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Your Middle TN Source for Professional Healthcare News

A Cut Above


Area Orthopaedic Providers Rolling out Latest Technology, Research

Tiffany Feltman, DO

There’s never been a better time … or place … for orthopaedic care. Throughout Middle Tennessee, surgeons and patients are reaping the benefits of innovative treatment options resulting in better outcomes and quicker recoveries.

THA Launches Data Sharing Initiative for TennCare Patients Data sharing is an ongoing struggle for healthcare providers, but the Tennessee Hospital Association has launched an initiative that seeks to improve outcomes for providers and patients, alike ... 7

Nashville Hip Institute

Saint Thomas Health recently announced the launch of the Nashville Hip Institute at Saint Thomas Midtown. Formerly known as Nashville Sports Medicine and Orthopaedic Center, the initiative is a partnership between Saint Thomas Health and surgeons Tania Ferguson, MD, and JW Thomas Byrd, MD, a respected pioneer in hip arthroscopy.

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Programs of All-Inclusive Care for the Elderly (PACE) began in San Francisco as an effort to both help and honor elders. Today the program, which now enrolls more than 42,000 adults aged 55 and over in 31 states, continues to live up to that original promise of coordinated, patient-centered, community care. “PACE serves nursing home-eligible populations but serves them in the community as long as possible,” explained Robert Greenwood, senior vice president of Public Affairs with the National PACE Association (NPA) in Alexandria, Va. Greenwood said the PACE protocol was developed in California by On Lok Senior Health Services. The program traces its roots back to the early 1970s as people were beginning to experience longer lifespans. On Lok, which means “peaceful, happy abode” in Cantonese, was formed in response

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Keeping PACE with the Continuum of Care


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“My decision to move to Nashville was inspired by the merger of my expertise in complex open hip surgeries with the revolutionary work of Dr. Byrd,” Ferguson said. Combining their individual expertise and unique backgrounds in hip surgery, the surgeons offer a vast range of interventions for conditions including femoroacetabular impingement, hip dysplasia, pelvic and acetabular fractures and arthritis. “My vision is that our driven program will decrease the number of young men and women requiring hip replacement surgery by innovating pathways to preserve their own hips,” Ferguson said. PHOTO: MEGAFLOPP



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Making a Difference One Case at a Time Dr. Tiffany Feltman Brings Hope, Options to her Patients at Hughston Clinic Orthopaedics man said. “Two weeks later they’re walking better than they’ve walked in years and spending time with grandkids. It puts patients back into their original lives. It brings instant satisfaction to make such an immediate impact, and that’s been really touching.” Revision patients include those who have had total join replacement in the past but continue to experience pain or infection. “I like to find out the reason why and fix it,” Feltman said of unwinding the mystery. “If someone needs revision surgery, then I’m going to try my best to make them better.”


One year after joining Hughston Clinic Orthopaedics, surgeon Tiffany Feltman, DO, is changing the lives of patients … one case at a time.

Making a Difference

The Birmingham native first arrived in Nashville as an undergrad at Vanderbilt University. She soon headed to Georgia to attend the Atlanta branch of the Philadelphia College of Osteopathic Medicine. Following an orthopaedic surgery residency in Philadelphia, Feltman sought out a practice where she could make a difference, which brought her back to Middle Tennessee. “I wanted to find a private practice that wasn’t already saturated with board certified adult reconstructive surgeons,” Feltman said. “I wanted to be somewhere I could bring something new to the practice. After meeting with the Hughston physicians, I just felt it was a good fit.” A nationally recognized orthopaedic group with offices throughout the Southeast, Georgia-based Hughston Clinic partnered with Nashville’s Premier

Treating Dysplasia Orthopaedics & Sports Medicine in 2016. Today the group represents more than 70 physicians, including 23 in Middle Tennessee.

A Rewarding Field

Feltman specializes in joint revision, joint replacement and adult reconstruction. “When you see adult reconstruction patients, they’re the most excited before surgery and ready for the change,” Felt-

She also has a passion for working with younger dysplasia patients, often in their mid-20s. “These are patients around my age who had some kind of congenital abnormality or severe arthritis growing up, and being able to do something to get them either where they don’t have to have total hip replacement immediately or get them back to normal everyday life is very rewarding,” she said. Such patients – often otherwise healthy – are often not diagnosed by primary care providers in original exams. It

isn’t unusual for Feltman to be the second or third physician to see and ultimately diagnose them. “Dysplasia patients are often put off a little because sometimes normal X-ray views don’t show dysplasia,” said Feltman, noting that a special view can be required for diagnosis. Fortunately, age allows most dysplasia patients to bounce back quickly, returning to their normal lives pain-free.

Exploring All Options

Feltman often reminds patients that not every visit to an orthopedic surgeon’s office results in surgery. “It’s a common misconception for people to think that if they go to an ortho they’ll have surgery,” said Feltman. “In reality we err on the conservative side and try to avoid surgery unless it’s the last line.”

And on a Personal Note

A year after joining Hughston Clinic Orthopaedics to help change patients’ quality of life, Feltman made a significant life change of her own. In September she said “I do” to her fiancé, Nate. The newlyweds can be found running, biking or kayaking around Nashville’s parks and lakes with their three dogs.

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Tennessee Orthopaedic Alliance, the largest orthopaedic surgery group in the state, continues to expand. Urgent/Injury Care Earlier this year, TOA opened an Urgent Care/ Injury Care Clinic in their oneC1TY offices to provide expert treatment for sudden injuries to bones, muscles, or joints. Supported by TOA’s network of surgical specialists, the clinic provides patients with access to specialty care without appointments and after normal practice hours.   TOA officials said the goal was to provide convenient and immediate access to non-emergent care for sports, recreational, home, or work-related injuries. Everything from strains, sprains and dislocations to

broken bones, fractures and more acute injuries, can be assessed onsite. In addition, the clinic offers casting, X-ray, MRI, and CT services. TOA’s Urgent Care/Injury Clinic is open 9 am-7 pm Monday-Friday and 9 am-noon Saturday. The clinic sees both adult and pediatric patients with fellowship-trained pediatric orthopaedic surgical specialists available for consultation.

Innovation in Orthopaedics

Morgan Lorio, MD, Sells 22 Patents for Spinal Surgery By MELANIE KILGORE-HILL Morgan Lorio, MD, is changing the future of spinal surgery. The Hughston Clinic Orthopaedics spine, orthopaedic and hand surgeon recently sold 22 patents to Germany’s Emerging Implant Technology. Expected to hit the market in 2018, Lorio’s living hinge design for spinal cages is positioned to improve Dr. Morgan Lorio outcomes for spinal surgeons, health systems and patients … and it couldn’t have come at a better time.

Industry Changes

“The spine industry has seen diminishing margins as hospitals pressure to decrease costs and maintain their own margins,” Lorio said. “There’s been less innovation in spinal surgery over the past few years, in part because the money for research and development has dissipated.” The push to reduce healthcare costs, coupled with the movement toward patient-centered medicine, has opened the door for 3D printing technology. Unlike their traditional counterparts, 3D surgical implants eliminate costs associated with assembly. “3D printers have become ubiquitous, like copy machines,” Lorio said. “My patents are an effort to circumvent the technical issues I’ve encountered surgically implanting devices into a patient’s spine nashvillemedicalnews


West, Langan Join TOA Last month, Justin W. West, MD, joined TOA in the Murfreesboro office where he treats both adult and pediatric patients. He is a fellowship-trained orthopaedic surgeon specializing in sports medicine, arthroscopic surgery of the shoulder and knee, and complex shoulder reconstructions including anatomic and reverse total shoulder replacements. He is also trained in cartilage preservation and restoration techniques. West earned his undergraduate degree in biochemistry from Tennessee Tech University and received his medical degree with high distinction from the University of Kentucky. Subsequently, he completed Dr. Justin West a residency in orthopaedic surgery at the University of Cincinnati Medical Center and a one-year sports medicine and shoulder surgery fellowship at San Diego Sports Medicine and the Scripps Clinic at Torrey Pines. He has extensive professional and collegiate sports medicine experience. While

in San Diego, West served as a team physician for the San Diego Chargers, San Diego Padres, San Diego State Aztecs, San Diego Gulls and several other college and high school sports teams. Currently, he serves as a team physician for MTSU, Sewanee, and Rutherford County Schools. In August, Justin W. Langan, MD, joined the practice at the TOA Saint Thomas West location. The fellowship-trained orthopaedic surgeon specializes in in both anterior and posterior hip replacements, as well as total and partial knees. He earned his undergraduate degree from Western Illinois Dr. Justin Langan University where he also lettered in football and soccer. Langan received his medical degree from University of Missouri-Kansas City School of Medicine where he was a member of the Gold Humanism Honor Society and served as president for the School of Medicine and Surgery Society. He followed with a residency in orthopedic surgery at Greenville Health System University Medical Center where he served as chief resident and received the American Orthopaedic Association Resident Leader award. He completed his fellowship in adult reconstruction at Southern Joint Replacement Institute.

where less pressure or retraction is desired when mobilizing neurological elements and other soft tissues,” he explained. “These expandable cages can be delivered through a smaller working corridor and still deliver a large footprint once deployed.” Lorio’s living hinge cages are placed into the intra-discal space between spinal vertebrae to provide structural support to the spine. “When using traditional implants, it’s difficult not to harm the adjacent soft tissues,” said Lorio, whose design was inspired by the corrugated partitions found in cardboard boxes. “Living hinge cages provide more functional ease for the surgeon and provide a better outcome for patients.”

