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FOCUS TOPICS ONCOLOGY • SENIOR HEALTH

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Meredith McKean, MD,

MPH

ON ROUNDS

A Call for Change

Tennessee’s High Infant & Maternal Mortality Rates America’s Health Rankings recently released sobering statistics on rising infant and maternal death rates, and state officials are taking note ... 11

Cancer Care on the Cutting Edge By DAGNY STUART

For decades cancer therapy was limited to various forms of surgery, chemotherapy and radiation therapy. Today, advances in cancer therapy are occurring at an accelerated pace, and Nashville physician/scientists are on the leading edge of these treatment advances.

Seeking ANCERS in Ovarian Cancer

More than 22,000 women are diagnosed with ovarian cancer every year, and in about 80 percent of those cases, the cancer has already metastasized to distant sites in the body. For patients with advanced ovarian cancer, the disease often recurs within a few years after initial treatment and is fatal. At Saint Thomas Cancer Care, gynecologic oncologists Michael Stany, MD, and his partner Jason Cory Barnett, MD, are using a predictive test to help determine how each patient’s tumor is likely to respond to a chosen treatment or combination of therapies. They are enrolling patients in ANCERS-2, a National Cancer Institute-sanctioned clinical trial, testing the new CANscript™ sensitivity assay, which mimics the tumor microenvironment to help predict tumor response to selected therapies. Using tumor tissue and blood (CONTINUED ON PAGE 6)

Health Care Hall of Fame Inducts Seven The Tennessee Health Care Hall of Fame recently welcomed seven new industry legends to its ranks during a luncheon event held at Belmont University’s Curb Event Center on Oct. 16 ... 12

Technological innovations help Vanderbilt-Ingram Cancer Center’s Dr. Eric Shinohara deliver high dose focused radiation more efficiently to cut down treatment time.

The Evolution of Senior Living Baby Boomers Demand Hospitality-Driven Services

By MELANIE KILGORE-HILL

Senior living is evolving at lighting speed, and it’s no surprise when you consider the stats: With 74 million baby boomers in the United States, individuals born between 1946-1964 represent the largest adult generation today, comprising close to one-quarter of the nation’s population. According to the U.S. Census Bureau’s 2017 National Population Projections, 2030 will mark an important demographic turning point in U.S. history, as all baby boomers will be over 65.

THA Hosts 80th Annual Meeting In mid-October, the Tennessee Hospital Association held its 80th annual meeting at the Franklin Marriott Cool Springs. With a theme of “Hospitals Make it Happen,” the 2018 event focused on educational and networking opportunities for hospital and health system professionals ... 15

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When Basic Science Becomes a Breakthrough Experts, Including Nobel Prize Winner, Discuss Importance of Discovery By CINDY SANDERS

The fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference was held last month in New York, drawing thought leaders from around the globe to focus on “Translating Science into Survival.” The joint event between the Cancer Research Institute (CRI), Association for Cancer Immunotherapy (CIMT), European Academy of Tumor Immunology (EATI) and the American Association for Cancer Research (AACR) featured presentations from more than 60 leaders in cancer immunology and immunotherapy, including a media panel featuring 2018 Nobel Prize winner James Allison, PhD. Allison, chair of Immunology and executive director of the Immunotherapy PlatDr. Jim Allison form at the University of Texas MD Anderson Cancer Center, and Tasuku Honjo, MD, PhD, of Kyoto University in Japan, were awarded the 2018 Nobel Prize in Physiology or Medicine for launching an effective new way to attack cancer by treating the immune system rather than the tumor. In particular, Alli-

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son’s basic science discoveries on the biology of T cells and his invention of immune checkpoint blockade to treat cancer led to the honor. Joining Allison at the conference’s immunotherapy media event was Nina Bhardwaj, MD, PhD, conference co-chair, director of Cancer Immunotherapy and chair in Cancer Research at the Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai; Crystal Mackall, MD, director of Stanford Center for Cancer Cell Therapy, director of the Parker Institute for Cancer Immunotherapy, and associate director of the Stanford Cancer Institute; and moderator Jill O’Donnell-Tormey, PhD, CEO and director of scientific affairs for the Cancer Research Institute. O’Donnell-Tormey stressed that this conference had always been about the science, rather than late-breaking, phase 3 clinical trials. However, she noted, focusing on the science, biology and mechanisms of immunotherapy could clearly lead to exciting breakthroughs as evidenced by the work of Allison and the other panelists. “Jim, as I’ve said before, is a died-inthe-wool immunologist who never set out to hope to cure cancer but rather was just trying to understand how T cells worked,” said O’Donnell-Tormey. She credited his recent accolades to being an outstanding scientist with an inquisitive mind and the

gift of persistence – noting that when he discovered CTLA-4, nobody … with the possible exception of CRI … really thought immunotherapy would become the fourth pillar of cancer treatment. Allison noted Lloyd Old, MD, one of the founders of immunology and the founding scientific and medical director of CRI, imparted a lot of wisdom, including ‘learn something from every patient.’ As immunotherapy has gained traction, Allison said that core tenet should be remembered. “One of the things I think we’re facing now is there’s somewhere in the order of 2,000 clinical trials going on with checkpoint agents in combination with something else. And that ‘something else’ is usually chosen just because a company owns it or because for some reason somebody decides it’s a good idea, but in very few cases has there been a combination that’s based on data … that’s based on understanding.” Harkening back to Old’s advice, Allison said more samples should be gathered from patients even if the combination therapy doesn’t have the desired outcomes. “You could understand something about a combination by knowing what didn’t happen,” Allison stated. He also made a plea for more unfettered basic science. While humbled and thrilled that his work has become clinically

significant, Allison said he started out as an undergrad whose attention was caught in a lecture on T cells, which had been newly discovered at the time. “I was really just trying to understand the immune system,” he noted. Allison said he believes there is too much emphasis today on having to always spell out relevance in order to receive grant funding. “How do you know what’s going to be relevant or not?” he questioned. “I know one thing – that nobody who was trying to discover how to use the immune system to treat cancer would ever have found CTLA-4 because there would be no reason to look for it.” He continued, “Pick your problem, work on it, do the best work you can and then try to figure out how we can use it to treat diseases.” Calling Allison a true pioneer, Mackall noted that his story is an important one to tell. “I want the average citizen to understand why we need to invest in science. Having smart people like Jim be free to pursue a hunch that he thinks might turn into something some day … or not.” When smart, talented people are given the opportunity, she continued, fundamental discoveries are made. “It takes a long time, and you’ve got to keep at it … but at the end of the day, you can cure people who were otherwise incurable. This is why it’s just so (CONTINUED ON PAGE 3)

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PHYSICIAN SPOTLIGHT

Dr. Meredith McKean Brings New Hope, More Options for Melanoma Patients By MELANIE KILGORE-HILL

It’s a long way from rural Iowa to Nashville, but Meredith McKean, MD, MPH, has navigated it well, with a few stops in between. In June, McKean was named among the newest research faculty members at Sarah Cannon Research Institute at Tennessee Oncology, where she oversees Sarah Cannon’s growing Melanoma Research Program. In her role, McKean investigates innovative therapies in clinical trials, caring for patients facing melanoma. “I always loved science growing up and was interested in natural science since that’s what I was exposed to growing up on a farm,” McKean said. A middle school genetics camp at the University of Iowa solidified that passion and served as her first exposure to the science behind cancer and inheritable diseases. “Looking back at my essays for scholarships, I always said I wanted to cure cancer,” she noted. “I thought I’d do it in a lab, but then I recognized the opportunity as a physician to be able to develop clinical trials for patients and to be able to care for them. It was an evolution that occurred through my training.” McKean received her bachelor’s degree from Iowa State University, where the promising athlete ran cross-country and track. She continued her education at the University of Iowa, earning her medical degree along with a Master’s of Public Health. During medical school, McKean’s research in the heart failure and heart transplant program focused on building a tissue bank and analyzing tissue for proteins predictive of patient survival. Following an internal medicine residency at the University of Colorado’s

Anschutz Medical Campus, where she examined male breast cancer tissue for molecular drivers, McKean completed her fellowship in Hematology-Oncology at the University of Texas MD Anderson Cancer Center. During fellowship, McKean studied biomarkers for response to immune checkpoint inhibitors (ICI) in metastatic melanoma, earning her an American Society of Clinical Oncology 2017 Young Investigator Award. “My background gave me a good understanding of how to set up clinical trials and evaluate samples from patients and to

try to predict who will respond,” she said. “I learned to look for early signals of resistance to treatment, and that’s helpful as a clinical trials investigator.” While studying various tumor types at MD Anderson, McKean found her time in melanoma research to be the most meaningful. “It’s exciting that over the last several years there have been newer agents developed – targeted therapies and immune checkpoint inhibitors – with additional therapies continuing to be investigated,” she said. “I saw how important it would be to say ahead of time who will respond to immunotherapy and who won’t. That’s the next big challenge in melanoma, as in a lot of tumors: Whose immune system needs additional treatment to recognize and attack cancer?” At Sarah Cannon, McKean and her team focus on identifying genetic drivers of each person’s individual cancer through a personalized medicine approach. She said Sarah Cannon’s Melanoma Program continues to develop, and she appreciates the organization’s enthusiasm for growing the clinical trial offering for patients. Sarah Cannon currently offers melanoma trials for phases 1 to 3, with plans to open up more opportunities for patients. “Melanoma was the first tumor that immune checkpoint inhibitors were approved in, so it’s really a breeding ground for understanding what other treatments

we need to add to immunotherapy to make cancers respond to treatment,” McKean explained. “Sarah Cannon is well poised to advance the field of melanoma treatment in a significant way.” Prior to approval of immune checkpoint inhibitors in 2011, the five-year survival rate for stage 4 metastatic melanoma was less than 15 percent. Thanks to ICI and targeted therapies, today’s five-year prognosis is closer to 30-40 percent. “There have been significant strides, but we need to find options for patients who aren’t responding to initial therapies,” McKean said. She also believes primary care providers and dermatologists play an important role in catching cancer in its earlier, more treatable stage, and urges providers to educate patients about spots that are changing color, bleeding or irritated. McKean is now working with investigators nationwide and plans to open more melanoma trials throughout the Sarah Cannon network. “When I was looking for a position after my fellowship, I was looking at academically centered programs, and what was appealing about Sarah Cannon was the mission,” she said. “I’m from rural Iowa, so I loved that the goal was to take these trials out to patients in the community setting. Our network is a team full of great oncologists who are providing treatment in their communities. The patients really are put first, and it feels like a family.”

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Science, continued from page 2 important that we believe in the power of science and innovation and technology.” O’Donnell-Tormey concurred, noting science isn’t linear and requires sustained funding and the luxury of time to be able to fully explore ideas. She added that not every hypothesis turns out as planned. “I think you can learn as much from failure as you do from success, and that’s what science is about,” she opined. Bhardwaj said Allison’s work illustrated how a scientist devoted to understanding a mechanism has had an enormous impact on thousands of patients … and probably tens of thousands, possibly hundreds of thousands in the future. She added his work has led to developments in cancer immunotherapy that have added many years to patients’ lives. “He’s really laid the foundation for the whole field in terms of developing many, many new agents,” Bhardwaj continued. “We will see the impact of this discovery for years to come.”

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ONcology Rounds CET Companies Awarded more than $3 Million in Grants

Last month, Cumberland Emerging Technologies, Inc. (CET), an incubator of early-stage life science companies, announced more than $3 million in research grant awards for three company tenants at the CET Life Sciences Center. “This significant funding points to the important role the CET Life Science Center is playing in supporting the creation of innovative biomedical technologies that stimulate economic development in Tennessee,” said A.J. Kazimi, CEO of Cumberland Pharmaceuticals, Inc., one of CET’s founders. The total of $3,070,000 in funding includes: A $2 million grant from the U.S. National Cancer Institute (NCI) to support a joint research program involving Cumberland Pharmaceuticals Inc., CET, and researchers at Vanderbilt University. The objective of the collaborative research program is to further develop a novel small molecule radiosensitizing agent for the treatment of certain lung cancers. By enhancing the cancer’s sensitivity to radiation therapy, this technology addresses a significant medical need of improving clinical outcomes for these oncology patients. This Phase II grant is awarded under the Small Business Innovation Research (SBIR) funding mechanism and follows successful completion of an initial Phase I award. A $750,000 grant to PATH EX, Inc. from the National Science Foundation (NSF) to develop a fluidic platform for selective bacterial and endotoxin removal from blood. This technology can potentially serve as a novel blood cleansing therapeutic for diseases such as sepsis. This Phase II grant was also awarded under SBIR funding and follows successful completion of an initial Phase I award. A $320,000 grant from the National Institute on Aging (NIA) to fund research by IQuity to predict and detect Alzheimer’s disease. For more information on this project, see page 9.

