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FOCUS TOPICS ONCOLOGY • FINANCES & TAXES

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Kurt Merkelz,

Oncology Innovation in Nashville City’s Key Players Lead Promising Research, Treatment Efforts By MELANIE

MD

KILGORE-HILL

ON ROUNDS

Sarah Cannon Investigates NGSBased Molecular Profiling

Money Management: Smart Strategies at Every Stage Different stages of life present different monetary demands – from paying off student loans … to buying a home and planning for a child’s education … to preparing for retirement ... 8

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Researchers at Sarah Cannon are using DNA sequencing technology to identify the most effective, personalized treatment for each tumor. At June’s American Society of Clinical Oncology (ASCO) annual meeting, Sarah Cannon researchers presented results of a six-year analysis that evaluated adoption and utilization of NGS-based technologies in community practices. Andrew McKenzie, PhD, Manager of Personalized Medicine at Sarah Cannon, said initial hesitancy over precision medicine has been replaced by excitement, as approval of new drugs resulting

from NGS research continue to show promise. “As research has advanced, people have become excited to see wide adoption of NGS testing, especially when connected into clinical research to develop more personalized treatments for people facing cancer,” McKenzie said. “NGS is especially helpful when matching patients to clinical trials. The proof is in the approvals we’re seeing, and that doesn’t have any sign of slowing down.” For Sarah Cannon researchers, that means more hope for patients in community-based, rural practices, which didn’t have access to NGS testing five years ago. That’s due partially to innovators like Sarah Cannon, who are building infrastructure to support

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Critical Insights into Nashville Health Tennessee Health Care Hall of Fame Inducts 2019 Honorees On Oct. 15, the Tennessee Health Care Hall of Fame inducted seven new members as part of the Class of 2019. The most recent honorees mark the fifth group of healthcare luminaries recognized since the inaugural class of inductees in 2015 ... 13

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Survey Shines Light on the Good, Bad & Role of Social Determinants By CINDY SANDERS

You can’t effectively manage what you don’t measure. Using this truism as a launching point, the Metro Public Health Department and NashvilleHealth set out to capture data that would bring Davidson County’s health profile into clearer focus. At the end of September, the two organizations released results from the Nashville Community Health + Well-being Survey, the first countywide health assessment conducted in nearly two decades. “NashvilleHealth and the Metro Public Health Department have worked in partnership for over a year to provide the Nashville community with critical and timely data on the of health of residents – data that can help organizations, governments and businesses make informed decisions, effectively direct resources and track progress in improving the health and well-being of Davidson County residents,” said Caroline Young, executive director of NashvilleHealth. (CONTINUED ON PAGE 12)

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Treating Brain Tumors With Fluorescence-Guided Surgery

The neurosurgery team at TriStar Centennial Medical Center is now using a new optical imaging agent during fluorescence-guided surgery on some high-grade gliomas.

Nearly 80,000 new cases of primary brain tumors are diagnosed each year in the United States and close to 25 percent of those are gliomas. Approximately 80 percent of gliomas are malignant. High-grade glioma (HGG) remains almost universally lethal, despite significant advances in adjuvant therapies, including chemotherapy, immunotherapy, and radiotherapy. Current treatment strategies include maximal safe surgical resection along with a combination of chemotherapy and fractionated radiotherapy. The goal of surgical resection is to remove as much by DeNene of the tumor as possible without Cofield affecting areas of the brain that VP of Surgical control motor and sensory function Services or neurocognitive functions such as TriStar Centennial speech. Surgical resection of gliomas Medical Center is challenging due to the difficulty in visualizing the tumor and its margins. Neurosurgeons at TriStar Centennial Medical Center are the first in Tennessee to use a recently approved optical imaging agent during fluorescence-guided surgery on

high-grade glioma patients. 5-aminolevuolinic acid hydrochloride (5-ALA HCl), is an imaging agent that facilitates the detection and visualization of malignant tissue during glioma surgery. The imaging agent is an oral solution administered to patients approximately 3 hours prior to surgery. Glioma cells take up aminolevulinic acid hydrochloride and convert it to the fluorescent chemical protoporphyrin IX. When illuminated under blue light, protoporphyrin in the tumor glows an intense red, while normal brain tissue appears blue. This enables the surgeon to see the tumor more clearly and to remove it more accurately while preserving healthy brain tissue. 5-ALA HCl, which was approved by The Food and Drug Administration in 2017, is well tolerated by patients. It is appropriate for use in patients with primary or recurrent brain tumors and can be used with existing standard operating neurosurgical microscopes. Studies have demonstrated that a more complete resection of high-grade gliomas can increase overall survival rates and enhance periods of progression-free survival of the disease. To learn more, go to TriStarCentennial.com

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PHYSICIAN SPOTLIGHT

Leading with Compassion

Compassus CMO Dr. Kurt Merkelz Changing Views on End-of-Life Care By MELANIE KILGORE-HILL

explained. “When you’re managing multiple chronic diseases at home, what you receive and how it’s evaluated varies among clinicians. Trying to standardize care delivery among hospice patients was the most important task to addressing quality.”

Caring for elderly and end-of-life patients can be a tough road, but it’s one Kurt Merkelz, MD, is grateful to walk. Now in his third year as senior vice president and chief medical officer for Brentwood-based Compassus, Merkelz is changing minds … and practices .. around end-of-life care.

Setting Goals

Starting Out

Born and raised in San Antonio, Merkelz was introduced to geriatrics as a teen while working as a patient transporter in hospital radiology. “I enjoyed talking to older people and was amazed at how alone and eager they were to talk,” he said. “They wanted someone to share their story with, and it was something I felt compelled to do.” The aspiring geriatrician went on to study nuclear physics at San Antonio’s University of the Incarnate Word and received his medical degree from the University of Texas Health Science Center. He completed residencies in family medicine and geriatric medicine at the University of Cincinnati and became assistant director of the school’s international health program. The experience created a passion for disadvantaged populations, as Merkelz supported medical brigade teams in Central America, China, Africa and Honduras, among other places. He went on to pursue additional education in public health policy and often treated elderly homebound patients throughout the city. It wasn’t unusual for Merkelz to bring residents along on home visits to help them better understand the reality of senior care, particularly among the underserved. “Residents were alarmed at the type of conditions patients lived in that you’d never know just by seeing them at the clinic,” he said. “It was eye opening.”

Joining Compassus

Merkelz was soon recruited back to his hometown. He began work as assistant professor of Geriatrics at the University of Texas Health Science Center at San Antonio before launching his own practice, treating patients in long-term care, assisted

living and skilled nursing facilities. Six years later he joined Compassus as medical director for the company’s Houston-area locations. In 2016, Merkelz was named the organization’s first chief medical officer. The new role prompted a move to Nashville, where Merkelz implemented a refreshingly unique outcomesbased approach for 40,000 patients in 130 Compassus locations across 29 states. “I was more interested in improving care delivery than I was in meeting organizational outcomes like length of stay or reduced readmission rates,” he said. “Those things are important but should be looked at upstream from the needs of the patient. What do they need to succeed in management of health outside of the hospital setting? Clinicians know pharmacology and physiology, but there’s often a disconnect between applying that and helping patients manage health concerns in their homes.” Under his leadership, Compassus has implemented priority areas rooted in concerns echoed by nearly all hospice patients: safety, autonomy, disease management and a desire to not be a burden. “They want us to value what they’re able to do, and they want to keep doing what they can for as long as possible,” Merkelz said. “Patients want to age in place, and they want a respect for quality of life. Those are outcomes I wanted to focus on.” His next step was to actualize practices into standardized care delivery. “The problem is there’s no consensus,” Merkelz

For Compassus, that meant focusing on comfort, safety and quality of life, with less focus on absence of pain and more on helping patients live their last days to the fullest. “As an industry, there’s under appreciation of all the complex components that go with end-of-life care, and so often we turn to the common denominator of pain,” he said. “Patients all say they don’t want to suffer, but there’s so much more to life than not suffering, and there should be more value-add from hospice than dealing with alleviation of symptoms. Pain relief should be a base expectation, not a qualifier. What more can we bring?” Too often, Merkelz said quality of life is defined by diminishing negative attributes (decreased pain, anxiety and nausea) rather than positive attributes: What gives meaning and purpose to who we are? “There should be an actionable agenda for end-of-life care and serious ill-

ness management to drive the positive attributes of quality of life,” he explained. “We need to help identify what’s most important to patients and try to help them live life fully, and there are so many ways to go about that. It’s often overlooked but so important.” He also educates providers on the true cost of pain meds, including side effects like numbness and sedation during those precious last days. He encourages providers to explore other modalities of pain management, particularly in the face of a national opioid crisis. And since hospice patients typically utilize the service less than three weeks, Merkelz also hopes to educate providers on the benefits of plugging in earlier in a patient’s treatment, to provide transition care and crisis intervention during a time of high anxiety. “What’s important for patients is to have the opportunity to be able to reflect on life, have it be appreciated, and to be shown the value you had in life,” he said. “At every life stage, we want to know we measured up. And at our final moments, we should be allowed to reflect, feel valued, have the opportunity to be human, and be recognized beyond our disease … not be defined by it.”

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Bridge Connector Launches Integration Solution Calling it a ‘game changer’ for hospital and health practices, Nashvillebased Bridge Connector has launched Destinations, an integration platform as a service (iPaaS) that rapidly and easily connects health data systems without the need for code. Interoperability continues to be a challenge in healthcare, with nearly onethird of U.S. hospitals and health systems citing insufficient data-sharing efforts, sometimes even within their own group. Bringing the advantages of interoperability to healthcare organizations of every size, Destination’s no-code user interface automates healthcare workflows across disparate systems. Any Destinations user may select from menus and suggested, pre-built, workflow-based templates to connect data — using clicks, not code — eliminating the timeconsuming and error-prone process of dual, manual data entry.