For Lorio, it’s Personal

The quest for better patient outcomes is personal for Lorio. As a pre-medical student in 1982, Lorio was working a parttime construction job when he fell 35 feet, sustaining a number of injuries including a broken back and split pancreas. The fall also resulted in transient paralysis. “Living with a spinal injury taught me to really examine and listen to patients,” said Lorio, whose experience motivated him to pursue orthopaedics. “The things I encountered made me a better listener, and I realized I’d have to stay on top of spinal research if I was going to take care of myself.” Lorio, who continues to act as a medical advisor for his patented technology, said webinars would be scheduled to address application of the cages as they become available early 2018.


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A Cut Above, continued from page 1 More Options for Hip Dysplasia

Periacetabular osteotomy is one of the latest dysplasia procedures performed at Nashville Hip Institute. In hip dysplasia, the socket is most commonly too shallow to sufficiently cover the femoral head, leading to hip instability and abnormal pressure on the periphery of the joint. PAO surgery involves cutting the bone and repositioning the socket to provide optimal coverage of the femoral head. This improves the mechanics and allows a more normal environment for the hip cartilage and soft tissues strucDr. Tania Ferguson tures. With a combined 40 years of experience, Byrd and Ferguson partner up on these and many other interesting cases. “The synergy of our skill sets has elevated the bar for our patients with dysplasia, but for many other diagnoses, as well, like avascular necrosis of the femoral head,” she said. “Our partnership is changing the playing field when it comes to hip pain, without question.”

TriStar Centennial’s GPS Technology Revolutionizing Knee Replacement

There’s more good news for ortho patients at TriStar Centennial, where GPS technology has made its way into the operating room. TriStar Centennial Medical Center was among the first hospitals in the nation to offer Exactech GPS Guided Personalized Surgery to individualize total knee surgeries for patients. The technology provides surgeons with real-time visual guidance and alignment data in total knee surgery. Similar to a car’s navigation device, this advanced platform provides a visual map of the patient’s joint on a screen, allowing surgeons to easily make adjustments, use minimally invasive techniques and perform implant alignment ®

Increasing Demand for PRP Therapy Previously, conditions such as arthritis or tissue injuries resulting from degenerative disease or sports injuries often caused extensive downtime, frequent rehabilitation and even surgery. With Platelet Rich Plasma (PRP) treatments – an injectable treatment offered by Tennessee Orthopaedic Alliance (TOA) and other practices to stimulate natural “growth factors” in the damaged tissues – many patients experience faster recovery and avoid surgery. “The results I’ve seen demonstrate that PRP is an excellent alternative to surgery, other drugs or extensive rehab,” said TOA physician Chris Anderson, MD. In fact, the practice has seen a 21 percent growth in the treatment over the past year. READ MORE ONLINE AT NASHVILLEMEDICALNEWS.COM




relative to the patient’s needs. “Compared to mechanical instrumentation, GPS navigation gives the surgeon better accuracy more often,” said Craig Morrison, MD, joint replacement surgeon with Southern Joint Replacement Institute at TriStar Centennial Medical Center. Morrison has used GPS in his operating rooms for four years. He was among the first to train on the newest iteration during its research phase and was instrumental in Centennial’s implementation of the technology in early 2017. “When we look at outcomes in knee replacement, having the knee aligned well means better long term results,” Morrison explained. “With traditional instrumentation, the bell-shaped curve is Dr. Craig Morrison wider and we see more patients outside of acceptable alignment. With navigation you narrow the curve so you’re more precise, and you limit the possibility that you’re out of alignment.” ExactechGPS provides surgeons with a comprehensive view of the knee joint and bone structure, which allows the surgeon to make adjustments to ensure accurate and precise placement of the implant. Morrison said prior attempts at computer navigated knee replacement put the computer out of the operative field, making it difficult to “change routes” once the surgery has started. “The bonus appeal is that it’s in the operative field, sterile, and under the surgeon’s control, ” he said. “You can change plans in real time if you encounter something you don’t expect.”

VUMC’s Quality Outcomes Database

In 2011, Vanderbilt University Medical Center was chosen to manage the collection and analysis of neurological data for the Quality Outcomes Database (QOD). Today, VUMC researchers work with more than 100 sites nationwide to interpret

data from more than 60,000 neurosurgical patients. “Our overall goals are to track safety and quality of care following spinal surgery,” said VUMC’s Clint Devin, MD, co-vice director for the national database. “We’re also trying to see which centers are performing the best at various procedures. Once we see which surgeons are performing well, we can create best practice approaches and understand what they’re doing to achieve better outcomes.” Site coordinators at each QOD location track safety measures and patient outcomes and participate in continuous audits. To that end, Devin and his team have created predictive calculators to help gauge five important points following surgery: • the ability to return to work, • improvement in leg, beck, neck or arm pain, • likelihood of achieving satisfaction, • likelihood of discharge to a rehab facility, and • likelihood of re-hospitalization. While 85 percent of surgery patients are pleased with outcomes, the team is examining data for insight into the 15 percent who aren’t. Researchers found opioid use prior to surgery is a key factor in a patient’s inability to tolerate post-surgical pain and have since discovered a cutoff of opioid use for elective surgeries. Patients with untreated psychological conditions like depression and anxiety also tend to fare worse afterward. “Some factors can’t be changed … but some can,” Devin said. “We want to find modifiable variables and start to implement them into practice to see how it improves outcomes.” Dr. Clint Devin In an effort to lower readmission rates, VUMC also has partnered with the Institute of Healthcare Improvement in Massachusetts to classify patients into high and low risk categories.

Devin said chronic pain typically sends patients back within 10 days of surgery, while those with medical complications typically return within 14 days. As a result, VUMC has instituted readmission initiatives and created optimization protocols for elective surgeries. Those standards have helped to lower VUMC’s readmission rate to 5 percent – half of the national average. Doctors also are using VUMC’s risk calculators to have personalized discussions with their patients. “Because of each patient’s unique characteristics, some may not do so well after an elective surgery,” Devin said. “It allows doctors to have a personalized risk/benefit discussion of a recommended spine surgery.”

TriStar Summit Welcomes Sandberg Last month, TriStar Summit Medical Center welcomed Rory Sandberg, MD, an orthopedic surgeon specializing in total joints replacement, to its medical staff. Sandberg received his medical degree from Albert Einstein College of Medicine in Bronx, NY. He completed his orthopedic surgery residency at the University of Arizona in Tucson and his fellowship in adult reconstruction at Indiana University in Indianapolis. He specializes in hip and knee replacement, partial knee replacement, revision hip and knee replacement (including infections), and non-operative treatment of hip and knee arthritis. Sandberg has joined Pinnacle Surgical Orthopaedics in Hermitage.

Novel Knee Surgery Uses Patient’s Regrown Cartilage Cells Vanderbilt’s Scott Arthur, MD, recently performed the state’s first knee surgery using a newly approved implant containing a patient’s regrown cartilage cells. Trademarked under the name MACI, the implant was approved by the U.S. Food and Drug Administration in December. It is the first FDA-approved Dr. Scott Arthur product that regrows knee cartilage cells on scaffolds. Previously, this type of regenerative therapy, which entails extracting healthy cartilage cells from a patient’s knee then regrowing them in a laboratory, was available only

in liquid form. “In the first generation, called Carticel, you would have to take a patch and sew it into the cartilage and then inject the liquid containing the cartilage cells behind the patch,” said Arthur, assistant professor of Clinical Orthopaedic Surgery and Rehabilitation. “With MACI, the M stands for matrix so it is a collagen matrix, and the patient’s own cartilage cells are implanted into the matrix. In the operating room, we shape the patch to fit into the cartilage defect.” MACI (Matrix-induced autologous chondrocyte implantation), a Vericel Corp. product, is approved for repairing cartilage defects in the knee for patients ages 18-54. The scaffolding better secures the regrown cartilage.

“It’s a good option for some joints with really difficult problems,” Arthur said. “A lot of patients who would benefit from MACI tend to be younger patients, athletic patients who want to regain a high level of function.” The MACI implant is approved for the repair of full-thickness cartilage defects of the knee, which is a fairly select patient group. Similar innovations with wider applications are on the horizon. “This is the next frontier in orthopaedics — trying to figure out ways to use your body’s own ability to repair itself,” Arthur said. “The future is utilizing stem cells and growth factors and cell therapy to encourage and enhance healing and recovery. That’s where we are going. We are in the infancy of trying to figure a lot of this out.” nashvillemedicalnews



The Little Clinic: Retail Health in the Continuum of Care age-appropriate screenings such as connecting patients to community providers for mammograms or colonoscopies.