Nashville Lung Using Advanced Robotics

Nashville Lung Surgery – part of AdvancedHEALTH, Middle Tennessee’s largest, independent, multi-specialty practice – continues to build its Thoracic Robotics program. This summer, specialists with Nashville Lung Surgery began using the latest da Vinci Xi Robotic system at Ascension Saint Thomas West Hospital. “This minimally-invasive technology allows us to perform complex procedures with less recovery time, pain and surgical trauma for our patients,” said thoracic surgeon Mathew Ninan, MD, FACS. “This technology also allows for high definition 3D visualization for more Dr. Mathew Ninan 4

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precise surgeries.” Ninan has personally trained the Thoracic Robotics OR team at Saint Thomas West, following the protocols used at Baylor Heart Hospital in Dallas, Texas. With the da Vinci Xi Robot, Nashville Lung Surgery is able to perform advanced thoracic robotic procedures, including: lung resections for lung cancer; mediastinal and chest wall lesion removal; foregut surgery, such as robotic laparoscopic hiatal hernia repairs and anti-reflux procedures, like the Linx magnet procedure. Nashville Lung Surgery also has performed full esophageal mobilization in the chest, as well as resected benign esophageal tumors with the robotic technology. As the Thoracic Robotics program continues to expand, the practice will be performing esophagectomy with a total port access approach to avoid the traditional open surgery.

OneOncology: Building Partnerships to Drive Community-Based Cancer Care

This fall, three leading oncology practices – Nashville-based Tennessee Oncology, New York Cancer & Blood Specialists and Memphis-based West Cancer Center – joined forces to launch OneOncology, a patient-centric, physician-driven, technology-powered company with the mission of improving the lives of those with a cancer diagnosis in communities across the country. Nearly 40 percent of Americans will be diagnosed with cancer at some point in their lifetime. With early diagnostic, research and treatment breakthroughs, survivorship has increased dramatically. For an increasing number of individuals, their cancer has become similar to managing a chronic disease and is cared for in a community-based setting close to home. Key goals behind OneOncology are to support and empower partnering community oncologists through peer learning and collaboration to leverage a collective experience to address practice and care delivery challenges and to connect oncologist with resources to improve quality, reduce costs and improve the patient experience across the care continuum. “With the launch of OneOncology, we hope to transform the future of cancer care,” said the new company’s President and CEO Tracy Bahl, a 20-year healthcare industry veteran with previous executive and board roles at CVS Health and Emdeon. “Cancer is increasingly being treated like a chronic condition rather than a terminal diagnosis. Working together with world-class oncologists, we will drive the change that community cancer needs through continual learning, creative and smart evolution, and a collective desire to positively impact the lives of every person touched by cancer.” The new company received $200 million from private equity firm General Atlantic and has partnered with Flatiron Health, an EHR developer specializing in oncology that has software in more than 275 practices around the country.

Tim Adams addresses attendees at the grand opening of the new Saint Thomas Cancer Center on the Midtown campus.

Ascension Saint Thomas Opens Cancer Center At the end of October, Ascension Saint Thomas Health celebrated the grand opening of their new comprehensive cancer center at Saint Thomas Midtown Hospital. Located on Hayes Street, the Saint Thomas Cancer Center is integrated into the hospital campus. According to health system officials, the new center was designed to allow patients to access cancer experts and advanced therapies in a supportive and encouraging environment. The space includes most cancer services under one roof, including diagnostics, cancer surgeons, medical oncologists, radiation oncologists, radiologists, and support services. Citing the array of services under one roof, Ascension Saint Thomas Health President and CEO Tim Adams noted, “The Saint Thomas Cancer Center is the next step in our journey to deliver comprehensive health solutions in convenient, accessible locations.”

Fahad Tahir, president and CEO, Ascension Saint Thomas Midtown & West Hospitals, said the center’s goal “is to support individuals beyond a disease treatment and to enrich their wellbeing – mind, body, and spirit – led by a sophisticated, skilled clinical team of experts.” He added, “We are humbled to expand access to innovative cancer treatments, integrated therapies, comprehensive education and prevention, personalized for those we serve, all under one roof.” The multidisciplinary team is comprised of experts in a range of cancer types, including brain, breast, colon, endocrine, advanced GI, gynecologic, lung and prostate. Certified therapy dogs provide emotional support and companionship to patients and their caregivers. The Saint Thomas Cancer Wellness Studio offers free, restorative programs focused on fitness and movement, nutrition, mindfulness meditation, education, and support during and after treatment.

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 George Buck, president emeritus, and Judd Peak, chief compliance officer and general counsel, with Frost-Arnett Company, take a vendor’s perspective to drill down on “Laws and Regulations Continue to Affect Patient Pay: The Fair Debt Collection Practices Act.” In part four of this six-part series, the authors look at the Fair Credit Reporting Act. Ming Wang, MD, shares the latest information on advanced presbyopic lenses for seniors to improve both distance and near vision, helping keep eyes ‘forever young.’ James Wilkins, JD, a financial consultant with Life Credit Union, provides insights to help “Keep Your Head in the Investing Game.”

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NMGMATen Minute Takeaway By CINDY SANDERS

The second Tuesday of each month, practice managers and healthcare industry service providers gather for the monthly Nashville Medical Group Management Association (NMGMA). The October meeting featured Palmetto GBA Medicare Part B Senior Education Consultant Paula Motes, followed by the fall networking social at the offices of Burr & Forman. Palmetto GBA, a Celerian Group Company, is the new Medicare Administrative Contractor (MAC) for Tennessee’s Part A and Part B providers (Jurisdiction J). The technical presentation included updates and notes regarding targeted probe, comprehensive error rate testing program, documentation and compliance, and utilizing Palmetto GBA resources. With changes occurring frequently, Motes provided a number of resources to help providers stay informed, starting with their website: PalmettoGBA. com/JJB, which includes links to Twitter, YouTube, blogs and other educational resources. Of immediate interest, she noted, is the change to the Medicare cards, which should be switched over by April 2019. Providers will need to use a Medicare Beneficiary Identifier (MBI) on claims,

(L-R) Matt Kroplin, partner at Burr & Forman and NMGMA board member, with Blake Wilson and Stuart Hunter of TMA Banking

NMGMA President Jimmie Holland of HCA with October speaker Paula Motes.

replacing the HICN, which was a patient’s Social Security number plus Beneficiary Identification Code. “This was passed by Congress to try to get Social Security numbers out of the public sphere as much as possible,” Motes explained. A transition period to the new identi-

fiers began last month. During this time, providers will need a patient’s Social Security number in order to look up the new MBI. The new number is randomly generated, uses a mix of numbers and letters, and is 11 characters in length. CMS has more details on the transition at cms.gov/ medicare/new-medicare-card. Covering a lot of ground specific to various practice segments, Motes said their array of online tools should answer many questions. “CMS encourages MACS to develop self-service tools,” she noted. “Try those first, but if you can’t get

Cancer Care on the Cutting Edge, continued from page 1 samples, the CANscript assay recreates the immediate surroundings of an individual’s tumor to evaluate that patient’s likely response to treatments chosen by the physician. “Cancer doesn’t obey the rules of cell growth and division, and the microenvironment of an individual patient’s tumor is unique, with molecular interactions that determine whether cells are living or dying,” said Stany. Current ovarian cancer therapies include various types of chemotherapy, plus VEGF inhibitor drugs Dr. Michael Stany like bevacizumab (Avastin) that block blood vessel growth and new PARP inhibitor drugs. While these standard therapies and novel drugs offer more care options, physicians can’t predict how an individual patient’s cancer will respond. By recreating the tumor’s ecosystem, the CANscript assay hopes to offer better insight into reaction to these options used either individually or in combination. In early tests using the assay, there has been a higher correlation to clinical outcomes, which has provided an opportunity for more personalized care. Stany said this trial, open for enrollment to patients with recurrent ovarian cancer, is offering guidance to physicians about which chemotherapy or combination of therapies is likely to be effective to enhance individualized care and improve patient outcomes. 6

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Unmasking Cancer Cells

Cancer cells feature a cloaking mechanism that enables them to evade attack from the body’s immune system, but scientists are using new technology to deliver a lethal blow to these rogue cells by enabling immune cells to lock onto specific proteins on those cancer cells. CAR T-cell therapy is among the most promising areas of cancer research, and Sarah Cannon is one of the leading research organizations offering this new treatment to patients. In CAR T-cell therapy, physicians obtain the patient’s blood and isolate T lymphocytes, which are shipped to special laboratories where a gene for a receptor called a chimeric antigen receptor (CAR) is inserted into the T-cell. Millions of the CAR T-cells are grown in the lab, then shipped back to the hospital and infused into the patient. The CAR T-cells bind to a specific antigen on the cancer cells, specifically CD19 or CD22 in lymphomas and leukemias, and destroys them. The initial clinical trials for CAR T-cell therapy were initiated for adult patients with lymphomas and pediatric patients with Acute Lymphocytic Leukemia. “These were patients who had poor prognoses because other therapies had proved to be ineffective,” said Dr. Carlos Bachier Carlos Bachier, MD, program director for Blood and Marrow

Transplant for the Sarah Cannon Blood Cancer Network and leader in CAR T-cell therapy research at Sarah Cannon Center for Blood Cancer at TriStar Centennial Medical Center in Nashville. “In CAR T-cell clinical trials for lymphomas, about 75 to 80 percent of those patients have gone into remission. Now with a follow-up of approximately two years, approximately half are still in remission and may be cured. This is a significant advance in a population where remissions are rare and survival is less than six months,” noted Bachier. Some CAR T-cell therapies have now been FDA approved for blood cancers, including pediatric Acute Lymphoblastic Leukemia (ALL), and non-Hodgkin’s Lymphoma in adults. Bachier said Sarah Cannon’s research infrastructure and deep physician expertise have enabled them to offer many new clinical research trials to cancer patients. “We treated our first patient in a clinical trial in April 2016. Since then in Nashville, we have treated 47 patients, and in the entire network, we have treated more than 60 patients. In Nashville, we currently have 23 clinical trials with these immune effector and CAR T-cells in a variety of malignancies, including blood cancers like lymphomas and leukemias, and solid tumors including lung cancer, breast cancer and other solid tumors.”

Treatment in a Flash

Patients with early or intermediate-stage prostate cancer who choose radiation therapy used to need up to 44

an answer, then call or reach out.” She added the Jurisdiction J Contact Center is open 7 am-5 pm Central at 877-567-7271. Mark you calendars for the next NMGMA meeting on Tuesday, Nov. 13 in the conference rooms at Saint Thomas West Hospital. The November meeting features Marion Karr, who will look at ethical leadership for the customer experience. For practice administrators interested in becoming involved with the NMGMA chapter, contact Jimmie Holland at website@nashvillemgma.org for a guest registration to the November event.

radiation treatments to eliminate their cancer. Now Vanderbilt-Ingram Cancer Center (VICC) provides high dose stereotactic body radiotherapy (SBRT), which enables men to be treated in far less time, as few as five treatments, with low toxicity. With SBRT, physicians deliver a high dose focused beam of radiation to the tumor. Long-term follow-up studies have shown excellent rates of cancer control. While prostate tumors typically respond well to radiation therapy, there is a risk of damage to adjacent tissues, including the bladder, sex organs and rectum. So VICC radiation oncologists are utilizing a hydrogel spacer to create a space between the prostate and nearby healthy tissues to increase the safety of the new technique. “The hydrogel spacer acts like an epoxy,” explained Eric Shinohara, MD, MSCI, associate professor and vice chair of Radiation Oncology. “You inject two syringes of materials that mix together and harden into a substance like a jelly, creating a space between the rectum and the prostate. This allows us to dramatically reduce the radiation dose to nearby tissues and minimize unwanted side effects.” During radiation therapy, the hydrogel spacer remains stable and is gradually absorbed by the body after the treatments have been completed. This ability to deliver high doses of radiation therapy in a short time span provides more convenience for patients as well as enhanced recovery time. nashvillemedicalnews

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Improving Quality, Lowering Cost of Care for Seniors Saint Thomas, Ascension ACO among MSSP Winners By CINDY SANDERS