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The Oncology Care Model Value Proposition Seeking the Win/Win/Win for Patients, Practices, Payers By CINDY SANDERS

At this point in the move from feefor-service to value-based reimbursement, everyone in healthcare is familiar with the triple aim of improving the patient care experience, improving the health of populations and reducing the per capita cost of care delivery. Yet, buying into the principles and putting them into practical application continue to be challenging for many providers. To address the disconnect and discuss the latest trends in delivering the most effective, cost efficient, patient-centered care, the American Journal of Managed Care® (AJMC) and its Institute for Value-Based Medicine® host regional and national conferences to share insights on payment reform and patient care initiatives and at the intersection clinical, operational and financial performance. The southeastern regional VB-Onc™ meeting was held in Nashville last month, and Philadelphia hosted Patient-Centered Oncology Care 2019 on Nov. 8. Nashville co-chair Stephen Schleicher, MD, MBA, a medical oncologist with Tennessee Oncology, and Philadelphia co-chair Kashyap Patel, MD, a partner with Carolina Blood & Cancer Care Associates and associate-editor-in-chief of AJMC, recently made time to update Medical News on the progress and challenges to delivering patient-focused, value-based care to cancer patients.

Value-Based Care “2016 launched the first cancer-specific, value-based payment model called the Oncology Care Model,” Schleicher said of the national CMS Innovation Center pilot. “There are about 185 practices involved, and the vast majority are community-based practices,” he contin- Dr. Stephen Schleicher ued, adding a handful of academic medical centers, including University of Alabama Birmingham and Vanderbilt University Medical Center in the Southeast, are also involved. While the goal of the Oncology Care Model (OCM) is to save dollars while providing high-quality, coordinated care, Schleicher said there is an absolute ‘patients first’ mentality. With many novel oncologic drugs costing thousands of dollars, Schleicher stressed OCM doesn’t look to restrict effective treatment but rather to find savings elsewhere. “First, when there’s a drug that comes out that is FDA approved that we know has beneficial properties for a patient – right patient, right time – we’ll do everything to ensure that drug is administered,” he said. “Where two drugs with equal efficacy are available where there is a big cost difference, the goal is to use the one that’s less expensive as long as there are no additional side effects.”

Schleicher continued, “The challenge is a lot of payers think there are many more times in a patient’s treatment when there are two options that are of equal efficacy … but that is the exception rather than the rule.” Instead, the focus is on care coordination to try to keep patients comfortable and progressing in their treatment plan in the home and clinic rather than higher acuity settings. “It’s better to keep the patient out of the hospital, and it’s higher value care to do that,” Schleicher pointed out. “It’s best for the patient and for society.” He added deploying palliative care with a focus on symptom control, using analytics to parse reported patient outcomes and improving communication and care coordination to holistically manage patients are a few of the innovative tools being used to bend the cost curve. The recent regional VB-Onc conference drew attendees from the back office to the front lines of care to bring everyone up to speed on where things stand with OCM and discuss the larger challenges to succeed in a value-based delivery model. “The Oncology Care Model is a fiveyear pilot, so it ends in 2021,” Schleicher noted. However, he speculated CMS would either extend the model or move to something more substantial like a bundle payment. “I don’t see anyone in the government or commercial payers backing away from value-based care anytime soon.” He added, “Patients are already

Tennessee Falling Short on Cancer-Fighting Public Policies While Middle Tennessee is often on the forefront of cancer research, all the news from the state isn’t good. According to a report released this summer, Tennessee is falling short when it comes to implementing policies and passing legislation to prevent and reduce suffering and death from cancer. The information is in the latest edition of “How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality.” “This report shows that we must do more to reduce suffering and death from cancer. But we have the power to make a difference for Tennesseans immediately by implementing proven cancerfighting policies,” said Emily Ogden, Tennessee government relations director for the American Cancer Society Cancer Action Network (ACS CAN). “This year alone in Tennessee, 37,250 people will be diagnosed with cancer and 32.9 percent of cancer deaths in Tennessee are attributed to smoking. We owe it to them and everyone at risk of developing the disease, to do what we know works to prevent cancer and improve access to 4

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screenings and treatment.” How Do You Measure Up? rates states in eight specific areas of public policy that can help fight cancer: increased access to care through Medicaid, access to palliative care, balanced pain control policies, cigarette tax levels, smoke-free laws, funding for tobacco prevention and cessation programs, cessation coverage under Medicaid and restricting indoor tanning devices for people under 18. This year’s report includes a special section examining efforts to stem youth tobacco product use by raising the legal age of sale for tobacco to 21. E-cigarettes have driven a dramatic 36 percent rise in youth tobacco product use over the last year – and in statehouses across the country, policymakers have prioritized efforts to keep tobacco products out of the hands of kids. The special section draws attention to the tobacco industry’s latest efforts – including preempting local governments’ ability to pass strong tobacco control laws – and outlines the principles that make tobacco 21 policies effective. A color-coded system classifies how well a state is doing in each issue. Green

shows that a state has adopted evidencebased policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short. Tennessee achieved a green arrow for access to palliative care and yellow for pain policy. In all other areas, the state is falling short.  ACS CAN is calling on lawmakers to join us in the fight to prevent cancer by passing comprehensive legislation that will raise the age of sale for tobacco in Tennessee from 18 to 21. This public health initiative could help protect youth from a lifelong addiction to tobacco.  “As advocates, we have the opportunity to work with our Tennessee legislators on implementing policies and programs that prevent and treat cancer,” said Michael Holtz, state lead ambassador, ACS CAN. “Together, we can build stronger, healthier communities and ensure Tennesseans have access to measures that prevent disease before it occurs, ultimately saving more lives from cancer.” To view the complete report and details on Tennessee’s grades, visit www. fightcancer.org/measure.

overwhelmed with their diagnosis and treatment. Anything we can do to limit unnecessary financial strains on patients I think we all agree is important.” For practices that haven’t yet dipped their toes into the value-based waters, Schleicher said it might not be an optional course in the future. While OCM was a voluntary program, he pointed out the new radiation oncology bundle is mandatory. The problem for many smaller practices is a lack of resources and infrastructure to effectively participate in an analytics-intense model. “We’re not good at understanding our costs, and that’s the first step in value-based care,” he noted. “It really takes analytical tools to understand how you are doing among your peers and your colleagues nationally.” In addition to understanding costs, he said measuring how you are doing on pathway adherence, understanding the patient experience, and taking a hard look at dispensing futile care at the endof-life are all important aspects of valuebased care. Schleicher, who also serves as chair of the quality and value committee for OneOncology said the impetus behind creating a national network for community-based oncology practices was to leverage economies of scale, intellect and expert knowledge to help practices prosper in this new model while maintaining their independence as a private practice. “Unfortunately, practices that are on their own might not have the expertise or resources to adapt to value-based care. For small practices, that’s where larger, innovative groups like OneOncology can add tremendous value,” Schleicher said. “We’re all in this together for our patients … we’re not competitors in this space.” Patient-Centered Care The Philadelphia conference turned the focus to the patient in the middle of the Oncology Care Model. As an OCM site, Patel has seen how putting the model into action is a win/ win for patients and providers at Carolina Blood & Cancer Care Associates. “Once we were designated by Medicare as an Oncology Care Model participant, we got additional fundDr. Kashyap Patel ing which allowed extra investment in care coordination and expanded access,” he noted. Not only did the practice purchase a new CT scan and start offering clinical trials, but they also invested in ancillary services in the clinic including in-house spiritual and hospice counseling, nutritional services and yoga sessions. Patel said, “We keep two open slots at the clinic every day so if a patient needs to be seen, they don’t have to wait two to three weeks for an appointment. We