Saturday Afternoon ‘To Do’ List: Take son for rapid strep test, purchase salad and salmon for dinner, get prescription filled after getting a positive on strep, earn fuel points, accomplish everything under one roof. One of the early entrants into the retail health space, The Little Clinic was founded in Louisville, Ky., in 2003 with a mission to simplify healthcare and make it more convenient and accessible to the patients served. Three years later and with a total of five clinics, the company moved its headquarters to Nashville. Today, there are more than 220 clinics in 10 states. In 2010, the healthcare provider was purchased by Cincinnati-based grocery giant Kroger and now has corporate offices in Nashville and Cincinnati. Marc R. Watkins, MD, MSPH, FACOEM, chief medial officer and vice president of The Little Clinic (TLC), said the relationship with a major grocer provides unique opportunities for TLC to work with patients to connect food choices with improved overall health. Watkins noted clinic services are generally considered ‘primary care lite’ with treatment for minor injuries and illnesses. While that is certainly true, he said TLC also provides treatment for chronic stable disease including monitoring hypertension and diaDr. Marc Watkins betes, sexually transmitted diseases, travel health, some health and wellness screens including sports physicals and biometric screening, vaccines and immunizations, along with basic behavioral health. Staffed by nurse practitioners and physician assistants working in concert with collaborating physicians – all board certified – he added the clinics have formed referral relationships and affiliations in their markets to connect patients to the larger healthcare system. Recently, TLC announced a collaborative partnership with Results Physiotherapy to offer patients additional pain solutions for a number of chronic conditions and injuries. “Committing to a model where we’re not in the business of prescribing opioids or controlled substances allows us to really look for partners that are doing the same,” Watkins added of the relationship with Results. nashvillemedicalnews


Triple Aim

Continuum of Care

Watkins said he absolutely sees retail health as an important part of the continuum of care. The company’s vision, he noted, is to offer convenient neighborhood medical care that feeds the human spirit and helps people live healthier lives. “We recognize we can’t do it alone,” he said. “To help people live healthier lives, we need partners.” However, he continued, “We stand as part of the ecosystem. We should be seen as a healthcare destination like any location.” Watkins noted, “One of the rubs that we’ve had from traditional medicine is that somehow we fragment healthcare.” However, he continued, healthcare is fragmented when there is a lack of communication. Watkins said TLC has made an aggressive push around sharing information with PCPs and other providers. Nurse practitioners and PAs are actively asking patients to identify a PCP if one exists and to consent to an electronic transfer of information. If the patient opts in, then a visit summary is automatically pushed to the physician on file. However, Watkins noted, “Almost 60 percent of our patients don’t have a declared primary care provider.” He added the goal is to connect those patients with locally based PCPs. “We’ve worked successfully in a lot of markets to make sure they (patients) don’t go unattributed … that they are connected with care.” He continued, “One of the things that we stress is that we’re not replacing PCPs in what we’re doing. We want to complement the PCP activity.” To that end, Watkins said TLC also has been aggressive in working to close gaps in care, particularly when it comes to

Watkins noted TLC is an important part of delivering the right care at the right place for the right cost. “We want our nurse practitioners and our physician assistants to practice to the top of their licenses in order to deliver the best evidence-based care for our patients,” he explained. “We will evaluate all of our patients understanding there will be times when conditions exceed our resources and capabilities. We are committed to providing evidence-based evaluations and recommendations that make good sense and that stay within the lane of safety and quality.” Watkins said by handling routine primary care, seeing patients outside of traditional office hours, and helping manage chronic stable

patients, TLC providers free up physicians and ERs to care for patients at a higher acuity level. “We can create more capacity through our partnership and affiliations by decompressing these specialists and the primary care physicians to allow them to focus on more complicated chronic disease,” he said. “Having care delivered at the right place is part of using healthcare dollars wisely,” he pointed out. Watkins attributed the clinic’s success to the attention placed on healthcare’s triple aim. “Part of what make us a little bit different is that we’re focused on providing the highest quality and the lowest cost … so we want to bend that cost curve but keep a high degree of quality.” He added, “We have a gold seal from The Joint Commission.” TLC also participates in a quality payment program and uses their EMR as part of their participation in MIPS. With their focus on preventive screening, the nurse practitioners and PAs ask age appropriate questions about alcohol use, seat belt safety, tobacco use, immunization status, and other important factors at every visit. “We are coding that into our EMR so it’s part of our workflow,” he added.



The Hallmark of Our Practice


Every provider strives for quality, but we do more...we measure ours. We have invested heavily in the Vascular Quality Initiative™ sponsored by the Society for Vascular Surgery. The VQI is a database that measures our results and compares them with vascular surgeons and practices around the United States. We believe to be really serious about quality, you must measure it. That’s why NVAVI is the only vascular surgery practice in Middle Tennessee that participates in VQI. But more than just measuring quality, the experienced team led by Dr. Patrick Ryan uses data to continually enhance best practices and improve outcomes. We hope you will allow us the privilege of partnering with you to treat your patients. You can rest assured they will receive the best evidencebased care and that you will be kept in the loop throughout the process.

DR. PATRICK RYAN 330 23rd Avenue North, Suite 100 | Nashville, TN 37203 | 615.321.6100




Keeping PACE, continued from page 1 to community concerns about caring for older individuals in San Francisco’s Chinatown, North Beach, and Polk Gulch neighborhoods. A consultant was brought in to assess building a nursing home in Chinatown but ultimately advised against it because the elders wanted to stay in their homes as long as possible and be fully connected to their family and community. By 1973, On Lok had opened one of the nation’s first senior day centers where elders came for socialization, health services, and hot meals before returning to their homes in the evenings. “The original concept was built on the British Day Hospital,” said Greenwood. He explained the U.K. model essentially created a nursing home with no bedrooms but all the other services traditionally found in a skilled nursing facilRobert Greenwood ity including physical therapy, occupational therapy, a health clinic and social services. By 1979, On Lok had launched a Medicare-funded demonstration project. However, Greenwood said, the team began to see gaps in services that weren’t typically reimbursable but would keep seniors home longer, including transportation and social services. In 1983, On Lok received waivers from the Centers for Medicare & Medicaid Services for a new funding mechanism for long-term care that used a risk-based capitation model and allowed On Lok flexibility in how the money was spent to address the full spectrum of an individual’s needs. “They

did that as an experiment, and it was very successful,” Greenwood said, noting that success paved the way for PACE to take off nationally. “In the Balanced Budget Act of 1997, PACE became a permanent provider type,” said Greenwood. “The core of PACE is there is an interdisciplinary team that delivers and coordinates their care.” He added, “It’s a requirement that your medical director is a gerontologist.” With a provider shortage, though, he said it is possible for a program to ask for a waiver. The team, he continued, works out of a PACE center so they are under one roof for improved communication. Much like hospital huddles, the team has a morning meeting to discuss any health or behavioral changes noticed among patients, a rundown of who is in the hospital and what is needed to support them at discharge, gaps in care or services, and any other items to improve coordination. One of the great advantages of the structure is the ability to tailor care to each patient and have the nimbleness to adjust the care plan whenever needed. The central mechanism of having a provider team under one roof that makes the program work so well, however, is also a perceived disadvantage for some potential participants. “That’s the number one objection – they don’t want to give up their community doctor,” said Greenwood, who added many PACE programs actually allow one or two visits each year back to the community physician with PACE reimbursing the provider for that visit. “The experience, though, is that once they are in the PACE program, they don’t usually ask for that,” he noted.

Keeping the game fair...

Greenwood said PACE participants are split fairly equally among those who live by themselves, those living with a family member, and those who live in a congregate setting. Care plans are as varied as participants and are centered on a patient’s personal goals, which might be very different from the goals of another patient. “The diagnosis might be exactly the same, but the care plan could be quit different,” he noted. While the payment model for PACE services has evolved over the years, it remains a capitated plan. “By federal law on the Medicaid side, we have to be paid less than what they (CMS) would expect to pay in a fee-for-service model,” Greenwood explained. “Medicare is riskadjusted like a Medicare Advantage plan.” New programs, said Greenwood, are almost always launched in conjunction with a sponsoring organization such as Johns Hopkins, which sponsors the PACE program in Baltimore. “By nature of being a managed care model, there are a lot of startup costs before you ever enroll

More about PACE Interested in learning more about launching a PACE program? Information is available at The organization’s annual meeting is also being held Oct. 15-18 in Boston, and the 2018 Spring Policy Forum is set for March 19-20 in Washington, D.C.

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the first patient,” he explained. “Usually the first year, you haven’t enrolled enough people to cover your month-to-month costs.” However, Greenwood continued, once programs get over that initial hump, they usually hit their stride. In fact, PACE programs have met with so much success that the hope is to extend the reach. The NPA worked with Congress to pass the PACE Innovation Act in 2015 to look at replicating the program in younger populations with physical or mental challenges. “There are other populations out there who need access to a continuous model of care,” said Greenwood. “I think the PACE success story is really the enhanced quality of life for a participant,” Greenwood said. In the original patient population, he continued, “it’s really about managing that end-of-life process and making it as enjoyable and meaningful for the enrollee and their family as possible.”