Results recently released from the 2017 performance year of the Medicare Shared Savings Program (MSSP) showed Accountable Care Organizations (ACOs) continue to make improvements in the quality of care for Medicare beneficiaries while lowering costs. The MSSP, which launched in 2013, now has more than 450 ACOs serving more than 10 million Medicare beneficiaries. Each year, the Centers for Medicare and Medicaid Services (CMS) give participating ACOs a spending benchmark and a list of quality parameters. Those who spend under the benchmark while attaining or exceeding quality expectations receive a share of the savings. For the 2017 program year, that totaled $1.1 billion in gross savings. While CMS shared $780 million with qualifying ACOs, the program still saw a net gain of more than $314 million in savings – a significant increase over 2016 when the overall program actually lost money because CMS paid out more in bonuses than it generated in savings. The news of demonstrable savings in 2017 is particularly of interest since CMS recently proposed moving ACOs to riskbased contracts more quickly, citing losses in 2015 and 2016 as a major reason. Cur-

rently, the vast majority of participants get the benefit of shared savings without financial risk if they fail to meet the benchmarks. The latest figures, however, not only found more ACOs achieved savings in 2017 compared to 2016 but that those with more experience tend to improve performance over time. Locally, Saint Thomas Health and Ascension Care Management (which started life as MissionPoint Health Partners) are an example of having the benefit of experience. Among the first ACOs in the country, Saint Thomas Health announced their partnership saved CMS $7.8 million in Tennessee in 2017 while exceeding quality expectations. “It is our best year, yet,” noted Tim Adams, president and CEO of Saint Thomas Health and ministry market executive for Ascension Tennessee. “Our ACO consists of approximately 40,000 Medicare beneficiaries. Over the five years, we’ve lowered the Medicare spend Tim Adams by $30 million.” Echoing the findings of the latest MSSP report, Adams said he thought experience played an important role in

the continued improvement of financial performance and outcomes. He noted it takes time to put processes in place, gain traction in systems, and see patient education take root and flourish. The idea of working across the continuum to achieve healthcare’s triple aim of better outcomes, increased patient satisfaction and decreased cost was appealing to Saint Thomas Health and Ascension from the beginning. “The concept was one our national ministry embraced and felt like that was where our industry was going and what we needed to be doing for patients in terms of care and cost.” He added the work pioneered with the ACO in Middle Tennessee has been replicated across Ascension markets. “We’re constantly measuring the quality and compliance of our members through software platforms,” Adams said. He noted providers routinely screen for depression and other behavioral, environmental and social factors that play an important role in determining health and wellness. “All those things we focus on … when you look at them holistically … provide long term, sustainable, better health.” Not only is the goal to lower readmissions but to lower all admissions by caring for members more effectively in an outpatient setting. He noted the shift meant chipping away at what has tradi-

tionally been a health system’s core business. However, he continued, rethinking delivery is both necessary and the right thing to do. “We recognize we have to find a way to lower healthcare costs,” Adams said. “The current year-over-year increase in healthcare cost is simply unsustainable. I’m proud to be part of a national health system that understands where we need to go despite its implications to our current business model.” Adams concluded, “We want to move from being provider-centered to person-centered … measuring success not in number of patients we see but in the health outcomes and value we deliver.”

For More Info on CMS Proposed Rule In August, the Centers for Medicare and Medicaid Services issued a proposed rule that would overhaul how the Medicare Shared Savings Program works. For more information on the proposed redesign, called “Pathways to Success,” go online to NashvilleMedicalNews. com and look for the link affiliated with this article.

Planning Ahead: Patients & Power of Attorney I recently met with a senior couple that had lived a fruitful and financially successful life together. They obviously cared for each other and had two children who were concerned with By BARBARA MOSS their welfare. Elder Law of Nashville The love family members felt for each other was very touching. Unfortunately, the wife “Jane” had been diagnosed with Alzheimer’s disease in 2009. Her condition had deteriorated to the point where she had been placed on medication to control combative behavior. The family worried that Jane would wander out of the house and had put locks that she could not reach on the doors. Jane hadn’t signed, while she was still competent, powers of attorney giving anyone the power to manage her financial affairs or to help her make healthcare decisions. By the time I saw her, she could not sign her name. Jane’s family could nashvillemedicalnews

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face expense and difficulties without the benefit of these documents. Providers, hospitals and other healthcare facilities have become increasingly more comfortable bringing up the subject of living wills with patients, yet the topic of creating a power of attorney document isn’t often part of routine care discussions. However, like a living will, the time to appoint a power of attorney is before you actually need one. Powers of attorney are documents that give someone (the “attorney-in-fact” or “agent”) the legal right to act in place of another (the “principal”). In Tennessee there are two types of powers of attorney: (1) a “general” power of attorney that gives someone the ability to make financial decisions, execute legal documents, pay bills, and handle other financial matters; and (2) a power of attorney for healthcare, which appoints someone to make decisions about health matters. Both types of powers of attorney are often called “durable” powers of attorney. That means that they continue in effect even when the principal has become incapacitated. Obviously, that’s a good thing, since that’s precisely the time that your patient needs the assistance of an agent.

Powers of attorney can be effective immediately when signed, or they can become effective later when the principal becomes incapacitated. For example, powers of attorney can be drafted to require a determination by a physician (or even two physicians) that the principal is incapacitated before they are effective. This type of power of attorney is called a “springing” power, because it springs into effect at a designated time or event in the future. Whether patients need a power of attorney that’s effective now or only in the future when they are incapacitated depends on the situation. If someone is in in a stable marriage with a trusted spouse, a power that is effective immediately might make the most sense. I have a friend whose brother is a firefighter in another city. She asked him to make the power of attorney for healthcare decisions effective now. My friend knew that if her brother were injured, hospitals wouldn’t disclose to her whether her brother had even been admitted without a current power of attorney. The alternative to a power of attorney could mean a court proceeding to have a conservator appointed. Conservator-

ships are expensive and time consuming, requiring up to three lawyers to manage. I’m often asked about whether people need to consult a lawyer to get a power of attorney. I haven’t spent a lot of time checking the legal websites to determine the quality of their forms. However, I do know that recently some friends were trying to prepare a power of attorney for their father, who was in the hospital with congestive heart failure, so that they could pay his bills. I looked at the legal form they had gotten off the web, and it would not have been accepted by any bank. Properly drafted and executed powers of attorney are not that expensive and are an important component in your patients’ planning for aging and potential incapacity. Barbara Moss is an elder law attorney and founder of Elder Law of Nashville. She focuses her practice on the legal needs of seniors and those in need of long-term care. Moss is recognized as a “Super Lawyer” in the field of Elder Law, has been named by her peers in Nashville as “Best of the Bar,” and is included in The Best Lawyers in America©. She is also an Accredited Attorney with the Veterans Administration.  For more information, go to elderlawofnashville.com.

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The Evolution of Senior Living, continued from page 1 A New Mindset

Today’s boomers are often in a tough position, as they struggle to care for elderly parents while also navigating their own age-related health concerns. The result is a discerning generation with heightened expectations for themselves and their parents – who are part of the silent generation that is more likely to comply than to push back. “Our grandparents’ generation typically was of the mindset, ‘You’re the expert, you tell me what I need,’” said Beth Dault, LMSW, assistant vice president of Social Work Services for senior living provider National HealthCare Corporation (NHC). “Even if they had concerns, they really didn’t want to rock the boat and were more likely to concede. Baby boomers were trendsetters in the 60s and 70s and Outdoor living spaces at The Heritage at Brentwood gives residents multiple opportunities to enjoy sunshine and nature. still are as they’re aging into senior services. They know they can demand their around-the-clock care was needed, boom“There’s been a huge shift.” expectations be met or go someplace else.” ers are creating demand for independent Casey Reese, NHC’s director of Netand assisted living options driven by hoswork Development, also credits that evoAging in Place pitality services rather than medical needs. lution to increasing patient acuity levels in Aging in place The movement has triggered a trickle-down hospitals, where length of stay requirements is among the greatest effect on skilled nursing facilities, as well. are getting pushed to demands of today’s “We’re seeing more care trends the next level. “Skilled boomers, and senior change, and clinicians have noticed nursing facilities had living organizations that we’re getting more ICU step-down to step up and meet are taking note. While patients in skilled nursing centers, where that acuity, and they older adults once stayed traditional long-term care patients are have to balance it with in their homes until now in assisted living,” Dault said. customer service initiaBeth Dault tives,” she said. At NHC, which operates 76 skilled Casey Reese nursing centers, 36 homecare programs, five residential living for Healthcare Professionals centers and 24 assisted living communities, leaders have implemented a system-wide morning huddle around NHC’s 20 promises for patients and staff. It’s part of their “Better Way Program,” which emphasizes meeting expectations by focusing on person-centered care for the 9,000 patients they serve a day.

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Forward-thinking senior living providers have transitioned to a campus concept to aging in place. In Williamson County, The Heritage at Brentwood is a unique LifeCare® senior living retirement community that allows residents to move in while independent and transition to skilled nursing if needed. “Our goal is for residents to remain independent, and everything we do in terms of activities and lifestyle functions is geared toward maintaining independence,” explained Judy Good, marketing director for The Heritage at Brentwood. Their unique model includes a fulltime certified fitness manager, who creates a custom wellness program for each resident. Judy Good Group classes including tai-chi and yoga are offered onsite

alongside a host of other activities. “Baby boomers have more acute awareness of living longer and healthier, and they’ve often established an exercise regiment early on,” Good said. “They want to continue a lifestyle that’s vibrant and active, and they’re seeking out communities that can offer that.” The Heritage residents enjoy meals created by a master chef, an onsite market, cocktail lounge, transportation department and full-service medical clinic staffed by Williamson Medical Group. Meanwhile, a full-time healthcare navigator ensures their 280 independent living residents receive necessary medical services, particularly when rehabilitation needs arise. The navigator helps ensure residents remain onsite as they transition from inpatient to outpatient rehab, with the end goal of moving back to their own apartment or villa. “Residents have the same therapist managing their physical therapy the entire time, so there’s a continuity of care,” Good said. “Once therapy ends, the fitness manager tailors a new program designed to meet their changing needs.” While senior care can get pricey, The Heritage uses a unique financial model that helps monthly fees stay lower, so residents enjoy a significant cost savings by moving in while independent rather than going directly to long-term, higher acuity care. The model seems to be working: The Heritage is now building 97 new independent living apartments and 11 assisted living suites on their 48-acre campus, where their Somerfield Health Center operates 64 private rooms for long-term care.

Community Care

At NHC, a holistic approach to aging has existed since the company’s founding. “One of the neat things about the vision of the company is that (NHC founder) Dr. Adams really wanted to change how senior care was delivered,” Reese said. “He had a vision of community care for seniors with different levels of care on one campus and was a pioneer in that area.” As NHC continues to expand their campus concept, they’re also growing to meet increasing demand for memory care services. To that end, memory care units have become standard in several assisted living communities, while a new 60-bed, stand-alone memory care facility is preparing to open in Knoxville. Regardless of whether residents require assisted living, long-term nursing care or memory care, Reese said heightened expectations abound, from personal wellness initiatives to Wi-Fi access. “There’s sometimes a misconception that life stops when you go somewhere that’s not your home … but once they visit, that resistance usually goes away,” Reese said. “They’re actually gaining more independence because they can better manage their new setting.”

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News of Note Impacting Seniors IQuity Awarded Grant to Identify Alzheimer’s Earlier

Nashville-based data analytics company IQuity recently received a $320,000 grant from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). The company – which utilizes data to predict, detect and monitor chronic disease – will build upon its diagnostic expertise to try to identify Alzheimer’s at an earlier point in the disease’s progression. To date, IQuity has focused its research exclusively on autoimmune and related diseases, including multiple sclerosis, fibromyalgia syndrome and inflammatory bowel disease. The new grant will allow the company to expand its focus to include Alzheimer’s disease and apply its genomic expertise to develop new diagnostic tools to help providers identify the disease early. As part of its research activity for the award, IQuity will use its new machine learning-based data mining and analytics platform – which analyzes many types of information, including genomic datasets, claims data and electronic medical records – to predict and detect Alzheimer’s. IQuity launched its analytics platform in July. “This grant is a significant validation of the promise our genomics research and data analytics capabilities holds for people suffering from this debilitating disease,” said IQuity CEO Chase Spurlock, PhD. “IQuity’s advances in RNA testing and data science have great potential to create predictive diagnostic tools that will lead to an earlier diagnosis of Alzheimer’s. New Dr. Chase Spurlock therapies that emerge for Alzheimer’s will be most effective when administered early, which is difficult with today’s diagnostic approach.” Alzheimer’s is the sixth leading cause of death in the U.S., with 5.7 million people suffering from the disease. The Alzheimer’s Association estimates the cost of healthcare and long-term care for individuals with Alzheimer’s and dementias will total $277 billion in 2018.  “All of us at IQuity are excited and honored that the NIA and NIH support our approach to developing innovative technology that can facilitate early detection and treatment responses for people affected by Alzheimer’s,” said Spurlock. “We are proud to be part of a global community of researchers and data scientists who are committed to discovering new early detection methods, prevention plans, treatments and, hopefully, a cure for Alzheimer’s.”

