com Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials. All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.
NashvilleMedicalNews.blog NashvilleMedicalNews.com @NashMedNews
NMGMATen Minute Takeaway The Nashville Medical Group Management Association recently announced the 2017-18 board. Nashville Medical News had the opportunity to sit down with the organization’s new president Joy Testa, CPC, Nashville Family Foot Care, to learn more about her and about NMGMA’s goals for the coming year.
The mission of the NMGMA is to improve the effectiveness of medical group practices and the knowledge and skills of those who lead them. Our goal for the year is to continue with this mission and build on our opportunities as members to meet, learn and grow. We plan to reach out to as many medical group administrators as we can so they are aware of the value of our organization.
NMN: How did you get involved in NMGMA and what are your goals for the organization this year? NMN: Who can join Testa: About 11 NMGMA and what are the years ago I got my first benefits? job in the healthcare Testa: Anyone field, and my manager who is actively involved Joy Testa told me I would be joinin the management of a ing the NMGMA and medical practice or who attending meetings monthly. Little did represents a product that would be of benI know then how beneficial I would find efit to a medical practice can be a member these meetings since I was new to the field. of NMGMA. I faithfully attended each month, When I came on board with my met some great people along the way, current physician employer, he wanted and soon decided I wanted to be more to know “How does NMGMA benefit involved. I expressed interest in joining me?” A valid question since there is time the board and wanted to just get my feet involved in attending meetings and other wet. I was tasked with being Membership events that take time away from the Chair, which I later realized was quite a office. The honest answer is that there is big job! What was great about that was I a direct and measureable benefit to memgot to know so many more members and bership. began putting names and faces together. Relationships with other medical
practice managers are invaluable as we work together through this maze known as healthcare. There are compliance concerns, new quality reporting requirements, staffing issues and financial obstacles lurking around every corner. At our monthly meetings we have wonderful speakers who give useful information on these topics and more that affect our day-to-day operations. Building connections with our affiliate members proves to be financially savvy, as well, because not only are you meeting awesome people you can trust, but it allows you the opportunity to compare services and pricing for the office. Membership in MGMA also brings the opportunity to grow in the field through the CMPE (Certified Medical Practice Executive) credential. This credential, and ultimately reaching Fellowship status, is a benchmark that can single you out and put you in full view of top physicians and executives throughout the healthcare industry. NMN: When and where are meetings? If a Nashville Medical News reader would like to learn more at the November NMGMA meeting, how would they go about registering? Currently the NMGMA is meeting in Midtown in the event center at West End United Methodist Church, located at 2200 West End Ave. We have a large meeting
space with ample parking. We typically meet the second Tuesday of every month from 11:30 am-1 pm. Registration can be done on our website nmgma.com or by reaching out to me or any board member. We would love to have as many guests as will fit in our current meeting space. NMN: Tell us a little bit about your background and practice. Testa: Making the shift into a healthcare career has been a journey that started initially with many years in retail management, a degree in Management and Business Administration from Belmont University and a CPC (Certified Professional Coder) credential that kicked off the whole transition. I certainly would not be where I am today without the early healthcare employers and mentors who gave me a shot and who taught me so much about this business. I have been working as a practice manager at Nashville Family Foot Care for over six years and just love our small group practice located on the campus of Centennial Medical Center. We specialize in the treatment of all foot and ankle conditions with an emphasis on diabetic foot care for the prevention of pedal complications. Our staff and physicians are truly dedicated to helping our diabetic patients remain healthy and happy.
Horrar Named Medical Facilities America CEO
Robert Horrar has been named president and CEO of Franklin-based medical facilities and hospital management firm Medical Facilities of America. Previously, he served as COO for the company. A 25-year healthcare veteran, Horrar previously served as a division president with Community Health Systems and held management positions with Humana, Inc. He earned his undergraduate degree from Centre College and his Master’s in Healthcare Administration from Trinity University.
Denness Takes Global Healthcare Lead at North Highland
Following the departure of longtime healthcare expert Fletcher Lance who has moved to VUMC, North Highland has announced Richard Denness will take on the role of healthcare global lead and managing director. Denness, who has 25 years of healthcare experience, will be Richard Denness based in the Brentwood office. He is a graduate of Missouri State University and has held a number of executive positions related to pharmaceuticals, medical devices, and healthcare management throughout his career.