Mark Your Calendars Greater Nashville Healthy For Good™ Heart Walk • Oct. 14 More than 8,500 area residents are expected to raise their heart rates and more than $1.8 million during the American Heart Association’s annual event, which is sponsored by Delta Dental and Vanderbilt Heart. Events begin at 8 am, walk begins at 9:30 am at Vanderbilt’s Capers Field. Details available at 2017 Run for Babies • Oct. 28 Hundreds of runners and volunteers will join together at Shelby Bottoms Nature Center & Greenway for the event benefitting the March of Dimes. Pre-registration and details are available at Onsite registration (additional cost) will be available 6:30-7:15 am on Oct. 28 with the 5K race beginning at 7:30 am. Alive Hospice 2017 Faith & Spirituality Symposium • Nov. 2 Kerry Egan, a Harvard Divinity School-educated hospice chaplain and author of On Living, serves as the 2017 keynote speaker during this daylong event at Gaylord Springs Golf Links Clubhouse. Details are available at community.

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THA Launches Data Sharing Initiative for TennCare Patients By MELANIE KILGORE-HILL Data sharing is an ongoing struggle for healthcare providers, but the Tennessee Hospital Association has launched an initiative that seeks to improve outcomes for providers and patients, alike. Through their partnership with Audacious Inquiry, the THA has developed a way to share real-time hospital data with TennCare and Tennessee hospitals to enhance the management of care provided to enrollees and patients. THA’s new service, called ConnecTN®, allows THA and its members to support statewide care coordination and quality improvement programs. Real Time Data “Part of what the TennCare Bureau really wanted to know is what’s happening with its patients,” said THA President Craig Becker. “It was quite an undertaking to put this together.” The program has been fully implemented by more than 40 Tennessee hospitals and health systems, with Craig Becker plans to add remaining

organizations by the end of 2017. Through ConnecTN, an enrollee’s primary care physician would immediately know about the TennCare patient’s interaction with a hospital, including visits to hospital emergency rooms. Actionable, real time data means immediate plans can be made for postdischarge care, whether that includes home health, nursing home care or follow-up for a chronic or emergent condition. The Care Coordination Tool allows the primary care provider to immediately communicate with his patient, regardless of which Tennessee ED is visited, to address the reason for the visit. They can then work together to establish a plan for better managing the patient’s health and avoid future ED visits. “We find that payers all want a certain amount of information about patients so we’re trying to create a single source so it’s not such a burden to hospitals,” said Becker, noting that much of that pressure for data collection comes from managed care organizations. “We look at this as a first step so we’re making sure we’re doing it right. If we can make it work, a whole lot of other things can be done using this data to avoid duplicate data collection.” A Secure Network Becker said hospital response has been

overall positive, although many administrators were initially concerned about the security of any data sharing system. “We want to make sure what we’re doing is extremely secure,” said Becker. “The data storage and transmission platform has been utilized in several other states and is considered to be extremely secure. We’re just being very cautious, but now that most of our big systems are signed up, it’s just a process of getting everyone

else online.” To date, Audacious Inquiry’s Encounter Notification System has delivered almost 42 million notifications and benefitted more than 24 million subscribed patients nationwide. “The whole idea is that this will grow and become even more standardized and efficient than we are right now,” Becker said. “We’re still in the adolescent phase of electronic health records, and there’s a lot of room for progress.”

THA 79th Annual Meeting Oct. 11-13 • Music City Center Hospital executives from across the state will gather in downtown Nashville for the Tennessee Hospital Association’s 79th Annual Meeting. This year’s theme, Tennessee Hospitals: The Pulse of Our Communities, celebrates the work of hospitals and health systems, along with the integral role they play in shaping neighborhoods, cities and rural communities. “We’re really trying to stress the notion of community and how we all work together,” said THA President Craig Becker. “We’ve got a really good lineup that will help us get down to the nuts and bolts and give us all tools to take back and work with.” The conference will emphasize the importance of maintaining healthcare access in rural areas, where community is strong but hospitals - typically among an area’s largest employers – often aren’t. The 2017 THA Annual Meeting will bring together presenters and guests who will speak to the power of Tennessee’s hospitals, as well as the efforts working to improve them. Visit for more details.

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or more than 45 years, NHC has provided quality, rehabilitative care to people of all ages. With skilled therapists and decades of experience providing compassionate post-surgical care in locations close to home, you can get back to what’s important to you. So what’s first on your list?

Discover NHC and get back to life. Visit to learn more about our rehabilitative care services, to explore our full range of services and to find the NHC nearest you. To learn more about our homecare services, visit ©2017 NHC 23664







The M&A Perspective

Four Questions for LifePoint Health’s Jeff Seraphine By CINDY SANDERS

LifePoint Health’s Chief Development Officer Jeff Seraphine recently took time to share his perspective on strategic acquisitions and creating true partnerships to enhance the core mission. A founding employee of LifePoint Health, he was named to his current role earlier this year after serving as president of the Eastern Group of hospitals. He is head of the national healthJeff Seraphine care company’s M&A efforts and also has oversight of LifePoint’s strategic resource group, which manages data and insight to help hospitals grow and meet the needs of their communities. NMN: Over the past few years, we’ve seen several mergers and acquisitions that made sense on paper but haven’t played out as expected once the deal was complete. What are some of the due diligence steps … and how do you assess the intangibles … that are critical to smooth integration? Seraphine: Due diligence is vital to ensuring a true partnership between entities, and we believe that integration truly starts at due diligence. Identifying both

opportunities and challenges early in the due diligence process is critical to a smooth transition. Sellers explore affiliations for different reasons, such as financial or operational concerns, proactive positioning within an uncertain regulatory environment, and competitive needs. We work to understand early in the process why an organization is looking at affiliation options, what challenges it faces, and what its team hopes to accomplish by becoming part of a larger system. Sometimes an organization can be hesitant to provide too much information because its leaders are concerned that certain issues could deter us from a purchase, but unless there is a significant problem that could really harm long-term viability or success, this is rarely the case. If we can understand challenges early, we are able to help with interventions sooner, which is better for everyone. To best accomplish this, it is important to take a comprehensive approach to due diligence and look at a range of functional areas to gain a full understanding of an organization going into a potential transaction. We do as detailed an assessment as possible – looking at operations, financial information and organizational culture – and we segment the information we learn into categories so that we can prioritize and

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consider areas that could affect a transaction on the front end, during integration, or post integration. When we assess facility operations, we look at risk factors that could impact overall facility performance and financial and regulatory risk. If we identify opportunities for improvement in any of these areas, we also consider how we will address those needs. Then, when the agreement is developed, we include the proper protections for risks discovered during the due diligence process. Contrary to common assumption, financial performance is not the only factor. In addition to overall performance and risk, we put a strong focus on cultural aspects of a transition. We have even added a cultural component to our overall assessment that builds upon LifePoint’s priorities including employee engagement and a culture of safety. We believe strong cultures begin with leadership so we carefully evaluate the perception of leaders, medical staff, and others. And we work to identify gaps in these areas early in the transaction process. We continue to refine the culture component of the overall assessment. NMN: What steps should be taken to truly integrate cultures and to reassure employees who suddenly find they will be part of a new organization? Seraphine: The most important thing is for all parties involved to consider and prioritize integration very early – as early as the signing of the letter of intent or memorandum of understanding. Once this commitment to prioritizing integration is in place, you have to work to communicate with and engage your employees, physicians, community and other key stakeholders. Developing a communications plan from the announcement of the LOI or MOU, through integration, and post-integration is incredibly important to ensure that staff, clinicians, community members, and other stakeholders are aware of potential changes within an organization. Sharing information in a unified voice – both the buyer and the seller together – sets the tone for the potential partnership. There is no such thing as too much communication with employees before a transaction, nor are there too many times to repeat a message. We know that employees are most concerned about how a transaction could affect them personally – how benefits, compensation, services, processes, and reporting structures could change. For this reason, we try to provide as much information as we can, as soon as we can, while being mindful of the process that must take place to research, evaluate and develop the right integration plan. To reassure them and build trust, if we don’t have details to share right away, we try to provide timelines for when they can expect to learn more. And to foster trust, we stick to these timelines as closely as we can. We are intentional about creating cul-

ture points early in the process, from the earliest meetings with leaders, staff and physicians, and we find opportunities to be sure we are sharing LifePoint’s culture. For example, we usually have our leadership onsite early in the process to give employees, clinicians, and others the opportunity to ask questions, hear from individuals in our company and put a face to the organization they are joining. We also bring our HR staff onsite as soon as possible within the process to answer the questions employees have about how a transaction would affect them personally. NMN: Is there a point when it makes more sense to walk away from a deal? Seraphine: Walking away from a deal is painful and not a decision taken lightly. That is why it is crucially important to conduct a thorough assessment. We try and identify areas of concern early in the process and address how they could be mitigated so they don’t take away from the ability for the facility to be successful in the long-term. Regulatory compliance and economic hurdles are the two most common areas of concern. However, if the buyer can navigate these issues, the sale may not be put in jeopardy. NMN: What’s your best advice to a buyer when considering acquiring another firm … and conversely to a company considering selling to another entity? Seraphine: To buyers, I recommend investing the needed time in due diligence and integration and do a thorough, comprehensive assessment of an organization. This will help you identify red flags but also spend time engaging with the seller to build trust for a potential long-term partnership. At LifePoint, our assessment tools are continually evolving, and we constantly work to enhance how we approach due diligence and integration. We ensure that an organization is culturally aligned … and that it is open to change – as there are often many changes that will happen over the course of time. I often tell sellers two years down the road, we want them to be able to answer the following two questions affirmatively: 1) Did we add value? 2) Did we do what we said we were going to do? Those two questions are what every seller should consider when talking with potential buyers – as they reflect action and trust – two valuable components of a successful partnership. I would also advise sellers not to assume they can work through the process of selling a facility alone but instead to rely on experts to support them. Often, sellers are part of a transaction process for the first time, for one of the most significant decisions a leadership team and board will make for an organization. We recommend that sellers work with professionals who can walk them through the process – such as a broker advisor, lawyer, or business consultant who can help the organization ask the right questions to help deliver the best result. nashvillemedicalnews