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ONcology Rounds

More News of Note from Area Oncology Programs Fight Against Childhood Cancer

in grant funding from Komen Central Tennessee for the practice’s mobile mammography The Nashville program. Predators hockey Our Mission in team, longtime supMotion (OMIM) has porters of Monroe screened more than Carell Jr. Children’s 21,000 women at 1,420 Hospital at Vanderevents since 2011. bilt and its programs, OMIM prioritizes recently presented the uninsured, low-income hospital with the prowomen in historically ceeds raised throughunderserved communiout the year from the ties. The new funding team’s 365 Pediatric will enable OMIM to Cancer Fund. provide more than 500 Predators goalfree mammograms in tender Pekka Rinne a one-year period to and executives from women in 11 of the 42 the Predators and New this season, a Monroe Carell Jr. Children’s Hospital at Vanderbilt patient is featured on counties in Komen’s Tri Star Energy the jumbotron as a Vanderbilt Health Champ of the Game. Tennessee service area. (Twice Daily) joined This grant focuses on team mascot Gnash uninsured African American and Hispanic yogurt have already been established for and Children’s Hospital leadership to celwomen. cardiovascular disease and gastrointestiebrate the team’s gift of $550,365.19 in cash “Saint Thomas Medical Partners and nal cancer. The new findings based on an donations and in-kind contributions raised Our Mission in Motion continues its strong analysis of data from studies involving 1.4 through the 365 Pediatric Cancer Fund partnership with Susan G. Komen Central million adults in the United States, Europe presented by Twice Daily. Tennessee,” said Yvette Doran, president and Asia suggest this diet may also protect The funds will be used to support pediand CEO of STMP. “These grants support against lung cancer. atric cancer research, to identify new ways our ability to serve more women across Participants were divided into five of curing childhood cancer and to deliver Tennessee and enable us to bring potengroups, according to the amount of fiber these treatments in an optimal way for each tially life-saving mammograms to many and yogurt they consumed. Those with the child. women who might otherwise not be able to highest yogurt and fiber consumption had a The Predators organization also care for their health.” 33 percent reduced lung cancer risk as comannounced it will commit $300,000 over pared to the group who did not consume three years to support Children’s HospiPooled Five-Year Survival yogurt and consumed the least amount of tal’s Soaring Higher, Dreaming Bigger: Results for Opdivo Released fiber. A Campaign Against Childhood Cancer. Bristol-Myers Squibb recently “Our study provides strong evidence The campaign will help create the Pediatannounced pooled five-year survival results supporting the U.S. 2015-2020 Dietary ric Cancer Center at Children’s Hospital for Opdivo (nivolumab) in previouslyGuideline recommending a high fiber and by expanding and upgrading existing space treated advanced non-small cell lung cancer yogurt diet,” said senior author Xiao-Ou as well as supporting research, training and (aNSCLC) patients. Shu, MD, PhD, MPH, programs. The long-term pooled efficacy and Ingram Professor of Over the past eight years combined, safety results from the Phase 3 CheckMate Cancer Research, the team has given more than $2 million in -017 and CheckMate -057 studies showed associate director for donations and in-kind contributions to the significant difference in overall survival (OS) Global Health and hospital and its programs.  benefit with the use of the immuno-oncology co-leader of the CanAs part of the 365 Pediatric Cancer therapy Opdivo. In this setting, Demonstratcer Epidemiology Fund presented by Twice Daily, Rinne ing a greater than five-fold increase in fiveResearch Program at purchased a suite at Bridgestone Arena that year overall survival rates, Opdivo’s OS was Vanderbilt-Ingram accommodates 16 children and families 13.4 percent vs. 2.6 percent for docetaxel. Cancer Center. “This Dr. Xiao-Ou Shu from Monroe Carell Jr. Children’s Hospital The OS benefit for Opdivo-treated patients inverse association was at Vanderbilt for all Predators home games. was observed across all subgroups. robust, consistently seen across current, On select nights, the suite will be auctioned The safety profile for patients treated past and never smokers, as well as men, off, and 100 percent of the money raised with Opdivo was consistent with previously women and individuals with different backwill go to the fund. Throughout the 2019reported findings in second-line NSCLC, grounds,” she added. 2020 season, Rinne will continue to join and no new safety signals were seen with Shu said the health benefits may be forces with the Nashville Predators Founextended follow-up. rooted in their prebiotic and probiotic propdation to raise money for the fund through Among patients with an objective erties. The properties may independently or Hockey Fights Cancer nights, special aucresponse to Opdivo, 32.2 percent continued synergistically modulate gut microbiota in a tions and more. to see a response at five years. For docetaxel, beneficial way. 0 percent of patients with an objective The study’s lead authors are Jae Jeong High Fiber, Yogurt Diet response continued to see a response at five Yang, PhD, a visiting research fellow from Associated with Lower Lung years. The median duration of response was the Seoul National University, South Cancer Risk 19.9 months for Opdivo-treated patients Korea, and Danxia Yu, PhD, assistant proOn the prevention side for lung cancer, and 5.6 months for patients treated with fessor of Medicine at Vanderbilt. a diet high in fiber and yogurt is associated docetaxel. with a reduced risk for lung cancer, accordDavid R. Spigel, MD, chief scientific Making Mammograms More ing to a study by Vanderbilt University officer and director of the Lung Cancer Accessible Medical Center researchers recently pubResearch Program at Sarah Cannon and a This summer, Saint Thomas Medical lished in JAMA Oncology. partner with Tennessee Oncology, has been Partners (STMP) received nearly $70,000 The benefits of a diet high in fiber and nashvillemedicalnews

.com

closely involved in the nivolumab research for several years and has co-authored papers, including this latest one, regarding the use, duration and efficacy of the immunotherapy as a treatment for aNSCLC.

UTHSC, ORNL Scientists Collaborate on NextGen Treatment for Advanced Prostate Cancer

Nearly five years after beginning their research, investigators from the University of Tennessee Health Science Center (UTHSC), with collaboration from scientists at Oak Ridge National Laboratory (ORNL), have developed what they believe will be a next generation treatment option for advanced prostate cancer. The journal Clinical Cancer Research published a  paper  on the findings online last month. Ramesh Narayanan, PhD, an associate professor in the Department of Medicine-Hematology in the College of Medicine at UTHSC, is the principal investigator on the project. Duane D. Miller, PhD, professor emeritus in the Department of Pharmaceutical Sciences at UTHSC, is a co-principal investigator on the research.  The UTHSC team identified a novel molecule that binds to the androgen receptor (AR), the receptors for the hormone androgen that fuel prostate cancer growth. This molecule, UT-34, developed at UTHSC and mechanistically studied and defined with the scientific computing capabilities at ORNL, has shown to not only slow the growth of tumors in pre-clinical models, but to shrink them to undetectable size.  Vera Bocharova, PhD, and Bobby Sumpter, PhD, directed the work at ORNL. According to the paper, “this provides the first evidence of the potential of an orally bioavailable AR degrader in advanced prostate cancer.” The findings were validated by an outside contract research firm. Approximately 18 million individuals are living with prostate cancer today, noted Narayanan. That number is expected to grow to 22 million by 2024. “You have an enormous number of prostate cancer patients, and under current therapies, these patients respond only for a brief period,” he said. “Most pharma companies are trying to find the next generation of treatment for advanced prostate cancer.” He added UTHSC has achieved a milestone by identifying these lead molecules. The next milestone would be the clinical trial process, which he estimates could commence in 12 to 24 months. Depending on those results, a drug could be available in three to five years. The molecules were licensed to GTx, Inc., which is now Oncternal Therapeutics, through the University of Tennessee Research Foundation. This research was funded by a grant from the National Institutes of Health, and by grants from GTx, Inc., and Oncternal Therapeutics. Narayanan was awarded more than $2 million from the NIH in March to continue this research. NOVEMBER 2019

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Oncology Innovation in Nashville, continued from page 1 availability of testing to oncologists outside of large medical centers. Sarah Cannon Research Institute studies also demonstrate the economic impact of NGS. “From both tissue exhaustion and economic standpoints, studies show it’s a much more efficient process to do it all at once,” McKenzie said, noting the potential loss of both time and health through repeated traditional biopsies. As NGS testing becomes widely available, Sarah Cannon researchers also are cautioning against exclusive use of Dr. Andrew McKenzie plasma-based testing, preferred by many oncologists for their convenience. “Samples from a blood draw are easier to obtain over a tissue sample, but you’re limited with those tests by what it can detect,” warned McKenzie. “Some providers are getting enticed by ease of use for plasma, where the gold standard is still tissue based NGS.” Those discrepancies are the subject of a paper currently in the works at Sarah Cannon Research Institute.

GI Innovation at VICC

Colorectal cancer research is getting a boost at Vanderbilt-Ingram Cancer Center, where researchers have received several million dollars in research grants

from the National Cancer Institute. Funds include a Gastrointestinal SPORE grant for a five-year period totaling $11.6 million and an $11 million Cancer Moonshot grant. In June, the department also made headlines by recruiting Cathy Eng, MD, to serve as the co-director of Gastrointestinal Oncology and co-leader of the GI Cancer Research Program. A national and international leader in colorectal cancer, appendiceal, and anal cancer research, Eng joined VICC after a 17-year career at MD Anderson Cancer Center, where she served as associate director of the Colorectal Center, chair of the Clinical Research Committee and chair of the Multidisciplinary Colorectal Cancer Tumor Board. Previously, she also served as chair of the National Cancer Institute Rectal/Anal Cancer Task Force, and co-chair of the Rectal/Anal Subcommittee for the Southwest Oncology Group (SWOG). She currently serves as vice-chair for the SWOG GI Committee, member of the ECOG-ACRIN Cancer Research Group GI committee and is a member of the NCI GI Steering Committee. “Vanderbilt-Ingram Cancer Center has a longstanding reputation, but the main reason I chose to lead the GI program is because of the opportunity to help strategically develop and mentor an internationally-respected, multi-disciplinary group,” Eng said.

In her new role, she is focused on expanding awareness of clinical trials targeting metastatic colorectal cancer, still the second leading cause of cancer deaths in the U.S. “If there’s a patient seeking clinical trials, we have multiple options, including several for treatment-resistant and rare mutations, as well as for generalized cancer with no mutations,” she said. Eng encourages providers and patients alike to consider trials earlier in their diagnosis, noting the rare use of placebo among the high-risk population. She’s also committed to increasing awareness and support of young adults with colorectal cancer and is building a program designed to meet their unique physical, educational and emotional needs. “People still think the average colorectal cancer patient is in their late 60s, but so many today are younger,” said Eng, who is working to identify causes of colorectal cancer in a disturbingly younger population. “We have to find a way to recognize the diagnosis and support them earlier, because I constantly hear from this population that people just don’t understand what they’re going through.” Unlike older patients, which often have the benefit of stable family and financial lives, young adults often are dealing with relationship and fertility concerns, job security and lack of funds. They also have added concerns of body image, quality of life and sometimes colostomy. “The reality is this is one of the most preventable cancers, and we have to find a way to recognize and support these patients earlier,” Eng said.

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Saint Thomas Health is bringing innovative diagnostic technology to cancer patients in Middle Tennessee. The system recently unveiled Hologic 3D/ Tomography units at their Midtown and West campuses, while the Hologic Affirm 3D Stereotactic Breast Biopsy System was added to Midtown. “We have many exciting technologies for optimizing care for our breast cancer patients,” said Lisa Bellin, MD, Ascension Saint Thomas breast surgeon. Hologic 3D/Tomography is approved by the FDA as a superior mammogram for women with dense breasts and detects 20-65 percent more invasive breast cancers compared to 2D mammography alone. Its SmartCurve™ system mirrors the shape of a woman’s breast and is clinically proven to improve comfort in 93 percent of patients who reported moderate to severe discomfort with standard compression technology. “3D breast tomosynthesis imaging is helping to screen our patients both more reliably and more efficiently,” said Bellin. “Tomosynthesis mammograms help find more breast cancers since the technology is more sensitive and specific, resulting in fewer callbacks and less anxiety for patients.” The Hologic Affirm 3D Stereotactic Breast Biopsy System ensures surgeons

can biopsy lesions found during screening with certainty, while providers also appreciate a large field of view, simple touch screen controls and clear displays of safety margins. Saint Thomas Health also added MagView Mammography Information System with High Risk Assessment Modeling, as well as SOZO bioimpedence spectroscopy (proactive lymphedema assessment) and its new OncoLens tumor board software. “OncoLens is a secure, tumor-specific sharing platform where our multidisciplinary providers can directly share and collaborate inpatient care,” Bellin explained. “The lymphedema impedance spectroscopy enables our lymphedema specialists to screen for increased fluid within our patient’s arms when less than a tablespoon worth of extra fluid has accumulated. Traditional methods cannot detect this until up to one to two cups of fluid has accumulated.” Bellin said this results in much more effective intervention and care for patients in improvement of the quality of life.