BlueCross BlueShield of Tennessee has promoted Todd Ray to a role as senior vice president of its Medicare Advantage and Medicare Supplement programs. Ray, who most recently served as the company’s vice president of Senior Products, will be responsible for the overall performance and management of all Medicare Advantage and Medicare supplemental product lines. He has worked in the health insurance industry Todd Ray for more than 20 years, joining BlueCross in 2013. Jeff Sundean has been promoted to the role of vice president of Properties and Corporate Services. He will be responsible for property and facility management functions and core corporate services for more than 6,000 BlueCross employees and 1.6 million square feet of company real estate in six regional offices. Sundean previously was responsible for the corporate facility Jeff Sundean operating budget. He has been with BlueCross for 16 years.
Tennessee Health Care Hall of Fame Class of 2017 On Oct. 17, the Tennessee Health Care Hall of Fame recognized six industry luminaries during a gala luncheon and induction ceremony held at Belmont University’s Curb Center. The Class of 2017 represents a wide array of industry expertise from provider, researcher and educator to policymaker, investor and business innovator … with the renowned honorees often filling multiple roles along the spectrum. Launched in 2015, the Tennessee Health Care Hall of Fame was created by Belmont University and The McWhorter Society with support from the Nashville Health Care Council to honor leaders with ties to the state who have enhanced Tennessee’s prominence on the national healthcare stage.
Born in Philadelphia in 1919, Brown spent her youth in a New York orphanage. Graduating at the top of her class, she attended Bennett College before heading to Meharry Medical College in Nashville to pursue her lifelong dream of becoming a physician. Following internship at Harlem Hospital in New York, she was disappointed to be turned down for surgical residency based on race and gender. Calling Matthew Walker, MD, who served as Meharry’s chief of surgery, her mentor offered her a faculty position back in Nashville despite advice from staff not to hire a woman. Not only did Brown hold that position for more than two decades, she became the first AfricanAmerican woman to practice general surgery in the South. Brown went on to serve as chief of surgery at Nashville’s Riverside Hospital and became the first African-American woman to be made a fellow of the American College of Surgeons. She was equally impactful in her personal life, becoming Tennessee’s first single adoptive mother in 1956 and first African-American woman to win a seat in the Tennessee Legislature a decade later. Throughout her life, Brown received numerous prestigious honors and was proud to serve as a role model “not because I have done so much, but to say to young people that it can be done.” Accepting the award posthumously on her mother’s behalf, Lola Brown noted her mother wasn’t allowed to be born in a hospital and wasn’t provided a birth certificate. “For someone who did not exist, she was able to change the face of medicine and the life of others.”
Bill Frist, MD
“I had the good luck to grow up in a medical family,” said Frist. The Nashville native added one of his earliest memories was going on house calls with his father. Seeing the positive impact a physician could have on patients started his own journey of health, hope and healing. After medical school at Harvard, his training included a fellowship in cardiothoracic surgery at Stanford University. Returning to Nashville, he joined Vanderbilt University Medical Center where he started the heart and lung transplant program and became founder and director of the Vanderbilt Multi-Organ Transplant Center. Throughout his career, Frist has performed more than 150 heart and lung transplants. In 1994, he was elected to the U.S. Senate and was chosen by his colleagues in 2003 to serve as Senate Majority Leader. During his tenure in Washington, he led efforts to enact the 2003 Medicare Modernization Act and historic legislation to reverse the spread of HIV/AIDS worldwide. After completing his second term, Frist chose to return home to continue his hands-on work impacting population health. He founded the nonprofit Hope Through Healing Hands to improve communities around the world. More recently, he founded NashvilleHealth to convene conversations and build partnerships aligning resources to improve the health and wellbeing of the city’s residents.
A partner and chairman of Cressey & Company’s Executive Council, co-founder of palliative care company Aspire Health, and active member on numerous boards, Frist is widely recognized as a dedicated public servant and devoted humanitarian.