Clover Health Expands to Nashville, Releases Flu Findings

Clover Health, a healthcare company using data and technology to improve medical outcomes, recently announced expansion of its Medicare Advantage health plans in five new major markets for the plan year nashvillemedicalnews

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beginning Jan. 1, 2019. According to company officials, Nashville and the other markets were selected based on a receptive customer base and the company’s ability to delivery high quality Medicare Advantage plans by partnering with top local healthcare providers. Prior to the expansion, Clover served more than 30,000 seniors and those eligible for Medicare in parts of Georgia, New Jersey, Pennsylvania and Texas. “Offering our plans in new cities and growing our presence in the markets we already serve is core to Clover’s drive to improve the health of seniors across the country,” said Clover Health CEO Vivek Garipalli. “Our approach of pairing cutting-edge technology with committed, personalized medical care is showing positive results for our members, and the expansion will allow Clover to reach even more Medicare beneficiaries.” Last month, Clover released results from the inaugural Clover Health Flu Shot Monitor, which revealed only 61 percent of Nashville seniors plan to get a flu shot this season. Nationally, 63 percent of the seniors surveyed said they planned to get the flu shot. “The flu is a deadly-serious issue and Nashville seniors are one of the most vulnerable populations during flu season,” said Clover Health Chief Scientific Officer Kumar Dharmarajan, MD. The most common reason cited in the survey for not wanting to get a flu shot was the concern that the shot would make individuals sick, followed by a belief that the flu shot wouldn’t be effective. The findings open up lines of discussion for physicians to clear up myths and address concerns. Officials said the survey illustrates the company’s commitment to preventive healthcare and to leveraging data to proactively address potential illnesses on the front end. As part of this corporate tenet, Clover utilizes a proprietary technology platform, which has an 85 percent accuracy rate in identifying patients at risk of being admitted to the hospital in the next 28 days.

HHS Advances Payment Model to Lower Drug Costs

In late October, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced and sought input on a new “International Pricing Index” (IPI) payment model to reduce what Americans pay for prescription drugs. Under the IPI model, described in an Advance Notice of Proposed Rulemaking (ANPRM), Medicare’s payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries. Overall savings for American taxpayers and patients are projected to total $17.2 billion over five years. “In an era where the pharmaceutical industry is pricing drugs at levels approaching a million dollars — and jeopardizing the future of our safety net programs — the time has come to fix the perverse incentives in the Medicare program that are fueling price increases,” said CMS Administrator Seema Verma.

The move from current payment levels to payment levels based on international prices would be phased in over a five-year period, would apply to 50 percent of the country, and would cover most drugs in Medicare Part B, which includes physicianadministered medicines such as infusions. The model purports to “correct existing incentives to prescribe higher-priced drugs and, for the first time, address disparities in prices between the United States and other countries.” Since patient cost sharing is calculated based on Medicare’s payment amount, patients should see lower costs under the model. For the first time in Medicare, the IPI model would create a system in which private vendors procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. The plan is that vendors would aggregate purchasing, seek volume-based discounts, and compete for providers’ business, thereby creating competition where none exists today. Under the model, instead of the current percentage-based add-on payment, physicians and hospitals would receive a set payment amount for storing and handling drugs that would not be tied to drug prices to remove any financial incentive to prescribe higher-cost drugs. AMA President Barbara L. McAneny, MD, responded to the proposed rule with the following statement: “Physicians share their patients’ concerns with the high cost of prescription drugs. We appreciate that the Trump Administration is working to address this important issue. The Administration’s proposal for an International Pricing Index Model for Part B drugs raises a number of questions, and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the health care system. We look forward to working constructively with the Administration as it seeks feedback.” Go online to NashvilleMedicalNews. com for links to a CMS policy brief, fact sheet, and CMS comments section (accepted until Dec. 24).

Council on Aging Honors Middle Tennesseans

The Council on Aging (COA) of Middle Tennessee hosted their 27th Annual Sage Awards on Oct. 29. With a belief that aging should be celebrated and embraced and that older adults have a lifetime of wisdom and experience to offer communities, the Sage Awards are presented each year to older adults who have made outstanding contributions to Middle Tennessee. This year’s honorees are: Carrie Hudson (Nashville), Mary Mills (Franklin), Dorothy and Joe Scarlett (Nashville) and Drs. Pramod and Geeta Wasudev (Brentwood). In addition to the individual honorees, COA presented Alive Hospice with the 2018 Organization Award. Carrie Hudson has served in several leadership roles for the National Association of Negro Business and Professional Women’s Clubs, Inc., CABLE, Top Ladies of Distinction, Inc., League of Women Voters, Grace M. Eaton Child Care and

Early Learning Center, Edgehill Community Center and Top Teens of America. She has helped older adults with registering to vote, transportation, meals, assistance and companionship. In Carry Hudson addition, she served on the Council on Aging’s Community Assessment Committee. Mary Mills, a lifelong Williamson County resident, has impacted the community through contributions to education, political leadership, church, historic preservation, economic development and healthcare. Mills spent 39 years in the education field, serving as a teacher and as a princiMary Mills pal. After retiring from the school system, she served as Williamson County Commissioner for 17 years. She is one of the founders of the African American Heritage Society, helping establish and preserve the first and only African American museum in Williamson County.

Dorothy and Joe Scarlett

Dorothy Scarlett inspired the creation of the Scarlett Family Foundation, which has opened educational opportunities for thousands of Tennesseans. The Foundation is dedicated to helping students realize their dreams through college scholarships, support of K-12 educational programs and innovation and reform initiatives. Joe Scarlett is the retired chairman and CEO of Tractor Supply Company and currently serves as the vice chairman of The Beacon Center and chairman of the Scarlett Hotel Group Drs. Pramod and Geeta Wasudev founded the Indian Community Seniors Support Services in 2014. The organization works with volunteers to help seniors with transportation, meals, doctor’s visits, social visits and end-of-life and funeral planning. Pramod is currently serving as president, and Geeta is an active member. Both are also active volunteers and leaders with the India Association of Nashville and Loaves and Fishes, helping to cook and serve meals to the homeless population at Holy Name Church. Through the American Red Cross, both provided medical expertise to victims of six natural disasters.

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Who is Getting Healthcare Right?

Healthgrades Releases 2019 Hospital Quality Report & National Health Index By CINDY SANDERS

For 20 years, Healthgrades has reviewed hospital quality and released an annual analysis of performance across a number of common conditions and procedures, assigning a rating of one to five stars for each. Last month, the online healthcare information resource released the 2019 Report to the Nation.

Why Ratings Matter

As the nation continues the move to value-based care, consumers have become more engaged in their health and healthcare. With higher deductibles and co-pays, more consumers have begun to think of healthcare in a similar fashion to other major purchases, looking online for information on cost and quality. When it comes to healthcare, however, the stakes are considerably higher than selecting a new car or refrigerator. In looking at the variation in clinical quality and outcomes across the nation, the 2019 Healthgrades analysis found patients treated at a hospital with a five-star rating, as compared to a hospital with a one-star rating, in a specific condition or procedure have a significantly lower risk of death and of experiencing complications during the inpatient stay. To create the latest report, Healthgrades analysts looked at Medicare Provider Analysis and Review (MedPAR) data from 2015 through 2017, which provides information on Medicare beneficiaries who access inpatient services. From the data dive, the report found: “From 2015 through 2017, if all hospitals as a group performed similarly to hospitals receiving 5-stars as a group, on average 222,210 lives could potentially have been saved and 157,210 complications could potentially have been avoided.” Healthgrades Chief Medical Officer

Brad Bowman, MD, noted, “Consumers have many choices for healthcare, but most important is understanding that there is a significant variation in care from hospital to hospital and doctor to doctor. In fact, hospitals within close proximity to each other can have significant differences in complication and mortality rates for the same condition or procedure. The analysis of hospital quality is intended to spotlight the importance of doing your homework before selecting your care. It could be a matter of life or death.”

National Health Index

At the same time Healthgrades released the 2019 Report to the Nation, the organization also released it’s second annual National Health Index. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the index looks at “who is getting healthcare right.” A former CMO of UnitedHealthcare and author of the book “Healthcare Choices,” Georgiou noted, “We Dr. Archelle Georgiou recognize that healthcare is broader than just the quality of the hospitals.” She continued, “Health and healthcare is comprised of many different factors. To understand whether a city is getting healthcare right is complex, which is why Healthgrades compiled numerous industry data sets to help paint a more complete picture of healthcare at the local level in cities across the country.” Healthgrades analysts turned to four key sources to evaluate health and healthcare in 130 metropolitan areas across the country. Data was pulled from the Behavioral Risk Factor Surveillance System (BRFSS) 2016 survey at the MSA level, provider specialty information and patient

experience survey scores from Healthgrades.com, 2017 population estimates from the U.S. Census Bureau, and the 2019 hospital quality rankings from Healthgrades. Georgiou said the team looked at 14 factors spread across four major categories. The big categories, she said, were: “Do people have access to care? Is the population healthy? Do they have high quality hospitals? And do they have high quality specialists?” She said in addition to having some form of insurance coverage, analysts also considered the percentage of population that didn’t feel restricted from seeking care due to cost, including high deductibles and co-pays. The group also looked at preventive and behavioral measures including the percentage of people ages 50-75 who had a colonoscopy in the past 10 years, percentage of women 40 and older who had a mammogram within the last two years, percentage who had visited a dentist in the past 12 months, had a normal BMI, reported physical activity within the past month, and the percentage of residents who reported having at least one person they identified as their personal healthcare provider. Hospital quality measures came from the latest Healthgrades rankings; and the team looked at the number of specialists per capita across multiple disciplines, as well as patient satisfaction with those specialists. “In order to have a healthy community, it’s all these different factors,” Georgiou said of the ingredients required to enable healthiness. Rochester, Minn., Burlington, Vt., and Charleston, S.C., led the way this year, she noted. San Francisco, which came in at 17th on the list, was identified as having the healthiest residents. Worchester, Mass., with an overall rank of 55, had the highest access to healthcare. Berlin, N.H., which ranked last

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at 130, struggles with population health and availability of high quality hospitals and specialists. Yet, Georgiou noted, the area does have a high percentage of the population insured and an above average rate of those who can access care affordably. She pointed out every metropolitan area has different strengths and challenges to address. Some cities might need to focus on community programming or public works to create more opportunities for physical activity. Others might have to look at creative ways to entice more specialists to the area. The index, she noted, provides a starting point for those discussions and a snapshot for patients making decisions about their care. “I think the index is a step forward in our whole mentality around being consumer-focused. It looks at the full continuum from access and insurance all the way through to your personal behaviors,” Georgiou concluded. “The National Health Index is designed to help consumers understand the health of their community, to empower them to navigate their care journey with confidence and to help them access the right care in their market.”

Snapshot of Nashville Of 130 metropolitan areas reviewed, Nashville came in at 59. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the city ranked higher than average in the number of specialists and way above average in the perceived quality of those specialists. She added the city ranked above average in the percentage of insured and with a normal BMI. “But here’s where there are opportunities – preventive care, having a relationship with a primary care provider, and being below average in the number of hospitals who perform well in those 32 conditions,” she continued. Georgiou was quick to note the Nashville area certainly has hospitals that rank highly in specific conditions or procedures. “Saint Thomas Midtown is in the top 10 percent of hospitals in the country for cardiology. Saint Thomas Hospital for Specialty Surgery and TriStar Southern Hills Medical Center are both in the top 10 (percent) for spine surgeries,” she said. In fact, most of the area’s major hospitals have five-star ratings in some procedures. “There’s good care going on here, but when you compare it to the population and how other cities’ hospitals are performing, they will have more hospitals performing above average in more conditions … so it’s like grading on a curve,” Georgiou noted. “This is a wonderful start to looking at where are your biggest opportunities and where to invest,” she continued of using the data as a jumping off point for improvement.