M&A Trends & Technology LBMC Experts Share Insights on Valuation, Vetting By CINDY SANDERS

Amid continuing uncertainty for the healthcare industry as professionals and politicians debate the best way to transform the delivery system, deals are still getting done … but buyers have to be even more savvy when it comes to due diligence to get the most accurate picture possible before committing funds. Despite ongoing health reform debates in D.C., Lisa Nix, shareholder and practice leader for Transaction Advisory Services with LBMC, said there is a continuing trend towards consolidation in the healthcare middle market. “It’s still a sellers’ market, and buyers still have Lisa Nix money to put to work,” she said. However, she noted, buyers are drilling deeper on the numbers. “Healthcare valuations remain extremely high with double digit EBITDA multiples in certain healthcare sectors, but buyers are definitely becoming more discriminating, performing – from what we can see with our clients – more due diligence pre and post letter of intent,” she said. “Deals that are ultimately getting done are high quality assets and those where the valuations are holding through the diligence process.”

Buying Trends

Nix said specialty physician practice consolidation continues. “We are still seeing a tremendous amount of activity with single specialty roll ups by private equity groups – particularly with dermatology, ophthalmology, radiology, dentistry and anesthesiology – as the trends continue with physicians desiring to focus more on the practice of medicine and less on the administrative and back-office challenges of operating a stand-alone practice,” she said. Other trends include state-specific regulations driving organizational and legal structures and governance, along with the continued rise of retail health. As a result of the high healthcare valuations, Nix said, “We are seeing more and more interesting structures in this competitive deal environment.” She continued, “An example of this is the increased use of various insurance products to cover some … not all … of either the buyers’ or the sellers’ transactional risks related to representations and warranties, tax indemnifications and other specific contingent liability exposures.” Nix added using this tactic is subject to an underwriting process that includes insurance due diligence. The continued meshing of retail offerings and medical services has led to more mid-level practitioners performing revenuegenerating services within their scope of practice to provide more access to patients, while leveraging physicians’ time more effectively and bolstering the bottom line. nashvillemedicalnews


Technology as Tool

Compliance and regulatory due diligence for healthcare service providers, particularly in the realm of billing and coding, is no longer an option and now usually occurs on the front end of the diligence process, noted Nix. Aiding in that step are sophisticated healthcare data analytics and benchmarking tools. Rachel Harris, senior manager for LBMC Healthcare Consulting Practice, said using technology to create dashboards has helped make sense of an enormous amount of data in a very visual manner for clients. The analytical team also helps buyers and sellers do a much deeper dive and review Rachel Harris a broader set of variables than the client might have initially considered. “We really saw a lot of hospitals and health system acquisitions that were about market share. They weren’t as concerned about how it looked post-close,” she said, adding the attention was most keenly focused on acquiring the patient base. It wasn’t that due diligence wasn’t completed, but the deals focused on a reporting package at the macro level. “But nobody really wanted the story it told,” she said of the 10,000-foot view. “What they missed is the noise underneath the reporting totals.”

Harris said as private equity groups and venture capitalists have become more involved in purchases … and as some M&A deals by hospitals and health systems have proven more complicated in hindsight … the level of detail in due diligence has become significantly more granular. “They want to know what the end of the story looks like as they are still writing it. They want to have some post-close assurances,” she said. She likened the level of detail that is now available through transactional analytics to the use of smart keys. Certainly, it’s possible to pop the hood, look around and provide some solid information on a car you are about to buy. However, she continued, mechanics now have the ability to do a deep dive on a car’s complex mechanical and electrical systems by simply inserting a smart key into a dock. “If you have the tools to analyze a buy at this intricate level in the same time or less, why wouldn’t you?” she questioned.

Four Components of Vetting

Harris said there are four key components to be considered during the due diligence process: integrity, stability, sustainability and opportunity. Integrity, she noted, looks at accuracy, which requires more intricate information in the reporting packages. “It’s understanding the parts … not just the sum,” she said. Harris added totals might look fine, but when you begin to dig deeper, you get a clearer picture if some important “over

and under” values have washed out to get to that final number. “Stability,” she continued, “is what you can rely upon.” The macro view of a cardiology service line might show what appears to be stable volumes and revenue stream across a three-year period. “But what analytics digs up is your biggest payer has drastically cut reimbursement starting in month 34 of 36 so your volume is stable, but you now have a big hit from the biggest payer. That might change the valuation,” she noted. “Sustainability is not only what’s sitting still but what can be relied on,” Harris continued. In the cardiac service line example, revenues won’t be sustainable despite stable volumes once the largest payer institutes a 25 percent reimbursement cut. “Payment reform really plays into sustainability,” she added, noting one of the questions now asked during the due diligence process is where a practice or facility stands in terms of MACRA compliance. “We calculate what happens with penalties or full participation.” Last, but certainly not least, is opportunity. “Once we’ve finally defined what we have as a core practice and found that it’s an accurate, stable, sustainable book of business, then we look for where there is an opportunity for growth,” Harris said. “When you are able to get into that level of details with analytics, it tells a much different story,” she added of the deep dive. (CONTINUED ON PAGE 10)

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Last month, the Nashville Medical Group Management Association met at their new location at West End United Methodist Church for an update from D.C. The lunch meeting, sponsored by Life Credit Union, featured Suzanne Falk, MPP, associate director of Government Affairs for MGMA, the local association’s national organization. Falk shared insights on trending topics ranging from QPP and MACRA to proposed 2018 regulations and ongoing health reform discussions impacting physician practices. “For every three pages of law that comes out, there’s about 300 pages of regulations,” Falk said ruefully. One new regulation practices need to address, she continued, is rooted in section 1557 of the Affordable Care Act. She said nondiscrimination standards tied to language barriers call for providers to formalize and document a language access plan. The Office for Civil Rights under the Department of Health & Human Services has recently released more detailed information on the final rule on Section 1557. Go online to for details.

MGMA’s Suzanne Falk delivers updates from D.C. to practice managers

Another issue MGMA has identified is the cost of virtual credit and electronic funds transfer (EFT) fees. Falk said a survey released last month by MGMA found one in six practices faces EFT service fees, which can be as much as 5 percent. “I don’t have to tell you that can really quickly eat into your bottom line,” Falk said. She added service providers are not required to tell practices about the fees. “Be vigilant and be your own advocate,” she advised. While there are a number of benefits from electronic transactions, MGMA and other provider organizations have advocated for the Centers for Medicare & Medicaid Services (CMS) to release regulatory guidance on such transactions. The Workgroup for Electronic Data Exchange (WEDI) created a task group co-chaired by MGMA and Aetna to draft a set of consensus-based electronic payment principles calling for more transparency regarding fees. With the move to MACRA, Falk cautioned practice administrators against ignoring Physician Quality Reporting System (PQRS) reports and Quality Resource Use Reports (QRURs). While it’s tempting to push them aside since the programs have ended, Falk said, “I can-

not stress enough how important it is to still check these reports. With that twoyear lag between payment and performance, we’re still feeling the pain of these programs.” She added practices have 60 days after a report is released to file a review request to address any discrepancies. Without such a request, Falk noted, the practice is out of luck even if a mistake was made. Falk noted MIPS topped the list on the MGMA 2017 Regulatory Burden Survey. She offered her own set of MIPS survival tips when discussing the move to MACRA. Like other recent NMGMA speakers, she stressed, “Please protect yourself from a MIPS penalty. There is no reason anyone in this room should get a penalty.” She also added that MACRA rules continue to evolve and the end of the year would bring a new wave of decisions. “What’s right for your practice and best now might not be tomorrow so stay engaged,” she added. For links to resources from MGMA and other agencies, go online to The next NMGMA meeting will be held on Oct. 17 at the new location at 2200 West End Ave.