The Oncology Care Model, continued from page 4 see patients as they need to be seen.” As a result, he continued, “We’re able to reduce the likelihood of a patient going to the ER after hours, which works best for the patient … and for us. “The patient doesn’t have to waste seven to eight hours of their life (in the ER), and I don’t have to round early the next morning,” Patel added with a chuckle. “Our patient satisfaction rate has gone up to the top tier in the 80-90 percentile.” While the physicians love not going to the hospital as much, the change runs much deeper than that. “It’s a win/win for everyone,” Patel explained. “We feel by providing patient-centered care, it has allowed us to fulfill our purpose as a doctor. At the end of the day, we all have a purpose. I see myself as not just a dispenser of medicine but as a healer.” By taking the holistic view, he said clinicians now really see patients as human beings with aspirations and expectations. “We broke all the silos. Instead of seeing the compartments, we now see the whole patient. We’ve become part of the patient’s microecosystem.” In addition to the increased satisfaction levels, Patel said the feedback the practice receives every six months from CMS shows a third win … lowered cost. “We reduced our hospitalizations by about 30 percent and reduced the total cost of care by about 17 percent,” he said. “About 50 cents on every dollar in oncology is spent in hospital-related services, but if you reduce the number of patients going to the hospital, it will significantly bend the cost curve,” he concluded. nashvillemedicalnews

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Focus on Four Key Tax Issues This time of year can be a bit of a scramble for leaders of healthcare companies – and most other businesses – with efforts to post a strong yearend mixed with increased personal and professional social obligations. But amidst that scramble, CEOs of all types of companies may want to talk with their chief financial officers about four key tax issues they’ll likely be dealing with in coming months.

By JAY HANCOCK

& BEN CARVER

Limits on Interest Deductions The federal Tax Cuts and Jobs Act of 2017 allowed the immediate expensing of certain equipment used in a business on its corporate business tax return instead of gradual expensing. However, this was coupled with a limitation on the ability of the company – if it has average annual gross receipts over $25 million in the previous three years -- to deduct interest expense. 

Ostensibly Congress’s goal was to prevent a “double dip” on the part of a taxpayer in which it borrows money to purchase qualifying equipment that it immediately expenses, and then also deducts interest expense. While for most businesses an accompanying reduction in tax rates more than offsets the impact of the limitation on interest deductions and other provisions in the law that broadened the tax base, the limitation can pose a particular challenge for thinly capitalized companies where debt exceeds equity. State impact of the Tax Cuts and Jobs Act States generally base their corporate income tax provisions on the federal tax code. That means they tend to adopt federal expansions of the tax base, which they generally did in the case of the 2017 tax cut. However, they do not typically adopt lower rates on their corporate business taxes when the federal government reduces theirs. Applying the existing state tax rate to a newly expanded tax base means companies usually pay higher … not lower … state corporate income taxes. But even though the federal provisions took effect in 2018, many states still are working on how to handle the expansions of the tax base, and not all are completely aligning with the federal tax code. In Tennessee, for example, the state reacted by adopting the new interest expense limita-

tions for the 2018 and 2019 tax years, but not for 2020 and later years. The “Wayfair” Decision Another state and local tax issue that could affect some segments of the healthcare industry results from a 2018 decision by the U.S. Supreme Court in South Dakota v. Wayfair, which gave states expanded power to tax remote sellers — those who do business there without an instate physical presence. Although the case dealt with sales tax, states are adopting the principles outlined in Wayfair to impose corporate income tax, franchise taxes and gross receipts levies on companies without a physical presence in their state. For now, this decision is most likely to impact a limited range of healthcare companies – for instance those that provide technology and those that sell taxable products, such as medical supplies and equipment, into states where they do not have a physical presence but where the states have adopted these new rules. But the growing importance of telehealth services means the Wayfair decision could soon impact physician practices and other providers from the standpoint of income taxes and other state and local taxes. Impact of Changes in Accounting for Leases The Financial Accounting Standards Board has mandated significant changes in the way leases are accounted for, and

although they do not take effect until 2021 for private companies, the changes are complex and companies should start preparing to implement them if they have not already done so. Stated simply, under the new standard, most leases will have to be placed on the company’s balance sheet, where under current rules they need not be. Although this change does not have an impact on current federal taxes, they may affect deferred federal taxes and could impact state franchise taxes and local property taxes. Key Takeaways Corporations or practices that are considering selling their stock or engaging in other reorganizations or transactions, should be aware of the federal tax and state changes. As with all such transactions, there can be potential pitfalls and complications stemming from not having the right strategy. Now is a good time to consult with your tax specialist to ensure that you are taking advantage of opportunities and avoiding challenges as you round out 2019 and head into the new year on a strong foot. Jay Hancock is a shareholder and leader of the state and local tax practice, at LBMC, the largest professional services solutions provider in Tennessee. Contact him at jay.hancock@lbmc. com or (615) 690-1982. Ben Carver is a shareholder in the Tax practice at LBMC, focusing on healthcare. Contact him at bcarver@lbmc.com or (615) 309-2402. For more information on the full range of firm services, go to lbmc.com.

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Money Management: Smart Strategies at Every Stage By CINDY SANDERS

Different stages of life present different monetary demands – from paying off student loans … to buying a home and planning for a child’s education … to preparing for retirement. Matthew Harrison, CRC, senior vice president/relationship manager for Medical Private Banking at First Horizon Bank Matthew Harrison (formerly First Tennessee), shared smart strategies for every stage. Harrison said his first piece of advice holds true no matter what age or career stage: “Everyone should start by finding a good financial planner –someone who is a dedicated financial planner and is a CFP.” He added, “They will put a roadmap together to tell you what you should be doing along the way.”

Starting Out

Harrison noted a common misconception is that an individual needs to have accumulated a significant amount of wealth to meet with a financial planner.

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Instead, he said you are never too young to begin to think long-term about managing finances to achieve your goals. For those starting out, there are a number of considerations. Often, paying down student debt is a chief concern. Harrison also said everyone should begin an emergency fund to save for the unexpected. When nearly every dollar is allocated each month, a costly car repair can throw a budget into complete disarray. Insurance – disability, life, liability and rental or homeowner’s – are also key considerations, he added. “For everyone, the ability to earn an income is really your most valuable asset so look at disability insurance to protect that asset,” Harrison noted. A financial planner will help you see the bigger picture. “For some people, it might be we need to attack debt. For others, if they are in a public loan forgiveness program, we might not tackle debt so aggressively,” Harrison pointed out. “There’s only so much pie that can be split, so you need to make sure you’re properly allocating resources … maybe you forego aggressive debt reduction until the emergency fund is built. At the end of the day, it’s a balancing act.”

Building a Career & Life

As providers and executives move into their 30s and 40s, income has typically increased … but so have financial demands. At this stage, there are often investment and partnership options to consider, homes being purchased, growing families with educational considerations, and a need to make sure distribution of assets has been considered in case of untimely death. “It’s very important for us to make sure if they don’t have a will that one is created and that we keep that updated, as well,” Harrison stressed. Another way to take care of a growing family is to consider both near-term and long-term educational goals. “You need to start thinking about allocations for education and how you are going to pay for that … and if you are going to pay for that,” he said. College options include 529 and UTMA plans, among

Pro Tip Gage Logan, Managing Director, Raymond James “The end of the year is a great time to review your overall financial plan. Double check your liquidity and make certain your asset allocation is appropriate. It is important you have done all you can to maximize contributions for the current year. If you ended the year in good shape, perhaps you should consider increasing contributions in the year ahead.  “How much money will you need to retire? Think of retirement savings as an expense. A good idea would be to increase your 401K or 403B contribution in the coming year. It’s best to plan ahead and not wait until the last minute to save for retirement. There are too many people today waiting until later in life to even begin thinking about financing their future. I believe it’s better to save too much in your younger years and get the chance to retire early and enjoy it. It is much easier to monitor and adjust a long term goal than it is to accomplish that goal in a shorter period of time. “

other strategies. “A portion of 529s can now be used also to fund private education for elementary through high school, but there is a maximum for private school of $10,000 per year. Even if it doesn’t cover all of tuition, it can help with tax implications.” To help navigate funding options for homes and business investments, some area financial institutions have medical private bankers who will work with physicians, advanced practice clinicians, researchers, and industry entrepreneurs and executives. Unlike a financial planner, however, there are usually asset thresholds required to be assigned a private banker. Harrison said in the traditional private banking world, those requirements are typically half a million or more in liquid assets or an ability to get to that level within a reasonable timeframe. He added most medical programs eliminate asset requirements for providers. Some banks have lending programs specifically geared to physicians. These can include mortgage options requiring little to no money down with very competitive rates and lines of credit that can be quickly accessed to launch a practice or purchase equipment.