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A Call for Change Tennessee’s High Infant & Maternal Mortality Rates By MELANIE KILGORE-HILL

America’s Health Rankings recently released sobering statistics on rising infant and maternal death rates, and state officials are taking note. Since 2016, severe maternal morbidity, an indicator of poor maternal outcomes that is comparable across states, paints a concerning picture. The most recent severe maternal morbidity rate in Tennessee was 181.1 per 10,000 delivery hospitalizations in 2014, compared to a U.S. rate of 171.7 per 10,000 delivery hospitalizations. The national infant mortality rate (deaths under one year of age) was 5.9 in 2016, while Tennessee’s rate was 7.4 – an increase from 6.8 in 2013.

A Public Health Epidemic

“From the public health perspective, we’re looking at what we can do to address the top causes of both issues,” said Tennessee Department of Health Assistant Commissioner Morgan McDonald, MD, who serves as the agency’s director of Family Health and Wellness. “The health Dr. Morgan McDonald of a woman before pregnancy is key to health during preg-

nancy, and we’re trying to optimize the time before, during and after that period for both mother and baby.” Recent findings also prompted investigation by the Tennessee Justice Center (TJC), a Nashville-based non-profit advocating for the healthcare of Tennesseans though policy and social changes. The agency released their Infant and Maternal Mortality Policy Brief in late September, addressing key areas of concern and suggestions for change. “We wanted to learn about underlying causes and see if we could bring issues to people’s attention,” said TJC Director of Children’s Health Kinika Young. “This information is alarming, and most people don’t realize rates are so high compared to other similarly developed countries. The U.S. just Kinika Young isn’t faring well.” According to the brief, a pregnant woman in the U.S. is three times as likely to die in the maternal period as a pregnant woman in Canada, while most European countries average maternal morbidity rates of six or less. “We’re well off in the U.S. when it comes to resources, but our priorities just aren’t there,” Young said. “We’re not sup-

porting public health issues among the most vulnerable parts of our society.”

Smoking & Pregnancy

According to the brief, the heightened rates of mothers who smoke, have poor health and struggle with substance abuse help explain the high rates of premature and low birth weight babies statewide. “While the national average percentage of women who smoke while pregnant is approximately 8 percent, Tennessee’s average was a hefty 12.9 percent in 2016, with several counties’ rates reaching higher than 27.1 percent. This is a huge issue, as approximately 32 percent of Tennessee infant deaths in 2016 were linked to mothers who smoked while pregnant,” the TJC brief outlined.

Opioids

Tennessee’s opioid crisis – especially problematic in East Tennessee – is another driver of the state’s higher-than-average neonatal abstinence syndrome rates. In fact, some counties report stats eight times higher than the national average. According to the brief, a mother who suddenly quits taking opioids places her baby at a high risk of severe consequences that include death. That’s why Young is passionate about educating providers about addiction recovery and birth control options for high-risk patients.

“If a doctor sees a woman of childbearing age who might be struggling with opioid abuse, they can provide information about safe ways to recover from addiction,” Young said. “Doctors can make sure they’re not going it alone and that they’re not afraid to have that open conversation about what’s going on.” In 2018, Gov. Bill Haslam unveiled the TN Together plan, which includes various modes of support for opioid abusers, including prevention education. The plan also aims to improve and expand drug treatment services and has tightened the reins on prescription drug monitoring. “We’re very focused on supporting mothers and families affected by the opioid crisis, as we recognize that prevention has to focus even more upstream,” McDonald said. “Once someone’s been identified as being affected by substance abuse, we need to get them into treatment quickly.” The state also is partnering with agencies to reduce and mitigate adverse childhood experiences, especially since early experiences carry a lasting impact on health behaviors and health outcomes.

Asking More Questions

The TJC brief also cites obesity and weight-related health problems as a cause for premature births and maternal death rates, noting Tennessee’s high rate of (CONTINUED ON PAGE 14)

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Health Care Hall of Fame Inducts Seven By CINDY SANDERS

died in 2008, saw his vision pital grew to 75 beds by 1923 come to life when the pediatwith a laboratory, maternity The Tennessee Health Care Hall of ric hospital was built in 2004. ward, operating room and Fame recently welcomed seven new indusSince opening its doors, the sterilizing rooms. Serving try legends to its ranks during a luncheon Monroe Carell, Jr. Children’s more than 4,000 patients from event held at Belmont University’s Curb Hospital at Vanderbilt has across the Southeast, the hosEvent Center on Oct. 16. The Class of 2018 undergone two expansions, pital became recognized for its is the fourth to be inducted since the Hall of including one currently underunique design and approach Fame’s founding in 2015. way, and is nationally ranked to care, which included a comThe most recent class included four across 10 pediatric specialmunity center with health posthumous honorees alongside three proties. Carell served in the U.S. classes, a prenatal and infant viders who have changed healthcare in the Navy before returning home clinic, foster care services, and United States and across international borto earn his degree in electria food pantry. The hospital ders. cal engineering at Vanderbilt also became a training center Monroe Carell, Jr.: A Nashville University in 1959. He was for nurses and went on to earn native, the former CEO of Nashville-based married to the late Ann Scott recognition by the American (L-R) 2018 Hall of Fame inductees, Dr. Lynn Massingale, Carol Etherington and Central Parking Corporation was the drivCarell, who shared his vision College of Surgeons. Millie Dr. William Schaffner ing force behind establishing a freestanding and passion for philanthropy, Hale served as the hospital’s children’s hospital in Nashville. The noted for more than 50 years. head administer and chief community leader and philanthropist, who Carol Etherington, MSN, RN, nurse, as well as being named secretary like Bosnia, Honduras, Kosovo and Sierra FAAN: An advocate for and treasurer of the board. Throughout his Leone and became the only nurse to serve the vulnerable, Etherington long, successful career, John Hale served as president of the organization’s U.S. has worked with traumaas the hospital’s chief of surgery and board board. A public health champion, Ethertized populations around president. He was also a highly respected ington established coalitions that led to the the globe and here at home professor of Clinical Medicine and Surgery founding of the Nashville Prevention Partthroughout her career. She and chief of staff for Meharry Medical Colnership and currently serves as chair of the initiated one of the country’s lege. After the hospital closed, John Hale Metro Nashville Board of Health. She is an first victim intervention probecame chair of the Department of Surassociate professor emerita at the Vandergrams in conjunction with gery at Meharry. In addition to providing bilt University School of Nursing and serves the Nashville Metropolitan acute care for African Americans in need, as associate director of Community Health Police Department and has this pioneering couple is recognized for Initiatives for the Vanderbilt Institute for been on the ground caring their holistic approach to creating healthier Global Health. for victims during numercommunities and addressing social determiJohn Henry Hale, MD, & Millie ous national crises includnants. Hale: A physician and nurse, the Hales ing post-9/11, hurricanes, Lynn Massingale, MD: An emersaw a need for healthcare services within floods and earthquakes. gency medicine physician, Massingale Nashville’s African American community She has also delivered care earned his medical degree from the Univerand set out to fill it. In 1916, Millie Hale across the world through sity of Tennessee Center for Health Sciences turned the second floor of their home into her work with Doctors followed by an internship at UT Medical a hospital for those turned away by other Dr. Matthew Walker III (R) accepts the Hall of Fame honor on behalf Without Borders in places Center in Knoxville. A year into his pracinstitutions. Starting with 12 beds, the hosof his late grandfather, a pioneering surgeon and public health advocate. tice in East Tennessee, he saw the struggle area hospitals had in staffing their emergency departments and thought there had to be a better solution. An innovator, the young physician co-founded and launched the predecessor company of TeamHealth, which has grown to one of the largest integrated care providers in the country staffing and managing hospital-based, ambulatory and post-acute care practices nationwide. Under his leadership, the company also took on a role of assisting the larger community by deploying critical response teams during times of disaster. Massingale served as chairman and CEO of TeamHealth until 2008, when he stepped away from his CEO From outfitting large orthopaedic institutes and hospitals to working with independent clinics duties to dedicate more time and energy to and athletic trainers across the U.S., Total Therapy represents a broad range of orthopaedic, thought leadership, care delivery innovation and humanitarian efforts. Massingale rehabilitation, strength and conditioning manufacturers to suit your specific needs. has been recognized as one of Modern Healthcare’s “100 Most Influential People in Healthcare” and one of the American Services Provided Include: College of Emergency Physician’s “Heroes Facility Space Planning & Clinic Setup Consultation • DME & Supplies of Emergency Medicine.” Inservice Training • Equipment Repair • Local Contact for Assistance William Schaffner, MD: A renowned epidemiologist and preventive medicine ambassador, Schaffner earned his medical degree from Cornell University before moving to Nashville for residency at For a quote or more information, Vanderbilt. He was asked to join the facJames Sanders: 615.397.2837 ulty in 1969 after he completed his training totaltherapynash@icloud.com • totaltherapynash.com and has become an international authority on public health, infectious disease, and

Total Therapy Takes Care of YOU so You Can Take Care of PATIENTS

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2018 Tax Reform

Implications & Implementation for Healthcare The Tax Cuts and Jobs Act (TCJA) passed last December includes a broad range of tax changes impacting both individuals and business entities. In this article, we will address some of the changes that directly impact healthcare companies and physician practices. One of the most complex and confusing changes By LUCY CARTER, in the new tax law CPA is the individual deduction related to pass-through income (Section 199A deduction). We will address the implication of this change and its impact on healthcare companies in a subsequent article in the Janu- & MARK ary 2019 issue of PATTERSON, CPA Nashville Medical News.

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ACA

A key component of the Accountable Care Act (ACA) was the individual mandate to acquire and/or provide health insurance coverage. TCJA effectively eliminates the mandate through elimination of the individual responsibility payment effective Jan. 1, 2019. The goal of the mandate was to provide an offset to the unfavorable economics of expanded higher cost healthcare by requiring and bringing in a younger, healthier population to health plans. The downside of this change is an anticipated 13 million fewer Americans being insured by 2027 (CBO projections). The projected reduction is due to anticipated higher premiums (10 percent above what was projected prior to the new tax law) and the non-acquisition of health insurance by the young and healthy. On the plus side, the CBO projects $340 billion dollars in savings over 10 years through the repeal of subsidies. The bottom line for practices is that self-pay and patient-responsible balances are likely to increase. Maintaining cash flow will require establishing consistent processes and monitoring collection of these balances.

Corporate Tax Rate & Alternative Minimum Tax (AMT)

The corporate tax rate for C-Corpo-

rations is reduced to 21 percent for years beginning after Dec. 31, 2017 (previously a flat rate of 35 percent for personal service corporations). The rate reduction has caused some entities to question whether they should convert their pass-through entities to a C-Corporation to take advantage of the low rate. Keep in mind that to take advantage of the lower corporate rate, the corporation must retain taxable income, which may not meet the goals of a practice or healthcare entity. For C-Corporations, the 21 percent rate will be beneficial to cushion the tax implications of debt repayment and nondeductible expenses.

Depreciation

The TCJA contains several new provisions that benefit the deduction of capital assets. 100 percent expensing (bonus) for certain business assets, which was effective Sept. 27, 2017. Used property qualifies under TCJA (under the old rules, only new property qualified for bonus depreciation). This change phases out between 2023 and 2026 with a 20 percent decrease annually. The downside for Tennessee taxpayers is that bonus depreciation is not recognized at the state level. Section 179 expensing of capital assets

has been increased from $510,000 to $1 million. Likewise, the threshold for phase out has been increased from $2 million to $2.5 million. Depreciation for luxury autos (i.e. passenger auto) has been increased for automobiles placed in service after Dec. 31, 2017. For example, first-year depreciation under prior law was capped at $3,160. The deduction under TCJA is capped at $10,000 ($18,000 if bonus depreciation is claimed). Qualified improvement property (QIP) is defined as an interior improvement to an existing non-residential building (exceptions are elevators, enlargement, and structural changes). QIP will qualify for Section 179 expense, and should qualify for 15-year depreciation and bonus depreciation (technical correction pending).