The Little Clinic: Retail Health in the Continuum of Care, continued from page 5 Simplifying Healthcare, Meeting Consumer Demands

Leaning on more than 15 years of customer loyalty data, Watkins said, “We’ve been active listeners to our customers. We want to create a fantastic patient experience for those who choose to come see us. We know it’s a competitive landscape.” An important element of the patient experience is offering transparent pricing, he continued. “We’re committed to trying to simplify healthcare. Our prices are our prices. Payers know what we’re changing for our services, and we’re not afraid to put those up because the consumer deserves to know.” He added most folks, particularly those accessing the system through walk-in medicine, want to be able to go the website and find a menu of services and costs. While 80 percent of TLC patients are covered by insurance, having transparent pricing allows the patient to decide if they want to pay cash, use their HSA, or run the cost through their insurer. Another key element of the delivery model is meeting consumer demand for convenience. In addition to hours seven days a week, TLC offers patients the opportunity to get in line … online. “One of the things that we’ve done in terms of innovation is we’ve allowed folks to secure their spot online. We don’t want to waste the time of our patients – it’s valuable. This will hold your spot. It’s not an appointment, but it will hold your spot and give you an estimated time when you can arrive. It also allows you to tell us a little bit about you so it speeds up the registration process.” 10



The Food Connection

“I think we offer something unique to this business vertical,” Watkins said of being housed inside a grocery store. “Our core business from Kroger is that we’re in the food business … we’re in the nutrition business.” That core competency, he added, meshes nicely with improved health. In addition to weight management services, he said TLC’s registered dietitians and nutritionists offer medical nutrition therapy, host discovery events showcasing healthy food prep, and create patient-specific meal plans. “We have a pretty novel program called Navigating for Nutrition,” explained Watkins. “These registered dietitians can actually take a patient – maybe a

diabetic or someone who wants to go vegan or just to eat healthier – and help them navigate through the store to help them make the right decisions.” Kroger, The Little Clinic and Feeding America have also teamed up for a second year of the ‘One Shot, One Meal’ campaign. Through April 2018, Kroger will donate a meal through the Feeding America network of food banks for every flu shot administered at a Kroger pharmacy or TLC location. Last year, the campaign helped Kroger reach a new milestone of donating 330 million meals.

Next Steps

Watkins anticipates continued expan-

sion of the TLC model. “Organizationally last year, we eclipsed two million patients. We’ll be in place to add another million or so patients to what we see this year so our volumes are growing,” Part of that growth could come from an expanded telehealth platform, which Watkins said has been in pilot mode but is nearing broader rollout. “We believe that’s going to offer an opportunity to provide more access points and offer a great deal of flexibility in terms of convenience to patients,” he said. Watkins credited The Little Clinic’s success to keeping healthcare simple, affordable and easily accessible. “We’re customer first in everything we do.

M&A Trends & Technology, continued from page 9 “My hope is it gives the buying entity real confidence.”

Due Diligence: Not Just for Buyers

Due diligence cuts both ways. Nix advised, “If you are contemplating selling your business, consider having sell-side due diligence performed. The benefits of embarking in a sell-side process several months in advance of transaction launch – particularly for companies that are cash basis, unaudited, and/or have challenging historical financials – far outweigh the costs.” Billing and coding issues could cause significant delays in closing a transaction. While the mistakes were most likely unin-

tentional, it raises a flag for buyers who tend to then expand the scope of review to ensure there are no other regulatory surprises waiting. “It should go without saying that it is certainly worth spending a little money up front and investing in a sell-side billing and coding diligence process in order to identify and remediate any billing and coding issues before such issues are identified by a potential buyer,” Nix said. She added some of the other benefits of a sell-side diligence report include: • Increasing credibility of seller’s financial information in the market, • Allowing buyers to make a more wellinformed … and possibly higher … bid, • Preparing the seller’s management team and minimizing business disruptions

during the buyer’s due diligence process, • Potentially lessening the buyer’s diligence cycle if there are reports with supporting data that could be shared with the buyer’s team, and Decreasing the surprises, which increases the probability of a successful transaction. Red Flags Although buyers don’t want to get a reputation of stalled or re-traded deals, Nix said significant issues that come up during due diligence process certainly can’t be ignored. When valuations don’t hold up, buyers have to change the deal structure, reduce the purchase price, wait on stronger results, or walk away. nashvillemedicalnews


The Promise of Blockchain How the Technology Could Transform Healthcare Transactions By CINDY SANDERS

What if data could be stored in a decentralized, agnostic database in a permissioned ledger format where users could be added to access only the data pertinent to them and for a controllable amount of time with everyone linked using cryptography to create immutable, time-stamped, secure transactions? That is the promise of blockchain technology. Change Healthcare Chief Technology Officer Aaron Symanski sat down with Medical News during the recent TN HIMSS Summit of the Southeast to talk about how the technology might be deployed in healthcare. Nashville-based Change Healthcare, Aaron Symanski one of the nation’s largest independent healthcare technology companies, sits at the nexus of revenue cycle management, improved workflow, and delivery of quality care. The company has been one of the national leaders in exploring the ways blockchain might transform the industry. “Blockchain is a database, a distributed ledger, where every participant in the network holds the same ledger … that’s the essence of it,” explained. Symanski. While the technology and tools required to create a blockchain are a little more expensive on the front end, Syman-

ski noted, “It makes it far more effective in doing business.” For example, he continued, if a provider and payer are routinely sharing hundreds or thousands of records and a question pops up about a patient transaction a month ago, there’s no confusion about what transpired or need to spend hours researching the transaction. “I see what you see. They are never going to be different,” he said of the ledger views. “That’s what blockchain brings to the table.” Anyone who has ever used Bitcoin, a global cryptocurrency, has been exposed to blockchain technology. “Every participant has a complete record of every coin that’s ever been in anyone’s hands and every movement that coin made between all the parties,” Symanski said. In healthcare, of course, there are myriad rules and regulations that would make some data – such as protected health information – undesirable to be open to everyone on the blockchain. However, Symanski explained, blockchain is really a platform where layers can be added that would control permissions. He said start-ups across the country are looking at applications that take into consideration smart contracts, interoperability, privacy – “They are all talking about protocols on top of that blockchain mechanism of identical storage.” Symanski continued, “A lot of what you see in blockchain today is financially based. It is a blockchain amongst a very small set of parties who are all comfort-

able with that complete visibility.” Moving into patient information adds a long list of new considerations … but ones that can be addressed. For example, it could be that a provider has access to all the encrypted data on a blockchain but cannot decrypt without a key that grants access only to the specific, limited dataset that they have been cleared to receive. “That’s another part of the conversation that’s really interesting. Who controls the patient data?” Symanski asked. One thought is it’s the patient. “One of the pieces of the conversation right now is that it’s the patient’s key to decide to distribute. A patient might want to provide a mental health status key to one provider but not to another.” On the other hand, Symanski said a lot of providers feel like feel like they should control the key since liability could move around with the record. There’s a valid argument for a physician wanting to ensure another provider accessing a patient record sees more than raw data. The initial provider wants the story and interpretation of that data to be part of the record, he said. “There are a lot of opportunities right now to move that conversation,” Symanski noted of the gathering momentum behind using blockchain more widely. “Is there one? Are there many? Are there many that

are connected together?” Additional questions also have to be considered as to whether information could be accessed globally. Even within the United States, Symanski pointed out it’s like working with 50 different countries that each has its own rules and regulations. Drilling down further, does one payer want another payer to see their volume and have access to their decision criteria? “What we’re working through, as we bring more parties to the table around blockchain in healthcare, is what are the right pieces to assemble that work,” said Symanski. “These are the great conversations that are happening right now because the technology makes it possible,” he added with clear excitement about the promise blockchain holds. From a boots on the ground perspective, he noted, “We’ve got a lot of innovation going on, and we want to bring that out to the market faster and faster … every company does. We see blockchain as being a platform we can build upon. Everything we do can be enhanced, we think, as blockchain technology rolls out and becomes more and more widely available.’ Symanski concluded, “We’re excited about the technology. The hope is it’s used everywhere that it will create value.” And the belief is that it can create value throughout the healthcare industry.

KraftCPAs PLLC & Kraft Healthcare Consulting, LLC present

Healthcare Helpings

Change Healthcare Launches First Blockchain Solution On Sept. 25, Change Healthcare announced the launch of the first blockchain solution for enterprise-scale use in healthcare, enabling payers and providers to boost revenue cycle efficiency, improve real-time analytics, cut costs, and create innovative new services. As one of the largest independent healthcare IT companies in the United States, Change Healthcare services customers across the continuum of care, using its Intelligent Healthcare Network™ to process 12 billion healthcare-related transactions covering over $2.0 trillion in claims annually. Change Healthcare CEO Neil de Crescenzo made the announcement during his keynote address at the Distributed: Health 2017 conference in Nashville. He said the Intelligent Healthcare Network™ will support blockchain transactions by the end of the year. Change Healthcare will employ Hyperledger Fabric 1.0, an open source blockchain framework and one of the Hyperledger projects hosted by The Linux Foundation, as its foundation for blockchain application design and Neil de Crescenzo development. Change Healthcare is a Premier member of the Hyperledger governing board and will be contributing code innovations back to the open source community to improve blockchain applications for the U.S. and global healthcare industry. “We are excited to work alongside our customers and partners to make blockchain real in healthcare,” said de Crescenzo. “As today’s healthcare system becomes more value-based, it’s essential that we aggressively and pervasively introduce new technologies into healthcare at scale — whether they leverage blockchain, artificial intelligence, or other emerging capabilities with the potential to improve outcomes and efficiencies. We are initially introducing blockchain technology to create a distributed ledger that makes claims processing and secure payment transactions work more efficiently and cost effectively for all healthcare stakeholders.”