Eyeing Retirement

Harrison said ‘eyeing retirement’

Pro Tip William Braddy, Wealth Advisor, Kraft Asset Management, LLC “Over the years the internet and increased regulations have made active management very difficult to impossible to outperform indexes. Be very aware of returns after taxes and fees. Ask questions!” And while not an investment tip, it’s important to keep in mind rules change when children become adults, which can block parents from managing medical and financial decisions in times of emergency. Braddy, noted, “Healthcare privacy is a serious issue. Parents with children of the majority need Health Care Powers of Attorney in place for them. Hospitals may not allow parents to help with decisions that need to be made.”

should begin at the start of a career. Even if it’s a small amount put back in the beginning, it establishes a habit of saving for retirement. While it’s easy to contribute to a plan when employed by a large practice, health system or firm with a mechanism in place, Harrison noted solo providers and entrepreneurs can work with a financial planner or investment advisor to set up individual retirement plans. By 50, he said individuals should really be thinking about long-term care, as it is one of the largest potential wealth drains in retirement. Harrison said that’s also the age to maximize retirement plan investment. “Once you hit 50, you’re able to make a catch-up contribution, which is an extra $6,000 per year for workplace plans.” As retirement draws even closer, Harrison said providers and corporate owners should begin planning for divestiture. “Are you going to sell? What are the tax implications? How do you minimize your tax burden?” he said are questions that should be explored with an expert. For those with stock options, Harrison noted, “You want to make sure you’re diversified in your portfolio. We also want to make sure you minimize your tax burden when exercising any stock options or selling any interest in a partnership or company.” This is also the time to analyze different retirement funding sources and how that will be drawn down. “Traditional IRAs and 401Ks and 403Bs are all regular income (tax deferred but regular income at withdrawal), so you want to make sure there are some tax-free buckets, as well – Roth IRA, Roth 401K and cash value of life insurance,” Harrison explained. Other topics for discussion include health insurance, long-term care wishes, transfer and withdrawal of wealth strategies and estate planning. With a bit of planning and expert help, it’s possible to successfully navigate every stage of life and career.

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The Times They are A’ Changing Proposed 2020 Physician Fee Schedule On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for the physician fee schedule (PFS) that includes provisions to update payment policies, rates, and quality provisions beginning on or after Jan. 1, 2020. The 2020 proposed rule (along w i t h By LUCY CARTER, other proposed CPA rules) represents a broader strategy designed to “create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.” How will these new strategies impact providers in 2020? Rate Setting & Conversion Factor Multiple changes are proposed to the practice expense component of the Relative Value Unit (RVU). Additionally, refinements to update premium data for malpractice expense and geographic practice indices are proposed (GPCIs).

• Practice expense RVU proposed changes include: • Several new equipment codes Corrections to indirect physician expense allocations In addition to the above refinements based on premium data, changes to the malpractice RVUs include seeking feedback on specialty mix assignments for low volume services. Geographic Practice Cost Indices (GPCIs) proposed changes include: • Weight by total employment when computing county median wages for each occupation code • Use a weighted average when calculating the final county-level wage index • The revisions to the components above, along with the budget neutrality requirement, result in an adjustment to increase the conversion factor from $36.04 to $36.09. The projected impact of these changes, based on specialty, are minimal. Many specialties will experience no change (i.e. family practice). The maximum projected increase is 3 percent for clinical psychologists and social workers and the largest projected decrease is 4 percent for ophthalmology.

Medicare Telehealth Services For 2020, the following codes are proposed to address telehealth services for the treatment of opioid use: GYYY1, GYYY2, and GYYY3. E-visits The proposed rule includes a work RVU of .25 for 98X00, and .44 for 98X01 and 98X02. Evaluation and Management Services (E/M) In 2020, CMS proposes to abandon many of the policies finalized for the 2019 year. The most significant change proposed relates to the 2019 change collapsing office/outpatient level 2, 3, and 5 E/M services. Instead, CMS proposes to largely follow recommendations from an AMA CPT workgroup on E/M (for 2021 implementation). Key proposed changes include: • Delete Level 1 for new patients (retain Level 1 for established patients). • Pay separate rates for five levels of established visit codes and four levels of new patient visit codes. • Revise the times and medical decision-making process for all codes. • Utilize a single add-on code (99XXX) for prolonged office/outpatient E/M visits.

• Require the performance of a history and exam only as medically appropriate. • Consolidate add-on codes GPC1X and GCG0X so that only the former remains in effect, related to ongoing care for a complex chronic condition. Proposed changes to E/M payment and coding policies, if implemented in 2021, will generate an estimated 16 percent increase for endocrinology, 15 percent increase for rheumatology and 12 percent increase for hematology/oncology and family practice. Ophthalmology is estimated to experience an estimated 10 percent decrease followed by radiology, physical/occupational therapy, pathology and cardiac surgery with estimated 8 percent declines. Therapy Services In the 2019 PFS final rule, CMS established modifiers to identify therapy services that are furnished in whole or part by physical therapy (PT) and occupational therapy (OT) assistants. A de minimis 10 percent standard was set for when these modifiers would apply to specific services. Beginning in 2020, the modifiers are required to be reported on claims (the 10 percent de minimis standard will continue to be applied). (CONTINUED ON PAGE 12)

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Healthcare Trends: Compensation Continues to Rise Execs, Physicians, Advanced Practice Clinicians See Increases By CINDY SANDERS

It’s a simple case of supply and demand. An aging population, sicker patients, move to new models of care and increased need for innovation have driven up the demand for skilled clinicians, administrators and industry executives. A shortage of providers across multiple disciplines and a tight labor market have made finding and retaining knowledgeable staff a priority … and that comes at a price.

The Marketplace

“In general, there’s been greater compensation delivered over the last one to two years as the economy has improved,” said Bill Hopkins, senior manager with Global Reward Services for KPMG, LLP. Over the past few years, he said salary increase budgets have inched up from the 2.5 percent to 2.7 percent range. “Those increase budgets are now creeping back up to the 3 percent level,” Bill Hopkins he added. “And general increases for higher earners and performers tend to be above that 3 percent level.” Hopkins continued, “Turnover is very costly to organizations, especially in healthcare.” Employers have to factor in both the cost to recruit and train a new hire and lost productivity. “Highly productive, high performance physicians are in high demand. Organizations, when looking at compensating them and making increases, want to make sure they retain them,” he said of the demand for competitive salaries and benefits. Hopkins added the same sentiment applies to any employee with institutional knowledge, with the stakes rising as you move up the organizational chart.

Physician Compensation Trends

In late May, the Medical Group Management Association (MGMA) released its 30th annual Provider Compensation and Production Report, a comprehensive view of compensation across the country with data from more than 147,000 physicians and non-physician providers (NPPs). Pointing to the latest data, Andrew Hajde, CMPE, assistant director of Association Content for MGMA, noted primary care physicians saw a 3.40 percent increase in Andrew Hajde median total compensation from 2017 to 2018. On average, specialists saw a 4.41 percent increase, and NPPs realized a 2.95 percent increase. For established providers, the largest increases in total compensation were for diagnostic radiology, general obstetrics and gynecology, neurological surgery, noninvasive cardiology and neurology. Hajde said providers have seen around a 7 to 11 percent increase in total compensation over the last five years. In comparison, inflation rates have been right around or below 2 percent since 2012. While statistically better off, he said it might not always seem that way from the physician’s perspective. “What it doesn’t take into account is the amount of effort they have to put in to achieve that salary,” Hajde explained. “Is it worth it to get that extra few percent if it takes 25 percent more effort?” Cristy Good, MPH, MBA, CPC, CMPE, senior industry advisor with MGMA, said compensation is being driven by competition, and those numbers extend beyond physicians. Other providers also are being actively recruited with good Christy Good

wages and benefits to fill gaps in care. “We’ve seen an increase in NPPs,” said Good. She said there is both a greater need for advanced practice providers in the wake of physician shortages and more capacity for individuals to become physician extenders with expanded programming at colleges and universities. “It allows a physician to be effective in a different way,” she added of the ongoing need for these clinicians. In the near term, both Hajde and Good expect to see continued high demand and tight supply of providers.

Ownership vs. Employment

Citing a 2019 American Medical Association report, Hajde noted the national organization’s Physician Practice Benchmark Surveys found fewer physicians are now owners than employees. The AMA Policy Research Perspective by Carol Kane, PhD, stated, “2016 was the first year in which less than half of practicing physicians (47.1 percent) had an ownership stake in their practice. With this report, a new milestone has been reached — 2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).” The report also found the distribution of physicians continues to slowly shift from small practices to much larger ones. The reasons for the changes, which have been part of a longer trend, are multifactorial. Good said there is certainly a “hassle factor” when it comes to addressing myriad regulatory requirements as an owner, but she also sees the move as a generational shift. “There’s probably more of a security factor in going to an employed model rather than starting your own practice,” she pointed out. “To start a private practice and to build your patient base when you’re up against all these big organizations, it’s challenging.” Finding work/life balance is another consideration between being employed and owning a practice. Hajde noted physicians have to consider whether they are willing to see patients 40-50 hours a week and then spend another 30 hours a week being a business owner.

The Impact of Tax Reform

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Could tax reform turn the tide on the trend towards employment over ownership? The trio agreed it’s too early to determine the answer. However, Hopkins noted, “The spirit of Section 199A and the way it’s designed should give solo practices and smaller groups, especially those in the rural areas, more incentive to stay independent.” Hajde agreed, “If they have more money than ever before in their pockets, they aren’t going to be as prone to seek out a different situation.” As for the overall employed physician trend, Hajde continued, “I expect, at the very least, it may

slow down. Will it reverse? I don’t think we have the data to know that, yet.” He added monetary considerations are only one part of the equation. However, looking at median incomes for many physicians, Hopkins said the Section 199A deduction for pass-through organizations could be beneficial to practice owners. “As long as their taxable income as an individual is below $157,500, they get the full benefit of the 20 percent deduction. From $157,500-$207,500, they get part of the deduction; and over $207,500, you’re out of the deduction,” he explained. And, Hopkins continued, those numbers double for married providers. Anything below $315,000 of taxable income (considering both partners) receives the full 20 percent deduction, with the deduction phasing out between $315,00-$415,000. Hopkins added the income threshold is based on taxable income so all other deductions should be considered first. He also said providers in private practice might want to weigh the benefits of taking time off compared to making extra income if they are near the cap. It might be a win/win to earn a little less but realize a similar or greater net income by keeping the deduction while also achieving a better work/life balance.