Business Interest Limitation

Under prior law, interest expense has generally been allowed as a deduction in the year in which it was paid or accrued. TCJA limits the deduction for interest expense on business returns to interest income plus 30 percent of: Net taxable income + Depreciation and amortization + Interest expense If your annual gross receipts are below $25 million, you will be exempt from this (CONTINUED ON PAGE 14)

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Wang Performs Novel Astigmatism SMILE Procedure In late October, Ming Wang, MD, PhD, announced he had performed the state’s first astigmatism treatment using the SMILE procedure at Wang Vision 3D Cataract & LASIK Center in Nashville. According to Wang, SMILE, which stands for Small Incision Lenticular ExtracDr. Ming Wang tion, is one of the most significant advances in laser vision cor-

rection in the last 25 years. Compared with LASIK, he said SMILE offers three distinct advantages: 1) smaller incision; 2) less dry eyes; and 3) less postoperative complications. The U.S. Food and Drug Administration approved the first laser correction using SMILE in late 2016 and expanded approval to include patients with astigmatism in October 2018. “This is an exciting development, since it means that now a much larger group of our patients will be able to benefit from SMILE and to be freed of dependence on glasses and con-

Health Care Hall of Fame, continued from page 12 the efficacy of vaccinations. He was named chair of Preventive Medicine in 1982 and remains a professor in the Department of Health Policy and in the Division of Infectious Disease. Schaffner is a frequent subject matter expert for publications and broadcast programming around the world, and he has elevated Tennessee’s reputation as a national leader in infectious disease and public health. A pioneer of comprehensive infection control programs in hospitals, his work on patient safety also expanded to the larger community. Schaffner’s research was a catalyst for the passage of childhood car restraint laws throughout the U.S. He cochairs the Scientific Advisory Board of the Agence de Médecine Préventive and has received countless accolades for his groundbreaking work throughout the world. Matthew Walker, Sr., MD: The prominent surgeon, educator, public health champion and activist was among the most highly respected physicians of his time. He became one of the first African Americans to become a Fellow of the American College of Surgeons and be voted into the Nashville Academy of Medicine. In the

early 1960s, he was named to the Board of Hospital Commissioners of Nashville General Hospital. A few years later, in 1968, he founded Meharry Neighborhood Health Center, which was later renamed Matthew Walker Comprehensive Health Center in his honor. Walker also launched Meharry Medical College’s surgical residency program and was credited with training half of all the African American physicians in the United States at the time of his death. Popular among his peers, students, and the patients he served, his passion for delivering the highest quality of care is still celebrated and honored with the Annual Matthew Walker Surgical Symposium, which is currently in its 39th year. The Tennessee Health Care Hall of Fame was founded by Belmont University, the McWhorter Society and the Nashville Health Care Council to recognize industry leaders with ties to Tennessee who have impacted care on a state, national, and often international basis. Nominations for the Class of 2019 are now open at tnhealthcarehall.com/nominate.

Tribute to Hall of Famer Colleen Conway-Welch The 2018 Tennessee Health Care Hall of Fame event began with a tribute to Colleen Conway-Welch, PhD, CNM, FAAN, FACNM, who died Oct. 12 after battling cancer for several years. Emcee John M. Seigenthaler, partner at DVL Seigenthaler, noted the Class of 2016 Hall of Famer, who spent 29 years as dean of Vanderbilt University School of Nursing, had forever changed the national healthcare landscape through her educational leadership. Conway-Welch was recruited to Nashville to become VUSN’s dean in 1984. At the time, the school educated about 100 baccalaureate students and a small number of master’s students. Under her leadership, the curriculum was completely overhauled and additional advanced degrees – including an accelerated master’s degree and doctoral programs – were added. Today, VUSN is one of the largest schools of nursing in the country and is routinely ranked as a top nursing school nationally. Conway-Welch, who also held national presidential appointments on health policy and education, retired from her VUSN post in 2013 and was named Dean Emerita by the university. A Fellow of the American Academy of Nursing and a Fellow of the American College of Nurse Midwifes, Conway-Welch was elected to the Institute of Medicine of the National Academy of Science in 1997 and was named a Living Legend by the American Academy of Nursing in 2016. The following year, she was elected to the Modern Healthcare Hall of Fame, and this past spring ConwayWelch was honored with the Health Education Visionary Award from the Society for Women’s Health Research.

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tacts” said Wang. Ross Ronan, a 47-year-old healthcare executive was the first patient to undergo the procedure for astigmatism. Ronan suffered from poor vision most of his life and had both a high degree of nearsightedness and astigmatism, which distorted his vision and classified him as legally blind without any correction. Wang, who graduated magna cum laude from Harvard Medical School and holds his doctorate in laser physics from MIT, has performed over 55,000 procedures including on over 4,000 physicians.

He holds a number of U.S. patents and performed the world’s first laser artificial cornea implantation. Following the laser procedure on Oct. 23, Wang noted the day was especially happy for him as he celebrated both his birthday and Ronan’s successful surgery, which should offer freedom from dependence on glasses and contacts. “He is the state’s first patient to receive this new astigmatism treatment using the small-incision laser vision technology – SMILE,” Wang said with a big smile of his own.

2018 Tax Reform, continued from page 13 limitation and any disallowed interest can be carried forward indefinitely.

Entertainment Expense for:

Under TCJA, no deduction is allowed

• Entertainment, amusement or recreation expenses; • Membership dues for a club organized for pleasure, recreation, or other social purposes (i.e. country clubs, golf and athletic clubs, airline clubs, hotel clubs, dining clubs); and • Facilities used in connection with any of the above. Exceptions to the above include: • Recreational expenses for employees; • Employee, stockholder, and business meetings; • Meetings of business leagues, chambers of commerce, boards of trade, etc.; • Professional organizations (TMA, NAM, NMGMA); and • Civic clubs of public service organizations (Rotary, Kiwanis, etc.).

Business Meals Expense

Under TCJA, the 50 percent limit for the deduction of food and beverage is generally retained. However, meals provided on premises for the convenience of the employer (i.e. meals provided to physicians to facilitate office coverage of patients) are

no longer 100 percent deductible. The 50 percent limit will apply until 2025. After that, on-site meals will be non-deductible. Two examples of meals that are 100 percent deductible are: • Meal expense treated as compensation, and • Expenses for recreation, social, or similar activities primarily for the benefit of employees (i.e. holiday parties).

Limitation on Deducting Business Losses

TCJA limits the amount that can be deducted by a member in an LLC or a shareholder in an S-corporation to $500,000 for married filing jointly and $250,000 for all other taxpayers. The deduction threshold limits the losses that can be used by the taxpayer to offset wages or other sources of income. Any amount above the threshold can be carried forward to future years, subject to the TCJA’s 80 percent limitation on net operating loss carried forward.

Part II: Pass-Through Income coming in January Lucy Carter, CPA, is a member and practice leader of the KraftCPAs healthcare industry team; Mark Patterson, CPA, is a member with the KraftCPAs tax services team. For more information, go online to kraftcpas.com.

A Call for Change, continued from page 11 women struggling with blood pressure and diabetes – both associated with premature birth and low birth weight. Women who struggle with obesity prior to pregnancy also have poorer health outcomes. “If doctors asks the question, ‘Do you plan on becoming pregnant in the next year?’ they can help steer patients toward smoking cessation classes, weight loss programs or birth control options,” Young said, “It doesn’t take long to ask that question, but we’ve got to reorient providers to their role in this and how it can improve outcomes.”

Improving Access to Care

Addressing Tennessee’s premature births, McDonald said leaders also are working on partnership building with rural hospitals and regional centers to ensure infants are born at facilities equipped for high-risk births. Meanwhile, the TJC is working to help drive down rates of uncom-

pensated care at community hospitals and to make more prenatal and preventative services available to more patients. Additional public health efforts outlined in the brief include Tennessee’s Fetal and Infant Mortality Review, and local health departments have been staffed with Certified Application Counselors to provide education and resources to pregnant women. Other efforts include the Tennessee Tobacco QuitLine, the Department of Health’s “ABCs of Safe Sleep” campaign, nutrition support from WIC, family support during and after pregnancy via home visiting services and expanded access to care. “We recognize the importance of both clinical and non-clinical interventions to improve the health of mothers and children,” McDonald said. “We must think about all policies that impact health across the life course, from neighborhoods to schools to places of employment to where we receive healthcare.” nashvillemedicalnews

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THA Hosts 80 Annual Meeting th

By CINDY SANDERS

In mid-October, the Tennessee Hospital Association held its 80th annual meeting at the Franklin Marriott Cool Springs. With a theme of “Hospitals Make it Happen,” the 2018 event focused on educational and networking opportunities for hospital and health system professionals. The three-day event kicked off with the Tennessee Center for Patient Safety’s Leadership Summit, which focused on best practices and quality improvement efforts from hospital leaders across the state. Topics ranged from antibiotic selection to decrease acute kidney injury to reducing hospitalacquired pressure injuries. In celebrating the organization’s 80th anniversary, THA President and CEO Craig Becker, FACHE, noted, “In my nearly 25 years with THA, we have faced many challengers and enjoyed many successes. What continues to amaze me is how hard our industry works – in spite of adversity – to provide reliable and effective Craig Becker care to millions of people in our state.” He added that when the organization was founded 80 years ago, it was with a pledge to lead in advocacy and to support community-based hospitals and health systems. Becker nodded to great work happening across the state from Mountain City to Memphis. However, a number of Tennessee communities have faced challenges in maintaining access to services, particularly in rural communities … although hospitals in larger markets are not immune, either. McKenzie Regional Hospital in Carroll County shut their doors earlier this fall. In late October, Tennova Healthcare, which is part of the CHS system, announced plans to close Physicians Regional Medical Center in Knoxville and Lakeway Regional Hospital in Morristown by the end of the year. Becker has been a vocal supporter of Medicaid expansion, which Tennessee has not opted to do, in order to stabilize access to high quality inpatient care. In the face of these challenges and an ever-changing healthcare landscape, the THA annual meeting created an agenda designed to spark innovation and inspire action to tackle a number of key issues. The broad array of speakers and panel discussions included topics ranging from the role of telemedicine in care delivery and integrating behavioral health to provide holistic care to addressing workplace violence and sharing insights from the patient’s perspective. The event also included the election of the 2019 board. Vanderbilt Health System CEO Wright Pinson, MD, MBA, FACS, will serve as chairman of the board. James Ross, AEMT, BSN, MSHA, nashvillemedicalnews

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president and CEO of West Tennessee Healthcare in Jackson, will serve as chairelect. Pinson follows Marvin Eichorn, executive vice president and chief operating officer of Ballad Health in Johnson City, who served as THA chairman last year. Under Pinson’s leadership, Vanderbilt Dr. Wright Pinson University Medical Center’s clinical activities have grown more than 50 percent. Beginning in 2011, he helped develop and organize the Vanderbilt Health Affiliated Network and is responsible for the oversight of a number of joint ventures. Pinson, who initiated the first liver transplantation program in the Pacific Northwest and for the Veterans Administration system prior to coming to Vanderbilt in 1990, is active in research and education, as well. His work as a clinical and laboratory investigator has resulted in 350 publications and numerous grants and awards. A professor in the Owen Graduate School of Business, Pinson is co-founder of the Master of Management in Healthcare program. He is board-certified in both surgery and critical care. Other 2019 board members from Middle Tennessee include: Tim Adams, CEO of Saint Thomas Health; Rogers Anderson, board member at Williamson Medical Center; Charlotte Burns, senior vice president with HCA/TriStar Health; Randy Davis, president and CEO of NorthCrest Medical Center; Christopher Edwards, MD, system CMO for Maury Regional Healthcare System, Christopher Holmes, president and CEO of FirstBank; Paul Korth, CEO of Cookeville Regional Medical Center; Scott Peterson, CEO of HealthSouth Rehabilitation Hospital of Franklin; Heather Rohan, president and CEO of HCA/TriStar Health; Cherie Sibley, COO of the Central Group for LifePoint Health; Alan Watson, CEO of Maury Regional Healthcare System; Don Webb, CEO of Williamson Medical Center; and Jeffrey Woods, division president of Acadia Healthcare. In addition, 26 hospital administrators, employees and volunteers were honored as the organization presented the THA Awards of Excellence in 14 categories. Alan Watson, CEO of Maury Regional Healthcare System in Columbia was presented with the Distinguished Service Award, THA’s highest honor. Watson was recognized for his more than 35 years of healthcare Alan Watson experience and leadership in enhancing care coordination across Middle Tennessee. The full list of Middle Tennessee honorees is available online at NashvilleMedicalNews.com.