Don’t miss our upcoming series where we’ll serve up bites of knowledge — and breakfast! Join us for a series of presentations on a variety of hot topics affecting the healthcare industry. December – Compliance, Billing Fraud & False Claims – Oh My! January – What the H? HIPAA, HITECH, HITRUST March – Practice Management Best Practices

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On Oct. 16, Michelle Robertson will begin her new role as chief operating officer for Saint Thomas Health, which is part of the Ascension health system. The COO position is part of a dyad leadership structure with Greg James, MD, who serves as the system’s chief cliniMichelle Robertson cal officer. Prior to joining Saint Thomas, Robertson served as CEO of Seton Family of Hospitals and COO of Ascension Texas. Robertson has been an Ascension associate for 27 years. She graduated from the University of Arizona with a BSN and from the University of Colorado with an MBA. A licensed registered nurse since 1989, Robertson began her practice in Austin as a pediatric nurse at the Children’s Hospital of Austin.

NHI Adds Kelly as SVP on Investments

Last month, Michelle Kelly joined Murfreesboro-based National Health Investors, Inc. as senior vice president of Investments. . Previously, she served as vice president for an Ohio-based healthcare REIT and GE Healthcare Financial SerMichelle Kelly vices in similar capacities.

VUSN Taps Piano for Top Research Role

Mariann R. Piano, PhD, FAAN, FAHA, a distinguished researcher in cardiovascular disease and expert on the effects of binge drinking and young adults, has been named senior associate dean for Research at Vanderbilt University School of Nursing (VUSN). Dr. Mariann Piano Piano will lead the VUSN’s research program, charged with supporting faculty scholarly endeavors, expanding the school’s research function and directing efforts to increase external funding, as well as direct the school’s Center for Research Development and Scholarship, which supports faculty in research scholarly activity. Piano will also represent VUSN on the Vanderbilt University Research Council, a group of 10 Vanderbilt leaders charged with providing input and overseeing strategic planning for research, with a particular emphasis in identifying and leveraging collaborations across the university. Previously, Piano was a professor and head of the Department of Biobehavioral Health Science at the University of Illinois College of Nursing in Chicago. She has published extensively on cardiovascular health and function, the adverse impact of alcohol and cigarette smoking on the cardiovascular system, animal models of alcohol abuse, cardiac nursing, and heart failure pathophysiology, symptoms and patient self-manage-

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Robertson Starts New Role as Saint Thomas COO

ment. She earned her undergraduate nursing degree from Loyola and her master’s and doctorate from the University of Illinois at Chicago and then completed post-doctoral work at Rush University. Piano was selected for her new role following a national search. She succeeds Ann F. Minnick, PhD, RN, FAAN, who headed the school’s research program for a decade and is returning to teaching and scholarly work.

Haile to Lead Neighborhood Health

Effective Oct. 1, Brian Haile will take over as CEO of Neighborhood Health. Haile, the former deputy chief of the Bureau of TennCare, has extensive experience in the public health sector. Former CEO Mary Bufwack, who is retiring after 29 years at Neighborhood Brian Haile Health, will serve as CEO emeritus through Dec. 31 to ensure a seamless transition. In Haile’s role with TennCare, he worked with federal officials and advised on technical development of InsureTN and designed and led implementation of newborn and hospital presumptive eligibility programs, among other projects. Other prior experience includes serving as senior vice president for Healthcare Policy at Jackson Hewitt and as executive director of the Insurance Exchange Planning Initiative for the Tennessee Department of Finance and Administration. After earning his undergraduate degree at Georgetown University’s Walsh School of Foreign Service, Haile also earned a law degree from Georgetown, where he was a public interest law scholar, a master’s degree in Public Policy from the University of California at Berkley, and a master’s degree in Health Economics from the University of Cape Town in South Africa.

Bonick Joins PhyMed as CEO

Marty Bonick, FACHE, a healthcare executive with more than 20 years of leadership experience in both for-profit and non-profit settings, has joined PhyMed Healthcare Group as CEO. Bonick comes to PhyMed from Community Health Systems, Marty Bonick where he was president of division operations, overseeing a $4.5 billion portfolio of 36 hospitals and their associated clinics, outpatient centers, ambulatory surgery centers and urgent care operations across six states. Previously, he was CEO of Jewish Hospital and senior vice president of Operations for Jewish Hospital & St. Mary’s Healthcare in Louisville, Ky. Bonick is a Fellow in the American College of Healthcare Executives. He holds dual master’s degrees from Washington University in St. Louis in Health Care Administration and Information Management, as well as an undergraduate degree from the University of Illinois. 

Mead Named COO of TriStar Southern Hills

Last month, TriStar Southern Hills announced Cory Mead, MHA, has been appointed COO for the 126-bed facility in south Nashville effective Oct. 16. Mead previously served as associate COO and co-ethics and compliance officer at HCA Cory Mead Healthcare’s Reston Hospital Center in Reston, Va. Other prior experience includes operational roles with HCA facilities in Missouri. Mead earned his undergraduate degree and master’s in Health Administration from the University of Iowa.

NashvilleHealth Adds Director of Community Engagement

Molly Sudderth has joined NashvilleHealth as the organization’s director of Community Engagement. Founded in 2015 by former U.S. Senate Majority Leader Bill Frist, MD, NashvilleHealth seeks to create a culture of health and wellbeing in Davidson County. Molly Sudderth Sudderth will assist with implementation of key strategies to support the organization’s efforts to build a collective, community-wide approach to health. She also has responsibility for communications and outreach efforts. Most recently, Sudderth served as senior director of Community Engagement at the Governor’s Foundation for Health and Wellness and was responsible for leading the foundation’s Healthier Tennessee Communities program. She has worked in communications in both the public and private sectors in Tennessee for almost 20 years, including serving in senior positions with the Nashville Convention & Visitor’s Bureau, the Office of former Nashville Mayor Bill Purcell and the Tennessee Departments of Children’s Services and Economic and Community Development.

Martinez Joins Total Health Medical & Dental

Conchita G. Martinez, MD, FAAFP is joining Meharry’s Total Health Medical and Dental in Antioch this month. Martinez is a family medicine physician with a passion for mission work who helped lead a team to develop bilingual health care services for uninDr. Conchita Martinez sured or underinsured families in South Nashville. Fluent in both English and Spanish, she will begin accepting appointments for both adults and children later this month. Martinez, a 2009 Nashville Medical News “Women to Watch” honoree, graduated medical school from University of Texas Health Science Center at San Antonio.



GRAND ROUNDS C-Suite Changes at Envision

Last month, Envision Healthcare announced key structural changes including a stock repurchase of up to $250 million based on market conditions and a number of shifts in their executive leadership. Staff changes are all set to go into effect on Oct. 2. Karey Witty, a 25-year healthcare executive has been appointed executive vice president and COO, which is a new role for the company with a direct report to Envision President & CEO Christopher Holden. Witty most Karey Witty recently served as CEO of Corizon Health. Prior to that, he held CFO roles for naviHealth and HealthSpring. Kevin Eastridge has been named CFO following the announcement of Claire Gulmi’s retirement, and Kenneth Zongor has been named to succeed Eastridge in his previous role as chief accounting officer for the publicly traded company. Gulmi will serve as an advisor for one year to assist in the transition. Brian Jackson has been named president of Envision Physician Services, where he previously served as COO. His promotion comes following the resignation of Bob Coward.

Monroe Carell Offering New Treatment for Type of Pediatric Leukemia

Monroe Carell Jr. Children’s Hospital at Vanderbilt has been selected as part of a select group of healthcare institutions to offer a new FDA-approved immunotherapy for a subset of pediatric acute lymphoblastic leukemia (ALL). Only 32 healthcare institutions in the United States will be certified to offer the therapy. Vanderbilt is only one of two centers in the state, and the only one located in the Middle and East Tennessee. This novel therapy, a personalized treatment known as chimeric antigen receptor (CAR) T-cell therapy, is an innovative treatment designed for children and young adults with relapsed or refractory pre-B cell ALL. This therapy, called Kymriah, takes a patient’s own immune cells and reprograms the cells to recognize and destroy the patient’s leukemia cells. “It is an honor and privilege to be selected as one of the first 10 centers in the country to offer this innovative therapy,” said Debra Friedman, MD, director of the Division of Pediatric Hematology/Oncology, associate professor of Pediatrics and E. Bronson Ingram Professor of Pediatric Oncology. “This is in recognition of our expert oncology and stem cell transplant teams and the multispecialty care that we can provide here. We welcome referrals from around the region for this exciting new therapy to offer new opportunities for more children and young adults.” Typically, 90 percent of ALL patients are cured with intensive chemotherapy treatment. The remaining 10 percent of ALL patients don’t respond to chemotherapy or relapse and have a very poor prognosis. Patients up to age 25 nashvillemedicalnews


who have these high-risk features may be eligible for this innovative CAR T-cell therapy. With Kymriah, a patient’s T cells are collected and shipped to the pharmaceutical company, Novartis, where the cells are engineered to express a chimeric antigen receptor designed to recognize the patient’s leukemia. The engineered CAR T-cells are grown in the laboratory and then shipped back to the hospital where they are infused into the patient. Each time a CAR T-cell recognizes a cancer cell it is activated to kill the leukemia cell. Once this happens, a signal is sent to the to the CAR T-cell to divide, producing even more of the cancer fighting cells. The FDA approved the CAR T-cell therapy on Aug. 30 following multicenter clinical trials at several sites around the country that demonstrated an 83 percent rate of remission in these very highrisk patients, and these remissions are long lasting in many patients.