Burnout & Balance

While compensation is always important, Good and Hajde reiterated it isn’t the only consideration driving change. Burnout is very real for physicians and practice administrators. There is a growing sense of frustration over the ‘other things’ that get in the way of caring for patients. Although administrative simplification has been a rallying cry for MGMA and provider organizations – and has even gained traction in D.C. – the promise has yet to become reality. When asked if there have been significant steps forward, Good noted, “We keep hoping, but I think from the physician’s perspective, they would say ‘no.’” While some physicians are all about the work 24/7, Hajde said some newer physicians are rethinking the model with a view toward achieving a better balance. “It’s very much a generational expectation in terms of what it means to be a physician,” he said. For those who want a distinct division between work and life, Hajde noted they tend to hover closer to the MGMA median of compensation. Those in the 75th percentile and up typically are working longer hours. “It can be done, but it’s a bit more difficult to have it all,” he said. On the flip side, it’s possible compensation evens out over time if those with somewhat shorter hours have longer careers by avoiding burnout. “It really depends on the individual philosophy of the physician,” Hajde added of the best path to take. nashvillemedicalnews

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HEALTHCARE ENTERPRISE

Making the Grade with Embold Health

Improved Savings, Outcomes by Identifying Top-Performing Docs By MELANIE KILGORE-HILL

How do companies know employees are getting the best healthcare available? Until now, they didn’t … but thanks to Embold Health, today’s employers can do more than cross their fingers and hope for best outcomes. The data analytics company is creating a new standard for healthcare quality by combining the largest dataset in healthcare, clinically validated analytics and the expertise of leading physicians and data scientists to shine a light on top-performing doctors, ensuring that people receive better care and that all doctors have the opportunity to improve.

Variations in Care

The Nashville-based company was founded in 2017 by Daniel Stein, MD, MBA, a primary care provider who previously served as chief medical officer of Walmart Care Clinics. Stein also served as an emergency room physician for the Veteran’s Healthcare System of the Ozarks and held various policy Dr. Daniel Stein positions in Washington, D.C., while completing his medical degree at Johns Hopkins School of Medicine in Baltimore. As a medical student, Stein first noticed a striking contrast in provider performance. “Even while training at Johns Hopkins, which is one of the best schools in the country, there were physicians whose skills hadn’t kept up as much, or doctors who were performing tests that the latest science showed weren’t necessarily beneficial to patients,” he said. “It struck me that from the outside in we all look the same; but from the inside, we’re all quite different when it comes to quality of care.” That realization frustrated Stein and followed him throughout his career. Even at Walmart, he realized that the biggest and most sophisticated companies still didn’t have sophisticated enough analytics to view performance in a clinically meaningfully way. The absence of a data-driven, scientifically objective way to measure provider care prompted Stein to form a data sharing collaboration with Blue Health Intelligence, the largest and most complete healthcare data set in the country. Stein also pursued collaboration arrangements with top academic researchers to help bring the best science and research to provider performance. nashvillemedicalnews

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Teaming with Walmart

In 2019 Embold Health publicly announced Walmart as their first partner. “We’re very excited for this relationship, since Walmart is a tremendous innovator in pushing the envelope around the importance of quality and innovation,” Stein said. The world’s largest retailer rolled out the initiative to approximately 115,000 employees and family members in select markets and is working with Embold to roll out the benefit on a market-by-market and specialty-by-specialty basis. “Healthcare is local, and the quality of care in one city is different than another and across specialties,” Stein explained. “We empower employers and employees, regardless of community, to get in and see those physicians who consistently deliver high quality care. Everyone deserves to know they’ll get care based on science, but much of healthcare’s existing quality measures like readmission rates and length of stay are a bit of a hodgepodge and often at hospital level. We’re looking at care delivered at the physician level.”

Key Drivers

Embold uses three key drivers to examine results for physician performance – appropriateness of care, effectiveness of care and total cost of care. “When we run analyses to share with employers, we show them opportunities to improve quality by helping employees find physicians who consistently perform better,” Stein said. That includes identifying those who provide inappropriate or unnecessary care – a problem Stein considers an epidemic in the U.S. For obstetric care, as an example, that means highlighting physicians with lower C-section rates and complications among healthy women with low-risk pregnancies vs. those with higher rates of C-sections and complications. By directing patients toward providers with better outcomes, employers remove the guesswork while, in the long run, reducing costs.

The Process

Embold provides physician information to employers, who decide how they want to craft their benefits plan. Employers then integrate that information into their health plan and equip employees with Embold’s user-friendly provider finder guide. Embold provides full transparency in sharing findings with clients, as well as the medical community, and Stein said providers are grateful for the

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Critical Insights into Nashville Health, continued from page 1 The survey, which was available in English and Spanish, was mailed to 12,000 homes covering different areas of the county to elicit response from participants across age groups, education levels, race/ ethnicity, income levels and gender. The response rate was approximately 15 percent with just over 1,800 respondents aged 18 and over answering the questions online or by returning the mailed paper questionnaire. While there certainly were some bright spots, the data Caroline Young underscored the role social determinants play in health and well-being and highlighted inequities and areas that need improvement before all Nashvillians have the opportunity to optimize physical, social and emotional health. First the (Mostly) Good Most adults in Davidson County have health insurance and visit their doctor annu-

Blog Log The Nashville Medical News Blog features additional insights and information from a crosssection of industry leaders. The blog can be accessed directly through NashvilleMedicalNews. Blog or from the homepage of the main website. NEW IN NOVEMBER:

Joel Headley, director of local search and marketing at PatientPop, discusses the importance of tracking reviews and acting on insights. A recent survey found nearly 75 percent of individuals have used online research to discover more about a provider or care service. Brian Howard, senior project executive at Messer Construction Co., looks “Behind the Scenes of the USP800 Pharmacy Guidelines.” Anne Layman Wires, BBA, MoM, CCUFC, vice president of Business Development and Member Relations for Life Credit Union, discusses the importance of knowing your financial health numbers. While most physicians and industry professionals know their numbers as it relates to physical health, how many know their numbers relative to their financial health, what those numbers should be, and how it impacts them? Mary Sue Patchett, executive vice president of community operations at Brookdale Senior Living, explains why you need to think about paying for senior living now, and provides tips on how to manage costs. 12

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ally. “The vast majority, 90 percent, of Nashvillians report having health insurance; and nearly 65 percent report seeing their doctor annually, which is very good,” said Young. Despite the exciting news, she pointed out the survey also highlighted groups where insurance and regular care weren’t as widely accessible. “The Hispanic/Latino community and the LGB community are less likely to be insured,” she explained. “Knowing this helps NashvilleHealth and other organizations better allocate resources and target programs to address this disparity.” Another concern, said Young, is that even with the high rates of insurance coverage, “more than one in five Nashvillians indicated they currently have healthcare bills that are being paid off over time.” While Tennessee continually ranks higher than the national average when it comes to smoking rates by adults – 22.6 percent for the state vs. 14 percent for the country according to the most recent CDC statistics – the survey found Davidson County beats both. Only 13.2 percent of Nashvillians report being current smokers, and 6.6 percent said they used e-cigarettes or vaping products. Interestingly, however, Nashville’s East Zone doubled the smoking rate with 26.3 percent of those respondents reporting being current smokers. Perhaps not surprisingly, that was also the geographic zone that was most likely to suffer from respiratory illnesses including COPD, emphysema, asthma and chronic bronchitis (26 percent). Another red flag underneath the overall good news was that vaping rates more than doubled when looking specifically at young adults ages 18 to 29. “Fewer Nashvillians report using tobacco than expected. This is good news, but the survey also shows a rise in vaping among 18 to 29 year-olds. This tells us that there is still a problem with nicotine addiction in our community and that we should look for ways to target programming and dollars to address the disease,” said Young. Needs Improvement Obesity continues to be a major challenge within the city. Based on self-reported weight and height, which was used to calculate Body Mass Index scores, two-thirds (63.6 percent) of Davidson County residents are categorized as obese or overweight. Unlike other health indicators within the survey, overweight and obesity was an issue across education and income levels. However, racial disparities do exist with 78 percent of African American respondents and 73 percent of Hispanic/ Latino respondents being classified as overweight or obese compared to 55 percent of White respondents. The Northwest Zone of Davidson County also had the highest prevalence of overweight and obesity with 72.5 percent of the area’s residents falling into one of the two categories. “The insights provided by the survey can better inform work already being done across the county and drive better decisions, alignment of resources, and creative new solutions,” said Young. “For example, Nashvillians report eating only three servings of dark green vegetables and five serv-

ings of fruit during the week. The USDA’s Dietary guidelines recommend 5-13 servings a day. This tells us we need to focus on helping residents incorporate fruits and vegetables into their diet.” She added that by having these baseline data points, it will be easier going forward to measure the effectiveness of various interventions. The survey also revealed a significant need to focus more on mental health in Davidson County. “We were not expecting that Nashvillians would report a greater number of poor mental health days per month than residents in our peer cities and the state overall,” said Young. Yet, residents reported having 5.3 poor mental health days involving stress, depression and emotional problems in a 30-day period. That rate outpaces the state average of 4.5 days and peer cities like Austin, Texas (3.3 days) and Charlotte, N.C. (3.4 days). The national average is 3.8 days. Women self-reported 6.2 poor mental health days per month compared to 4.3 days for men, and more than 20 percent of Nashvillians indicated having been diagnosed with a depressive order. Currently, 15.5 percent of county residents report taking medicine or receiving treatment from a healthcare professional for a mental health and/or emotional condition. “Our hope is that clinicians and researchers throughout our community will be able to take this data and drill further down on the possible causes and contributing factors,” Young noted. The Role of Social Determinants The health and wellness divide in Nashville largely tracks along education and income levels. Although the 5.3 poor mental health days a month was surprising, that rate pales in comparison to the 10 monthly poor mental health days reported by those

who never graduated from high school. Similarly, while 30.5 percent of Nashville adults have been diagnosed at some point with hypertension, that rate dips to 17.7 percent among those with a college degree. Conversely, the hypertension rate is 39.6 percent for those who didn’t graduate from high school. When it comes to opioid use, income and education are major factors, as well. Those in households earning less than $25,000 a year were 12 times more likely than those making $100,000 or more a year to use opioids not prescribed to them within the past year. Nashvillians with a college degree took opioids not prescribed to them at a rate of 3.8 percent compared to the 11.8 percent of those without a high school diploma taking unprescribed opioids. Next Steps “We are making the survey and its findings available to anyone who has interest in using it to better understand the health of Davidson County residents,” said Young. “We have already received great feedback from local researchers on the richness of the data,” she added. Young noted this is some of the first data of its kind looking at LGBT population health, which area researchers have been particularly interested in exploring it more deeply. “For the first time in nearly 20 years, we have rich, timely data that is providing critical insights into the health and wellbeing of Nashvillians and will serve as a baseline by which we can measure future interventions and programs,” Young continued. “Now, we need to put it to work … and we need the medical and research community’s help,” she concluded. Links to the full survey results and executive summary are available online at nashvillehealth.org.