After graduating with a degree in business from the University of Kentucky and spending three years as an officer in the U.S. Air Force stationed in Europe, Gordon began his business career in Tennessee in 1955 as a merchandise manager for Cain Sloan Company. Making the switch to healthcare, he became known as an industry innovator. In 1969, Gordon co-founded hospital management company General Care Corp., which was later purchased by HCA. In 1982, he co-founded ambulatory surgery center company Surgical Care Affiliates, which was subsequently bought by HealthSouth. Gordon was also a key architect of HealthWise America, which was later acquired by United Healthcare. He was one of the first healthcare entrepreneurs to introduce the concept of physician ownership/ joint ventures as a business model, an early pioneer of freestanding outpatient surgery centers, and one of the 10 original founders of the Nashville Health Care Council. “I didn’t set out to be a pioneer,” Gordon told the audience, “but early in my career, I recognized where disruption could improve healthcare.” Gordon has received countless awards and honors for his work within the healthcare industry and the community. He continues to give back as a mentor to young entrepreneurs and marvels at the innovations coming out of Nashville. “We are the healthcare capital of the world, and we will continue to be at the forefront of change.”
Harry Jacobson, MD
Immigrating from Germany at age four, Jacobson grew up in Chicago and attended medical school at the University of Illinois. After training in medicine at Johns Hopkins and nephrology at Texas Southwestern in Dallas, he spent two years in the Army Medical Corp before embarking on a career focused on kidney disease and failure. Jacobson was recruited to Nashville to join the Vanderbilt faculty and grow the medical center’s nephrology department, which has become a top 10 program in the nation. During this time, he also co-founded Renal Care Group, which grew into one of the world’s largest dialysis companies. In 1997, Jacobson was named Vice Chancellor for Health Affairs at Vanderbilt and CEO of Vanderbilt University Medical Center. During his tenure, VUMC tripled revenues, moved into the top 10 for National Institutes of Health research funding, and completed more than $1 billion in new facilities – including his favorite achievement, the Monroe Carell, Jr. Children’s Hospital. After retiring from Vanderbilt, he co-founded TriStar Health Partners, which invests in transformative healthcare ventures across the industry spectrum. Jacobson, who has
been an advisor to a number of venture firms and member of many healthcare boards, is a past chair of the Nashville Health Care Council. While Jacobson has been the recipient of many individual honors throughout his illustrious career, his emphasis has always been on creating a collegial culture where everyone has the opportunity to excel. “Healthcare is a team sport,” Jacobson told the audience with a smile.
Stanford Moore, PhD
Moore, who was honored posthumously, was born in Chicago in 1913 before moving to Nashville and graduating from the Peabody Demonstration School (now the University School of Nashville) and Vanderbilt University where his father was a law professor. He continued his education at the University of Wisconsin, earning his doctorate in organic chemistry in 1938. The professor and highly accomplished researcher developed many significant scientific breakthroughs. In 1949, he published the first method for the complete analysis of the amino acid composition of a protein, redesigned an automated amino acid sequencing system for ribonuclease, and contributed to the growing understanding of how protein functions on a structural and chemical basis. In 1972, he was awarded the Nobel Prize for Chemistry in recognition of his work, which changed the field of genetic medicine worldwide. Althought, the decorated scientist and life-long educator spent the majority of his career as a biochemist and professor at the Rockefeller Institute in New York, he is the namesake of Vanderbilt’s recently completed residential Moore College and a recipient of the university’s Founder’s Medal.
Donald Pinkel, MD
Pinkel, the first Director and CEO of St. Jude Children’s Research Hospital, hailed from Buffalo, New York. Joining the U.S. Navy in 1944, he was sent to Cornell University as a pre-med officer candidate before graduating from the University of Buffalo School of Medicine in 1951. While in med school, Pinkel developed an interest in hematology and started a clinic for young patients while still a pediatric resident. Soon after, he was recalled to active service during the Korean War. Contracting paralytic poliomyelitis, Pinkel worked with the renowned Sidney Farber, MD, at Boston Children’s Jimmy Fund Clinic during his rehabilitation. Pinkel was then recruited to develop pediatric service at Roswell Park Cancer Center in Buffalo before being enticed to Memphis to work with a new facility – still under construction – focused on childhood malignancies and blood disorders. Pinkel oversaw St. Jude’s rise to international prominence in pediatric hematology and oncology research and treatment over the next 11 years. He left the hospital in 1974, going on to develop pediatric oncology programs at hospitals across the nation before retiring to California in 2001 where he taught for years at Cal Poly State University.
© 2011 ST. JUDE CHILDREN’S RESEARCH HOSPITAL
Dorothy Lavinia Brown, MD