GRAND ROUNDS Mark Your Calendar

NAM Holiday Open House • Dec. 6 • 5-7 pm The Nashville Academy of Medicine and Medical Foundation of Nashville invites members and other interested physicians, along with community partners, to their offices at 3301 West End Ave. for a holiday open house and to learn more about the organization. For details and to RSVP, go online to nashvillemedicine.org/membership/ events.

Lipscomb Launches MHA Program

Last month, Lipscomb University officials announced the launch of Nashville’s first Master of Health Administration  program. The new MHA program is specifically designed to help mid-careerist build their skill set for healthcare leadership roles through an integrated, interactive, immersive curriculum. The administration of Lipscomb University’s  College of Business  developed the new graduate program after collaborating with an executive advisory board for nearly two years to develop the institution’s Master of Management in Health Care program and now the Master of Health Administration degree. The advisory board is comprised of  17 industry executives including senior leaders of  hospitals and health systems, health technology companies, outpatient clinics, home health agencies, healthcare support services, and allied industry professionals that intersect with healthcare including information technology, human resources and finance.   “Healthcare education is a major focus  at Lipscomb University, and it is important to not only train the healthcare practitioners at the highest level but also those who are leading these organizations, so they are meeting the needs of their patients, clients and customers effectively,” said  Ray Eldridge, dean of Lipscomb’s College of Business. “This program takes an innovative look at not only how healthcare works today, but where it is going in the future.”  “There is a need for young professionals to be prepared at the highest level to lead the healthcare organizations of tomorrow especially in a healthcare hub such as Nashville,” said Mitch Edgeworth, CEO of adult hospitals and clinics at Vanderbilt University Medical Center. “Lipscomb has made a tremendous impact in healthcare education for generations, preparing its graduates for medical school, careers in healthcare and many other fields. The new Master of Health Administration degree blends that solid program with Lipscomb’s College of Business for an integrated program that will equip its graduates with the skills to solve problems creatively, lead organizations and teams effectively and drive disruptive change in health care.” Bart Liddle,  assistant dean in Lipscomb’s College of Business,  said students will visit with industry leaders across the continuum of care in their

environments expanding the traditional borders of the classroom. “Classes could be held at hospitals, in a corporate office or at the state capitol among other locations depending on the topic of study. Examining how the various aspects of healthcare work together is also a key component of the program,” he said.  In addition to targeting  midcareerists, the new MHA degree is also designed for  clinicians who want to learn the business of healthcare and progress in leadership roles within their organizations, as well as individuals from non-health care industries who want to transition their experience and skills to a career in healthcare. Courses are offered in a hybrid of in-person and online format and may be completed in six semesters. Classes will begin in Fall 2019.  

Lewis Joins Tivity Health

Veteran healthcare exec Tommy Lewis has joined Tivity Health as senior vice president overseeing investor relations. Lewis, who is past president and current board member of TN HIMMS, spent 15 years with Change Healthcare and its predecessor EmdeTommy Lewis on, most recently serving as a senior vice president of strategic enterprise initiatives. Lewis earned an undergraduate degree in computer information systems from Murray State and an MBA from Middle Tennessee State University.

Centerstone Appoints Rhodes Foundation President

Officials with community-based mental health and addiction services provider Centerstone recently announced that Ramona Rhodes has been named president of Centerstone’s Foundation. Rhodes has extensive strategy and operations experience, Ramona Rhodes and previously served as executive vice president and chief operating officer of the foundation. In her new role, Rhodes will be responsible for overseeing and advancing Centerstone’s mission through philanthropy and will work in direct collaboration with Centerstone’s Foundation Board of Directors in the areas of endowment investment and management, stewardship of donor intent, growth of philanthropic support to Centerstone, and day-to-day operational management of the team located across five states.   Rhodes has 29 years of experience in behavioral healthcare fundraising and marketing. During her tenure at Centerstone, the organization has grown from a small, Nashville-based agency to a multi-state, multi-tiered national organization serving over 180,000 individuals annually. She earned her bachelor’s degree from Lipscomb University. NOVEMBER 2018

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GRAND ROUNDS VUSN Receives $1.43 Million to Develop Sexual Assault Nurse Examiner Education

Last month, officials with Vanderbilt University School of Nursing announced the school has received a $1.43 million award from the U.S. Health Resources and Services Administration (HRSA) to develop and implement a Sexual Assault Nurse Examiner (SANE) education program for emergency nurse practitioner (ENP) students. Vanderbilt’s program is projected to increase the number of SANE-trained and certified advanced practice registered nurses practicing in emergency departments in rural or underserved communities in the U.S.

Mavis Schorn, PhD, CNM, FACNM, is the grant’s principal investigator. “Currently, there are just over 800 sites in the country that provide SANE services,” Schorn said. “Sexual assault nurse examiners have specialized education to conduct forensic examinations that have been shown to provide better physical and mental health care for assault survivors, deliver better evidence collection and support higher prosecution rates.” Vanderbilt will offer SANE education to incoming students in its ENP Post-Master’s Certificate program. These students are current family nurse practitioners who are seeking addition-

al education to become ENPs. They will complete SANE training concurrently with their ENP education and will be able to select adult/adolescent and/ or pediatric/adolescent SANE training. The school may also offer the SANE education program to its other masterlevel students if openings are available. “Positioned within emergency departments, ENPs are often the first to discover an individual has been sexually assaulted,” Schorn said. Because ENPs have education and experience in providing care for males and females of all ages, they are perfectly positioned to provide sexual assault care, she noted. An additional aspect of VUSN’s

program is its intended impact on rural or underserved areas. “Research has shown that the incidence of sexual assault in rural communities exceeds urban areas. Although data on numbers of SANE are limited, some states report few or, in some cases, no examiners in rural areas,” Schorn said. “Without access to local SANE services, survivors must travel to get this essential care from providers with specialized training.” The new initiative is supported by Vanderbilt University Medical Center; Our Kids, which currently provides pediatric/adolescent SANEs in 47 Middle Tennessee counties; Nashville’s Sexual Assault Center; and EmCare, a national organization that is one of the largest staffing organizations for emergency departments.

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

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Dolan Taking Helm of Launch Tennessee

PHOTO BY JOE HOWELL/VANDERBILT

Linda Brady, MD, a pediatrician with Old Harding Pediatrics and Monroe Carell Jr. Children’s Hospital at Vanderbilt, was selected as recipient of the national 2018 Excellence in Diagnosis (V-RED) Award from the Vasculitis Foundation. Brady was chosen for her diagnosis of a rare disease that was masquerading as a cold. When her patient didn’t respond to standard treatment, Brady tenaciously pursued additional tests that led her to the rare diagnosis of granulomatosis with polyangiitis (GPA, formerly Wegener’s Disease). Responding well to a new line of treatmen, her patient is now in remission. Last month, the American College of Emergency Physicians’ Emergency Quality Network (E-QUAL) named hospitals making the honor roll for exceptional performance in several key metrics. Sumner Regional Medical Center was recognized as one of 23 hospital awardees nationwide for the E-QUAL Honor Roll: Sepsis. Nashville law firms were well represented on the American Bar AssoAdult gerontology acute care nursing students train in a simulation lab. ciation Health Law Section’s 2018 VUSN has been recognized for efforts to educate more male nurses. “Regional Top 10 Recognitions.” In the South region, Waller, Baker Donelson, Bradley Arant Boult Cummings and Butler Snow took the first four slots on the list. Stites & Harbison, Polsinelli and Burr & Forman, which all have offices here with strong healthcare practices, also made the top 10. The American Association of Men in Nursing has named Vanderbilt University School of Nursing an AAMN Best School of Nursing. The honor recognizes a nursing school for significant efforts in recruiting and retaining men in the nursing profession. “Healthcare needs more nurses and it needs more diversity. Male nurses bring an understanding of male healthcare needs and perspectives that are needed,” said VUSN Dean Linda D. Norman, DSN, FAAN. She added professor Tom Christenbery, PhD, MSN, and instructor Chance Allen, MSN, spent months researching, collecting data and documenting school activities that led to the recognition. Alive, the only non-profit provider of hospice care and end-of-life services for Middle Tennessee, recently announced that one of its medical directors, Robert Berkompas, MD, has been appointed an adjunct assistant [professor at Meharry Medical College. He will be teaching a Capstone project class on end-of-life care to fourth year students. Franklin-based M*Modal, a leading provider of clinical documentation and Speech Understanding™ solutions, was recently named the leading vendor in a healthcare industry report by technology and services market research company, Black Book™ Research. M*Modal ranked #1 in overall document capture and transcription technology solutions and services for the fifth consecutive year in both inpatient and outpatient care settings. Ascension Saint Thomas Midtown  recently received the American Heart Association/American Stroke Association’s Get With The Guidelines – Stroke Silver Plus Quality Achievement Award. The hospital also received the association’s Target: StrokeSM Honor Roll/Target: StrokeSM Elite award. To qualify, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, for ischemic stroke. Local healthcare interior designer Rebecca Donner, owner and founder of Nashville-based Inner Design Studio, was recently recognized as an industry leader and presented the second annual International Interior Design Association (IIDA) Tennessee Chapter Legend Award. The Legend Award recognizes standout professionals in the local interior design community. Melissa Hogan was recognized last month in California at the 2018 Global Genes RARE Champion of Hope Celebration as this year’s advocacy honoree.: Advocacy Honoree. The Nashville native is president of Project Alive, a research and advocacy foundation focused on Hunter Syndrome, and was nominated by others in the rare disease community for her advocacy work that helps so many rare disease families, including her own. The Greater Nashville American Heart Association held its annual Heart Walk on Sept. 15 on Vanderbilt University’s campus, drawing a record-breaking crowd of over 10,000 Middle Tennesseans who joined together to raise close to $2 million to fight heart disease and stroke.

Margaret Dolan, CPA, MBA, has been tapped to succeed Charlie Brock as president and CEO of Launch Tennessee. Most recently, she was a principal at consulting firm neil Strategies llc. She also served as president and CEO of LocalShares, which became a subsid- Margaret Dolan iary of Worth Group. After beginning her career as a tax specialist with KPMG, Dolan went on to hold executive positions with Ingram Industries and Saint Thomas Health Foundation. In her new role, Dolan will oversee the public/private entrepreneurship partnership, which includes the IMPACT Fund and the Small Business Innovation Research/State Technical Transfer Research Matching Fund. Launch Tennessee also puts on the annual 36|86 Entrepreneurship Festival.

Robbins Joins Saint Thomas Heart

Interventional cardiologist Mark Robbins, MD, recently joined the Saint Thomas Heart team and Ascension Saint Thomas West Hospital. His clinical expertise includes coronary heart disease, peripheral vascular disease, and structural heart. Robbins has a Dr. Mark Robbins special interest in preventing heart disease and health lifestyle modifications. Board certified in internal medicine and cardiology, Robbins will serve patients at Saint Thomas West and at his existing practice in Winchester, Tenn. Previously, Robbins served as director of Interventional Cardiology at Vanderbilt Heart and Vascular Institute and as director of Cardiac Catherization and Laboratory and assistant professor of Medicine at Vanderbilt University Medical Center. Robbins earned his medical degree from the University of Mississippi and was chief resident at University of Mississippi Medical Center and completed two fellowships at the Cleveland Clinic. nashvillemedicalnews

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GRAND ROUNDS VUSN Names Johnson Assistant Dean, Diversity & Inclusion

Wellview Names New CEO, Secures Funding

Wellview co-founder James Story has moved from president to CEO of the Nashville-based employee wellness company. He succeeds Dan Drechsel, who will lead the board as executive chairman. Story has nearly a decade of experience in the employee benefits industry. He co-founded the company in 2013 with Chief Medical Officer Cole Barfield, MD. In other news, the company also secured $1.5 million in growth capital earlier this fall. The funding round was led by BIP Capital of Atlanta.