The Times, continued from page 9

Physician Supervision Requirements for PAs CMS proposes to modify the regulations on physician supervision of physician assistants to give PAs greater flexibility to practice more broadly in the current healthcare system. Changes in flexibility will be governed by state law and state scope of practice.

Principal Care Management (PCM) Services CMS proposes to introduce new coding for PCM services which would pay clinicians for providing care management for patients with a single serious and high-risk condition. A qualifying condition would be expected to last between three months and one year, or until the death of a patient. The condition may have led to a recent hospitalization, and/or place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline. Proposed MSSP Quality Measure Changes for 2020 Performance Year CMS is soliciting comments on how to potentially align the Medicare Shared

Savings Program (MSSP) quality performance scoring methodology more closely with the Merit-based Incentive Payment System (MIPS) quality performance scoring methodology. CMS believes that aligning quality metrics across programs will allow ACOs to more effectively target their resources toward improving care. Summary The comment period for the proposed rule closed Sept. 27, 2019. Now we wait. While we wait for the final rule, reviewing the impact of the proposed changes on specific specialties is encouraged. The proposed rule is published in the Federal Register, Vol. 84, No. 157/ Wednesday, August 14, 2019/Proposed Rules (link available in the online version of this article at NashvilleMedicalNews.com). CMS has also published a fact sheet which is published on their website at cms.gov/newsroom. Lucy Carter, CPA, is a member (owner) in KraftCPAs PLLC and practice leader of the firm’s healthcare industry team. Contact her via email at lcarter@kraftcpas.com. For more information, visit www.kraftcpas.com/healthcare.htm.

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Tennessee Health Care Hall of Fame Inducts 2019 Honorees By CINDY SANDERS

On Oct. 15, the Tennessee Health Care Hall of Fame inducted seven new members as part of the Class of 2019. The most recent honorees mark the fifth group of healthcare luminaries recognized since the inaugural class of inductees in 2015. Created by Belmont University and Belmont’s McWhorter Society with the support of the Nashville Health Care Council, a founding partner, the annual event recognizes industry pioneers, legends and leaders with ties to the state. The seven members inducted this year were:

she worked with the YWCA’s Domestic Violence Program where she established a new shelter to serve women and children, as well as helped implement law enforcement and court reforms to better protect domestic violence survivors.

David Barton, MD: A psychiatrist and early advocate for delivering compassionate, holistic end-oflife care, Barton and fellow honoree John Flexner, MD, founded Alive Hospice. A faculty member at Vanderbilt University School of Medicine, who later launched a practice as a community clinician in general psychiatry, Barton became increasingly interested in how the medical community approached dying and end-of-life care. Alongside Flexner, he began to establish new approaches to holistically care for the terminally ill and developed one of the first courses in the country to help train medical students in caring for those with life-threatening illnesses. In December 1974, Barton hosted a meeting of multidisciplinary providers at his home to discuss how to apply these concepts in the community. Within a year, Alive Hospice was incorporated, becoming the first hospice in the Southeast and one of the first few in the nation.

Nancy-Ann DeParle: A national healthcare policy visionary with deep Nashville roots, DeParle’s healthcare career has spanned Tennessee, two White House administrations and boards of countless healthcare companies and non-profit organizations. A graduate of UT, she was the university’s first female student body president. She went on to earn her law degree from Harvard and to be named a Rhodes Scholar at Balliol College of Oxford University. Beginning her career at Bass, Berry & Sims, she went on to serve as Commissioner of the Tennessee Department of Human Services under Gov. Ned McWherter, becoming the youngest Cabinet member in state history. She joined the Clinton administration as the associate director for Health at the White House Office of Management & Budget and went on to become administrator of the Center for Medicare and Medicaid Service (CMS), where she implemented the State Children’s Health Insurance Program. DeParle later served as counselor to President Obama and director of the White House Office of Health reform where she spearheaded Affordable Care Act enactment. Currently, she is a partner and co-founder of Consonance Capital Partners, which supports innovative healthcare companies.

Mary Bufwack, PhD: Serving as CEO of United Neighborhood Health Services (now Neighborhood Health) for nearly 30 years, Bufwack helped change the landscape for affordable primary care in Middle Tennessee and beyond. Leveraging federal resources and community partnerships, she grew the number of Neighborhood clinics from three to 13 during her tenure, initiated school-based and homeless services, and helped pioneer a comprehensive, integrated network to care for the medically underserved. Today, Neighborhood Health serves more than 30,000 uninsured and underinsured Middle Tennesseans. Bufwack earned her doctorate in anthropology from Washington University in Saint Louis and spent several years on the faculty of Colgate University before relocating to Nashville. Prior to joining Neighborhood Health,

Lloyd C. Elam, MD: The Little Rock, Ark., native spent nearly five decades in Nashville. The first African American to graduate from the University of Washington School of Medicine, he completed internship at the University of Illinois and a residency in psychiatry at the University of Chicago before being recruited to Meharry Medical College to join the faculty and develop the Department of Psychiatry. Additionally, he founded Meharry’s psychiatry residency program and launched one of the first hospital day programs in Nashville for psychiatric patients. The community health model was in its infancy, but as a proponent of providing better access to care, Meharry’s Community Mental Health Center, which now bears his name, was founded. His leadership led to being appointed interim dean of the medical school, and at the young age of 39, he was

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named Meharry’s sixth president, a role he held for 13 years. Elam remained an active faculty member, mentor, advisor and community leader until his death in 2008.

John M. Flexner, MD: After earning his medical degree at Johns Hopkins, Flexner completed his internship and residency at Vanderbilt and Yale and his fellowship training in hematology at Vanderbilt. He served as a professor of hematology at Vanderbilt University School of Medicine from 1959 to 2011 and was named professor emeritus prior to his death in 2011 at the age of 85. Alongside fellow inductee Dr. David Barton, Flexner helped change the process of death and dying by founding Alive Hospice in 1975. Although known to be candid and honest about the seriousness of a patient’s illness, he was equally renowned for his warmth and quick wit. Early in his career, Flexner became interested in pain management, which later led to his work within navigating end-of-life care. He also wrote several papers on T-Cell lymphomas and contributed to the seminal work of his collaborator, Dr. Robert Collins. Flexner was elected an American Cancer Society Professor of Oncology in 1981, one of only 17 in the country. Richard L. Miller, FAIA, EDAC: A 52-year veteran of the healthcare design industry, Dick Miller moved to Nashville shortly after earning his architecture degree from the University of Kansas. After relocating, he quickly rose through the ranks of Earl Swensson Associates, now ESa, which specializes in healthcare design and has created iconic facilities across the country. Just six years after joining the firm, Miller was named president and was elevated to chairman last year. Starting with less than two dozen employees, ESa is now recognized as one of the top-ranking healthcare design firms in the nation and employees more than 180 professionals across different disciplines. Passionate about the role healing environments play on improved patient outcomes and staff engagement, Miller has led countless projects including Centennial Medical Center and the Monroe Carell Jr. Children’s Hospital at Vanderbilt here at home. He has coauthored three editions of a widely used text on healthcare design and is actively involved in a number of healthcare nonprofit organizations in Middle Tennessee.

Jonathan B. Perlin, MD, PhD, MSHA, MACP, FACMI: Nationally recognized as one of the country’s most influential health leaders, Perlin has provided leadership for the Veterans Health Administration and HCA Healthcare. As Deputy and Under Secretary for Health of the VHA, Perlin led the nation’s largest integrated health system and oversaw the benchmarking of clinical performance and full implementation of the system’s EHR. He initiated the Million Veterans Program, mapping genomes of one million veterans to better understand disease and therapy and to prevent injury to service members. In his role as chief medical officer and president of Clinical Services at HCA Healthcare, Perlin led HCA to build a clinical data warehouse as the basis for a learning health system, which uses data from 32 million annual patient encounters to inform and improve care. This model provided the foundation for landmark clinical trials that identified ways to nearly halve healthcare-associated infections and prevent elective pre-term deliveries. Additionally, he guided HCA and U.S. policy to require influenza vaccination for healthcare workers to prevent transmission to patients. Perlin, a member of the National Academy of Medicine, also has served on or led multiple committees with broad national health implications.

Making the Grade, continued from page 11 feedback. That’s because most have never seen data about their own performance. “We’re focused on driving improvement through transparency, and we are fully transparent with measures, methodology and physicians,” Stein said. “As a PC myself, I know physicians get up wanting to help patients, but in reality the practice of medicine is hard. There are always new practices, treatments and guidelines, and most of us don’t get feedback on how care has been delivered, although we want it.” From Embold’s physician page, providers in Embold markets can request a report to learn how they perform relative to their peers. Consultations also are available to help empower providers and equip them with tools and data to improve. “We want to help improve healthcare in this country,” Stein said. “We think everyone deserves to go to a physician who delivers high quality care, and every physician should be delivering high quality care based on the latest science. Embold provides information, insights and ability to help empower better quality care for everyone.” NOVEMBER 2019

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Proposed Changes to Stark, Anti-Kickback Regulations Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed changes to the Stark Law and Federal AntiKickback Statute. Among the goals of the proposed changes are supporting value-based and coordinated care initiatives and modernizing the law and statute in the process. By JESSE NEIL Yet, some fear the changes will mean more compliance pains and increased financial pressure for smaller healthcare entities. The changes call for complete or partial risk on the part of providers, and while this is the type of change policymakers believe is needed to move the healthcare economy from volume-based to value-based, it could mean major challenges for some providers. Consider the following questions with regard to the proposed changes. Will the new rules improve care? The proposed rules call for providers and stakeholders to work together in the coordination of care, and they provide more flexibility for providers to share cost savings and develop innovative risksharing models. Under current Stark Law, physicians are banned from referring patients to facilities in which they have a financial stake unless a specific exception applies. The proposed changes to the law would expand the activities that can meet an exception in order to protect legitimate value-based arrangements from penalties. Additionally, the changes put an emphasis on cybersecurity resources and technology and set out rules regarding when it is appropriate to donate cybersecurity technology. As described by CMS Administrator Seema Verma in an Oct. 9 article in FierceHealthcare: “A hospital that wants to protect electronic health records and other data may be worried about providing cybersecurity software to physicians for free or reduced cost due to the Stark Law. Our proposed rule would allow for such a common-sense arrangement while ensuring physicians won’t be obligated to make referrals.” Expanding the circumstances in which sharing cybersecurity resources and technology meet a safe harbor will not only improve care coordination and the sharing of health data now, but should also benefit the industry down the road. Are the changes worth the added complexity? Yet, like any public policy, there are trade-offs. The proposed changes 14

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involve new definitions and complicated exceptions, among other things. You could argue that the changes don’t take away all the burdensome rules; instead, they add more caveats that, if satisfied, may allow a provider to avoid current regulatory restrictions. It is hard to believe that the proposals won’t, on balance, help stakeholders with the transition to value-based models, but only time will tell which specific proposals are the most beneficial. Are providers really prepared to make the leap? The new rules call for providers to ultimately take on substantially more financial risk in these value-based arrangements. However, full financial risk requires a good deal more in upfront investment, and the nuances of the risk assessment changes have yet to be clarified. Downside risk could be a barrier for smaller healthcare entities. It will be a challenge for small and mediumsize providers to assemble and deploy the infrastructure and expertise to make the shift to managing downside risk. For smaller, regional players, it’s going to be harder to take advantage of the proposed flexibility. If a provider goes fully at risk, the provider will have to invest in a wide range of assets. The providers who have a lot of resources, lawyers, big data and highly-trained technical professionals will continue to succeed, but it will be a pretty significant burden for rural providers or single-specialty providers. In the end, these may be the exact things the government is trying to incentivize providers to invest in, and at some point cost/benefit analysis will compel practically all providers to make these investments to one degree or another. Though policymakers say the goal of the proposed changes is to simplify the system, there will always be winners and losers. Providers and stakeholders should carefully review these changes to see how the proposed rules could impact their interests. CMS is allowing for a 75-day comment period, ending 5 pm on Dec. 31, 2019. Go online to NashvilleMedicalNews.com for links to the proposed changes to the Stark Law and Anti-Kickback Statute. Jesse Neil is a veteran healthcare attorney at Waller, a top-10 national healthcare law firm. His depth of knowledge and experience helps clients bridge the complex worlds of healthcare operations and public policy. Prior to joining Waller, he served as in-house counsel at Community Health Systems and previously served as assistant attorney general for the Office of the Tennessee Attorney General where he led investigations into healthcare entities and pharmaceutical companies with respect to compliance with fraud and abuse statutes. For more information, go to wallerlaw.com.

GRAND ROUNDS

Power of Prevention: Diabetes Awareness Health Expo

Set for Saturday, Nov. 16 from 10 am-4 pm at the Cal Turner Family Center at Meharry Medical College, this free public event is presented by the Dorothy Marie Kinnard Foundation (DMKF). The day will feature health screenings, healthy cooking demonstrations and samples by Chef Batts, exercise and fitness activities, children’s activities and much more. There will also be educational events including the ‘Ask the Doctors’ panel discussion with some of the city’s leading medical experts on health moderated by six-time Emmy® Awardwinner Vicki Yates of NewsChannel5. For more information on the event, call (615) 283-8281, go online to dmkf. org or email to  info@dorothymariekinnardfoundation.org.

Lung Association Hosts LUNG FORCE Expo

On Friday, Nov. 22, the American Lung Association will host 2019 LUNG FORCE Expo focused on e-cigarette dangers, radon, mindless meditation for people with lung disease and much more. The event, which will be held at the Hilton Franklin Cool Springs, is designed for patients and healthcare professionals to learn more about the latest trends, resources and research surrounding lung cancer, chronic obstructive pulmonary disease (COPD), asthma and other respiratory issues. The LUNG FORCE Expo Patient and Caregivers Program is at 9 am and the Healthcare Professionals Program is at 7:30 am. For more information, go online to action. lung.org and click on Tennessee.

THA Wraps Annual Meeting, Installs Officers

Last month, James Ross, presi-

dent and chief executive officer (CEO) at West Tennessee Healthcare, Jackson, was installed as chairman of the Tennessee Hospital Association 2020 Board of Directors during the organization’s 81st Annual Meeting. “J.R.’s caJames Ross reer at the bedside and in executive positions at the hospital offers an insight that will benefit both hospitals and patients as he begins his year as THA chairman,” said Wendy Long, MD, THA president and CEO. Throughout Ross’s 34-year career at West Tennessee Healthcare, he has held various positions, including emergency medical technician, surgical intensive care registered nurse, critical care unit director, executive director of physician services and chief operating officer. He also serves on the Madison County Board of Health and is a member of the American Nurses Association and American College of Healthcare Executives (ACHE). In 2014, Governor Bill Haslam appointed Ross to the Ten-

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Moran Installed as President of AAFPRS Nashville-area facial plastic and reconstructive surgeon Mary Lynn Moran, MD, FACS has been installed as 2019-20 president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). She is the first female facial plastic surgeon Dr. Mary Lynn Moran to serve as president of the world’s largest specialty association for facial plastic surgery. Based in Franklin, Moran focuses on cosmetic and reconstructive surgery of the face and neck, as well as advanced nonsurgical techniques. She has extensive experience in the surgical rejuvenation of the aging face, rhinoplasty, revision rhinoplasty and is a nationally renowned expert in neurotoxins and filler injections. Moran is  double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology. 

Nalley Admitted as Newest Member at KraftCPAs Effective Nov. 1, Scott Nalley has been added to the membership team at KraftCPAs PLLC as the 16th  partner at the firm. Nalley began with the audit team at Kraft in late 2004 before leaving in 2007 to work at Vanderbilt’s internal audit department. He reScott Nalley turned to Kraft in 2013 and is now part of the firm’s Risk Assurance & Advisory Services (RAAS) team, where he oversees several of the firm’s largest internal audit engagements. In addition to those key roles, Nalley is heavily involved in the firm’s system and organization controls (SOC) practice, as well as consulting engagements for HITRUST and HIPAA clients. He also helps lead the firm’s campus recruiting efforts and is actively involved in multiple community and professional organizations, including Leadership Health Care. He is a 2003 graduate of the University of Memphis.

Landis Joins NVAVI Nashville Vascular and Vein Institute has expanded the practice staff with the addition of new physician assistant Jennifer Landis, PA-C. She brings extensive clinical and business knowledge from nashvillemedicalnews

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her ER experience and as an entrepreneur who started her own skincare company. Landis will assist Patrick Ryan, MD, in the operating room, as well as seeing patients in the clinic. Landis earned her undergraduate degree in healthcare and hospital marketing from Clemson University and her master’s in Physician Assistant studies from South College in Knoxville.

VUMC, Nashville Healthcare Community Mourn Loss of Children’s Hospital Leader Last month, Vanderbilt University Medical Center announced the loss of Luke Gregory, MDiv, MBA, MHA, FACHE, chief executive officer for Monroe Carell Jr. Children’s Hospital at Vanderbilt  and senior vice president for Business Development. Dr. Luke Gregory Gregory died on Oct. 18 after a lengthy battle with lymphoma. The embodiment of a servant leader, he joined the medical center in 2007 as senior vice president and chief business development officer. In January 2011 he was named CEO of Children’s Hospital. Under his leadership, Children’s Hospital has undergone critical expansions of inpatient space and outpatient clinics, including the current four-floor expansion that is nearing completion. Gregory was also instrumental in the growth of off-site services, including Monroe Carell Jr. Children’s Hospital Vanderbilt at Williamson Medical Center, an outpatient surgical center in Spring Hill and the soon-to-open surgery and clinics facility for children in Murfreesboro. “We are feeling a profound sense of loss over Luke’s passing at so many levels. He was an exemplary leader who served his colleagues, our patients and their families with great compassion. Personally, I’m extraordinarily grateful for the opportunity that I had to work alongside this exceptional man for the past 13 years and want to express my deepest sympathy to his wife, Susan, and their children,” said C. Wright Pinson, MBA, MD, deputy chief executive officer and chief health system officer for Vanderbilt University Medical Center. Prior to joining VUMC, Gregory, a longtime Nashvillian, served as senior vice president for Operations with Baptist Hospital and was CEO and recently chairman of the board for Blakeford Inc. An Eagle Scout, he served as an executive board member with the Middle Tennessee Council for the Boy Scouts of America and was actively involved in a numerous other community organizations. Meg Rush, MD, MMHC, has been named interim president of Children’s Hospital effective immediately. She has served as chief of staff for Children’s Hospital since 2007, adding the responsibilities of executive medical director in 2012.

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nessee Emergency Medical Services Board of Directors. Paul Korth, CEO at Cookeville Regional Medical Center, serves as chairman-elect and Wright Pinson, MD, MBA, FACS, CEO at Vanderbilt Health System, serves the board as immediate past chairman. A number of Middle Tennessee hospital and health system executives serve on the statewide organization’s board. The full list is available online at NashvilleMedicalNews.com.

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