WISH Welcomes Two

The Women’s Institute for Sexual Health (WISH), a division of Urology Associates, PC, recently welcomed two new providers. Brandy Hood, MD, completed her undergraduate degree at Mississippi State University before medical school at the University of Mississippi School of Medicine in Jackson. After graduation, she became a research resident at the Wake Forest Institute of Regenerative Medicine and began her general surgery internship at Wake Forest shortly afterwards. Laurie Tompkins, MSN, ARNPBC, completed an associate’s degree in nursing from Belmont University and her bachelor’s and master’s from Vanderbilt University School of Nursing. She is certified as a menopause practitioner and has served as a clinical instructor for Women’s Health Obstetrics Inpatient

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Ambulatory Exec Nantais Joins VUMC PHOTO: KEITH WOOD/VUSN

Rolanda Johnson, PhD, MSN, assistant dean for academics and associate professor of nursing, has been named assistant dean for diversity and inclusion for Vanderbilt University School of Nursing. She replaces Assistant Professor Jana Lauderdale, who Dr. Rolanda Johnson returned to her faculty role. In her new role, Johnson oversees VUSN’s efforts to support and foster an environment that is culturally appreciative and inclusive, particularly for historically underrepresented and marginalized groups and individuals. She also continues as assistant dean for academics, charged with assisting students with special curriculum needs or who experience academic difficulty. Johnson joined VUSN in 1998, the same year she received her PhD in Nursing Science from Vanderbilt. She has held multiple leadership roles for VUSN initiatives and was the first African American to hold a vice-chair position in Vanderbilt’s Faculty Senate. Johnson is the founding president of the Nashville Chapter of the National Black Nurses Association. Earlier in 2018, she was honored as a Vanderbilt Pioneer for her role with the Faculty Senate and at VUSN.

and Outpatient Care at Vanderbilt and the University of Missouri.

Vanderbilt University Medical Center recently added a Thomas Nantais to the health system as the executive vice president with oversight of adult ambulatory operations. VUMC has adult ambulatory clinics in 22 counties, plus sites in Southern Kentucky and Northern Alabama, logging nearly 2.2 million patient visits annually. Previously, Nantais served as a long-time senior executive with Henry Ford Health System in Detroit, serving as chief operating officer of the Henry Ford Medical Group for the past 14 years.

Spero Health Launched to Address Growing Opioid Epidemic

Last month, Spero Health, Inc., a newly formed healthcare organization specializing in local, affordable, outpatient care for individuals suffering from substance use disorder, announced that it has acquired investment growth capital to meet the demand in communities across the country for high-quality, comprehensive and integrated addiction treatment services. Heritage Group, Health Velocity Capital, South Central, Inc. and Frist Cressey Ventures partnered with the management team to launch Spero Health. To accelerate the company’s growth, Spero Health recently acquired the assets of 20 freestanding outpatient clinics located throughout Kentucky, Ohio and Indiana. Providing care for more than 5,000 patients each month, Spero is one of the largest office-based opioid treatment providers in the country. Led by President and CEO Steve Priest, Spero Health utilizes an innovative evidenced-based integrated care model that combines both physical and behavioral healthcare services under one roof to treat the whole patient. This integrated care model combines physician services (including medication assisted treatment), behavioral health counseling, recovery support services, medication management and patient and family education. Its community-based approach to treatment allows patients to continue working and caring for their families as they overcome addiction. Spero Health is in-network with Medicaid and most commercial insurance plans.

Business Briefs

Franklin-based Censis Technologies, a leader in surgical inventory management, recently announced completion of their acquisition of Applied Logic, a St. Louis-based surgical tracking software company. Last month, AllianceBernstein announced the firm will become the anchor tenant of the office tower affiliated with the Fifth + Broadway development that is under construction. The New York-based global investment firm announced earlier this year the intention to relocate its global headquarters

to Nashville over the course of the next six years, bringing more than 1,000 corporate jobs. Nashville-based Wellvana, which is financed and co-founded by Charlie Martin of Martin Ventures and several San Antonio physicians, recently closed on $4.5 million in funding. The company aligns physicians in a clinically integrated model to achieve healthcare’s triple aim. OneDigital Health and Benefits, which is based in Atlanta, has bought locally based Paradigm Group. Bob Levy, managing principal for Paradigm, will continue on in that role for OneDigital Tennessee. Envision Healthcare closed on its purchase of Decatur Radiology Physicians in Decatur, Ill., in mid-October. The buy comes just days after private investment firm KKR, which is also rumored to be interested in purchasing Acadia Healthcare, closed on its $9.9 billion acquisition of Envision, taking the publicly traded healthcare company back to a privately held firm. Nashville-based SmileDirectClub is grinning all the way to the bank following $380 million in private equity capital led by Clayton Dubilier & Rice and a company valuation of $3.2 billion. The funds are earmarked for innovation, research and development, and international expansion. Local healthcare advisory firm Bernard Health recently announced a new partnership with Baird to provide healthcare planning and health insurance advice to clients of the national financial services firm. Nashville-based medical property investor and developer Montecito Medical has recently completed the acquisition of a Class-A medical office building in Willmar, Minn., and the Chardon Surgery Center, a Class-A medical office and surgery center in the metropolitan Cleveland area. NueCura Partners recently finalized a third investment in Nashville-based decision support healthcare startup EvidenceCare. This latest investment was $468,367, bringing NueCura’s total cash investment to $959,000. In this round of Community Health Systems divestitures, the company recently announced completion of the sale of 238-bed AllianceHealth Deaconess Hospital in Oklahoma City and of Sparks Health System in Arkansas, which includes 492-bed Sparks Regional Medical Center in Ft. Smith and 103-bed Sparkes Medical Center in Van Buren. Additionally, CHS has announced a definitive agreement to sell the twohospital Mary Black Health System and related business in South Carolina. Nashville-based Gen Cap America recently announced it had sponsored a buyout of Orthopedic Physical Therapy Products (OPTP) in partnership with management. OPTP is based in Minneapolis, Minn. Terms of the transaction were not disclosed. Brentwood-based QualDerm Partners has added two more practices to its growing network. Andrew D. Quillin, MD Dermatology and Westerville Dermatology have joined the company’s Ohio

network of affiliated physician-owned practices. Nashville health technology company axialHealthcare recently announced a data sharing partnership with Surescripts to improve patient safety and alert providers to high-risk patients amidst the opioid crisis. axialHealthcare, a leader in pain care and opioid medication solutions, will collaborate with Surescripts to leverage prescription fill information for patients whose care is monitored by axialHealthcare’s capabilities to assess and analyze patient risk related to pain management, opioid use, and opioid use disorder. Amedisys has signed a $340 million deal for New Jersey-based Compassionate Care Hospice, which cares for more than 3,000 patients daily at 53 sites across 24 states. Council Capital, a healthcarefocused private equity firm based in Nashville, recently announced it has invested in The Center for Neurological and Neurodevelopmental Health and The Clinical Research Center of New Jersey (collectively, “CNNH”). Terms of the transaction were not disclosed. Headquartered in Voorhees, N.J., CNNH provides neurology-led medical assessment, testing, and treatment for children and adolescents with neurological, developmental, learning, and neuropsychological issues.

Massey Named CFO of Diversicare

Earlier this fall, officials with Brentwood-based Diversicare Healthcare Services announced the appointment of Kerry Massey as executive vice president and chief financial officer. He began his duties on Sept. 10, 2018. Massey has extensive finance and accounting experience. PreviKerry Massey ously, he spent six years as vice president and corporate controller of Compassus and spent seven years with M*Modal and its predecessors, where he ultimately was promoted to vice president and corporate controller. Earlier in his career, he was an audit manager with Ernst & Young. Massey earned a degree in finance and accounting from the University of Memphis.

Weston Named SVP, Chief Growth Officer for Compassus

Brentwood-based national provider of post-acute care Compassus recently announced the addition of Damien Weston as senior vice president and chief growth officer. In his new role, Weston will focus on increasing awareness of the company’s hospice, palliative and home health programs in 30 states and achieving near-term, intermediate and long-term growth. For the past 17 years, Weston has served in both operations and sales leadership positions at Kindred Health Services. He earned his bachelor’s degree in business management from Northwest University in Bellevue, Wash. NOVEMBER 2018

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GRAND ROUNDS Nashville General’s Hospital Authority Board Appoints New Members

The Hospital Authority at Nashville General Hospital recently announced its appointment of three new board members. Loretta Bond is an assistant professor of nursing at Belmont University, Bond has extensive experience in academic standards, as well as the academic accreditation process. Dr. Loretta Bond She received her DPN at Rush University in Chicago and her MSN at Marquette University in Milwaukee. Shindana Feagins, MD, completed her residency training at Nashville General Hospital in 2005 and currently serves as a physician at Feagins Medical Group. She received her undergraduate degree at the University of Southern California and her medical degree from Meharry Medical College. Alexandria Fisher currently serves as a lawyer at Frost, Brown Todd, where

she is an integral member of the health services team. She received her bachelor’s degree at Union University and earned her law degree from Vanderbilt University Law School.

Alexandria Fisher

KEPRO Chooses Two from Nashville

KEPRO, a Beneficiary and Family Centered Care QIO (BFCC-QIO) based in Pennsylvania but with multiple offices, has tapped two local healthcare veterans over the last few weeks for key leadership roles. Working out of the Nashville office where KEPRO has contracts with TennCare and CoverKids, Joel Portice has been named CEO for the quality improvement and cost containment company. Portice has a deep background Joel Portice in healthcare technology and previously led Intermedix before

DaVita Metro Center Celebrates Grand Opening

DaVita Kidney Care, a division of DaVita Inc., celebrated the official grand opening of their Rosa L. Parks Boulevard location in Metro Center. Nearly 40 patients, teammates and physicians celebrated the opening of the new dialysis center.

the company was acquired by WPC Healthcare. Prior to that, he held executive positions with HMS Holdings and Verisk Health and was co-founder and COO of Enclarity before the company was acquired by LexisNexis. Portice succeeded a retiring Joseph Dougher. The company also tapped Michael Ansel as chief growth officer. Ansel will be responsible for KEPRO’s long-term strategy to grow and transform the organization’s solution delivery in the private, public and federal markets. Previously, he served in the same capacity for Matrix Medical Network and prior to that was executive vice president of business development for BioIQ.

Manceau Joins AdvancedHEALTH

Amanda Manceau, DO, FACOG, recently joined AdvancedHEALTH – Middle Tennessee’s largest independent multi-specialty practice – at Advanced Women’s Health of Nashville. Specializing in prenatal/perinatal care, gynecologic care of all ages, and minimally invasive surgical procedures, Manceau is a Fellow of the American Board of Obstetrics and Gynecology. She earned her undergraduate degree Dr. Amanda Manceau from Vanderbilt and osteopathic medical degree from Nova Southeastern University in Fort Lauderdale, Fla. She then completed residency at University of Texas at Austin Dell Medical School before practicing in Oklahoma City while her husband, Victor Kha, DO, completed his fellowship in pulmonary disease and critical care medicine.

COMING IN DECEMBER

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GRAND ROUNDS PYA Healthcare White Papers

PYA, a national management consulting and accounting firm with offices in Nashville, has released three white papers on healthcare industry topics over the last two months. “Pursuing a Provider-Sponsored Health Plan: Key Considerations,” “Urgent Care Centers: A Solution to Overuse of Hospital Emergency Rooms – Valuation Considerations,” and “Compensating Physicians for Executive and Administrative Services” each offer expert insights and guidance into the respective topics. To access the white papers, go online to pyapc.com and click on the ‘Insights’ tab.

University Health Network, Vanderbilt Create Statewide Healthcare Alliance

At the end of September, University Health Network (UHN) – a clinically integrated network and accountable care organization (ACO) based in Knoxville that includes The University of Tennessee Medical Center (UTMC), University Physicians’ Association and others in East Tennessee – announced an affiliation with the Vanderbilt Health Affiliated Network (VHAN). The goal of the new relationship with UHN is to create a statewide network to improve quality and reduce the cost of healthcare across Tennessee. The agreement creates a relationship between UHN, which is comprised of 87 practices and more than 1,000 providers and VHAN’s 12 health systems, more than hospitals, 350-plus practices and 5,000 providers. Through this connection, all providers participating in UHN, including UTMC, are in-network for people across Tennessee who are covered by select insurance plans working with VHAN. “When like-minded organizations like UHN and VHAN work together to solve large-scale population health problems, communities across the Southeast can benefit tremendously,” said David R. Posch, MS, executive vice president of Population Health for Vanderbilt University Medical Center and David R. Posch executive director of VHAN. 

Chisolm to Lead TriStar Maury Behavioral Health Hospital

Now that work is underway building the $24 million TriStar Maury Behavioral Health Hospital, the HCA division has hired the new hospital’s first chief executive officer. Troy Chisholm, FACHE, has been tapped to lead the 60-bed facility in Columbia, which will be nearly 50,000 square feet when completed Troy Chisholm late next year. Chisholm, who starts his new position this month, has nearly 25 years of behavioral health administrative experience. Most recently, he served as administrator of psychiatry and behavioral medicine at Greenville Health System in South Carolina.

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