MMC Welcomes Four New Physicians

Murfreesboro Medical Clinic (MMC) recently announced the arrival of four new physicians to the Rutherford County multi-specialty, physician-owned clinic. Amanda Petty Gammel, DO, has returned to MMC as a pediatrician after having been an employee while in college. She received her bachelor’s degree from Middle Tennessee State University before attending Virginia Col- Dr. Amanda Petty Gammel lege of Osteopathic Medicine for medical school. Petty Gammel completed her pediatrics residency at Le Bonheur Children’s Hospital in Memphis. Ryan Drumright, MD, an ophthalmologist, has expertise in cornea treatments and refractive surgery. A Rutherford County native, he earned his undergraduate degree at Tennessee Tech and then attended the University of TennesDr. Ryan Drumright see Health Science Center for his medical degree. Drumright completed his residency in Jackson, Miss. and fellowship work in Gainesville, Fla. Molly Eaton, MD, a family medicine practitioner originally from New York spent the last 10 years practicing in Buffalo before relocating to Murfreesboro. She did her undergraduate work at Case Western Reserve University in Cleveland, Dr. Molly Eaton Ohio, and earned her medical degree and completed residency at State University of New York at Buffalo School of Medicine. Paul Myers, MD, a family medicine practitioner, earned his undergraduate degree at Cumberland University in nearby Lebanon before earning his medical degree at the Univer- Dr. Paul Myers

sity of Tennessee College of Medicine. Myers then completed his residency at the University of Louisville Family Medicine in Glasgow, Ky.

Boll Joins Saint Thomas West

Vascular surgeon Julia Boll MD, RPVI, has joined Saint Thomas Hospital West. A Registered Physician in Vascular Interpretation (RPVI-certified), Boll earned her undergraduate degree at Northwestern University and her medical degree from Rush Medical College in Chicago. She completed her residency in general surgery at Rush University Medical Center and her fellowship in vascular surgery at Vanderbilt University Medical Center.  Boll has co-authored multiple peer-reviewed articles and book chapters in the field of vascular surgery.

Lance Joins VUMC

Longtime North Highland healthcare leader Fletcher Lance has made the move to Vanderbilt University Medical Center. In his new role as executive vice president for Vanderbilt Health Professional Solutions, Lance will lead efforts of the new VUMC subsid- Fletcher Lance iary focused on launching and incubating auxiliary businesses. Previously, Lance spent 12 years with north Highland Worldwide Consult-

ing where he was a managing director and leader of Global Healthcare. Prior to north Highland, he was COO and one of the founding partners of Qualifacts Systems. Lance earned both his undergraduate degree and MBA from Vanderbilt.

Alive Hospice Names VP of Mission-Based Services

Middle Tennessee nonprofit Alive Hospice has appointed Judy Orr as vice president of mission-based services. In her new role, Orr serves as part of Alive’s executive leadership team and directs several key programs Judy Orr and functions with a direct impact on the community including fundraising for charity hospice care, overseeing Alive Grief Support, and leading the Alive Institute, Alive’s center for education, outreach, innovation and advocacy; and marketing. Previously, Orr served as assistant vice chancellor for Creative Services at Vanderbilt University for 20 years. Her career also includes 10 years at Ingram Book Company as director of advertising and creative services. She earned a master’s degree from the University of Tennessee College of Social Work and a bachelor’s degree from Vanderbilt. She previously served on the Alive Board of Directors.




GRAND ROUNDS Awards, Honors, Achievements David Penson, MD, MPH, chair of the Department of Urologic Surgery at Vanderbilt University Medical Center, has been named an associate editor for The Journal of the National Cancer Institute (JNCI). The American Association of Medical Soci- Dr. David Penson ety Executives recently recognized medical societies for their contributions during the Seventh Annual Profiles of Excellence national awards program. The Tennessee Medical Association was honored with the Communications Award for its redesigned website. Middle Tennessee had four executives on Modern Healthcare’s “100 Most Influential People in Healthcare 2017.” Milt Johnson, chairman and CEO of HCA, led the way at #10. Also making the list were Wayne Smith (#46), chairman and CEO of Community Health Systems; Bill Carpenter (#73), chairman and CEO of LifePoint Health; and Jonathan Perlin, MD, (#77), president of Clinical Services and CMO for HCA. TriStar Centennial Women’s Hospital and The Children’s Hospital at TriStar Centennial were recently recognized by the National Safe Sleep Hospital Certification Program  as Gold Safe Sleep Champions for their commitment to best practices and education on infant safe sleep. They are the first hospitals in the Middle Tennessee region to receive the Gold Safe Sleep title. Jason M. Greene, PharmD was recently installed as the 2017-2018 president-elect of the Tennessee Pharmacists Association (TPA). Greene is pharmacy manager for Reeves Sain Drug Store/ Fred’s Pharmacy in Murfreesboro, where he has worked since 1998.

DXE Medical now Cardio Partners Ohio-based DXE Medical, which has an office in Brentwood, has officially changed its name to Cardio Partners, Inc. According to company officials, the change signals the company’s continued journey of moving from a device-centric organization to a full Sudden Cardiac Arrest Solution provider including CPR T=training, program management, AEDs, defibrillators, accessories and service. 

Buying & Selling

Nashville-based SpecialtyCare has partnered with New York private equity firm Kohlberg & Co. to purchase the physician services business line from American Securities. In other news from the company, SpecialtyCare leader Melvin Hall, PhD, will move from CEO to executive chairman and Sam Weinstein, MD, will transition to CEO from his previous roles as president and chief medical officer.




Nashville-based Ardent Health Services has partnered with the University of Texas System to acquire East Texas Medical Center (ETMC) Regional Healthcare System. Ardent Health will assume majority ownership and operate the newly formed 10-hospital health system. In addition to the regional hospitals, the deal includes the ETMC Rehabilitation Hospital and the ETMC Specialty Hospital in Tyler, Texas plus the Olympic Plaza Tower, 13 regional rehabilitation facilities, physician clinics, two freestanding emergency centers, regional home health services covering 41 counties, a behavioral health center and a comprehensive 7-trauma center care network, including a Level 1. Execs with Brentwood-based Quorum Health Corp. have signed agreements to divest L.V. Stabler Memorial

Hospital in Alabama and Vista medical Center in Illinois. Brentwood-based AAC recently announced an $85 million deal to acquire AdCare Inc., which runs an inpatient hospital, residential treatment and outpatient services in New England.

Yi received his medical degree from Vanderbilt University School of Medicine and completed his surgical residency at Medstar Washington Hospital Center in Washington, DC.

PlayMaker Adds Sales VP Franklin-based PlayMaker, a customer relationship management software firm focused on the post-acute care space, recently added Holly Miller as vice president of sales. For the past 15 years, Miller has worked with HealthStream, most Holly MIller recently serving as associate vice president of sales for NonAcute & Medical Technologies.

Yi Joins Surgical Team at TriStar Southern Hills TriStar Southern Hills Medical Center recently welcomed William Yi, MD, general surgeon, to TriStar Medical Group Southern Hills Surgical Consultants. Yi specializes in the treatment of diverticulitis, gallstones, gastric ulcers, hernias, Dr. William Yi lipomas, cysts and cancers of the breast, stomach and colon.

Crichton Group Benefits Seminar

In mid-September, The Crichton Group hosted a group benefits seminar at Bass, Berry and Sims to provide updates into timely topics in the health insurance industry, including controlling pharmaceutical spend, the lack of primary care utilization – and how onsite clinics and wellness centers could help address this gap in the healthcare system, along with effective ways to educate the workforce on federal benefits, especially Social Security and Medicare. Featured speakers included Frank Cardenas, the founder of FEDlogic, LLC, which navigates individuals and families through Social Security retirement and Medicare; Andrew Clayton, president of Pareto Captive Ser(L-R) Andrew Clayton, The Crichton Group SVP Austin Madison, vices, a leading employee benefit Nathan Gabhart & Frank Cardenas group captive manager that helps employers stabilize health insurance; and Nathan Gabhart, RPh, CEO of TrueScripts Management Services, a consulting firm providing benefit management services.


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Wishes Granted

Vanderbilt University’s The Wond’ry, in collaboration with the Vanderbilt Institute in Surgery and Engineering, recently won a five-year, $500,000 National Science Foundation grant to become an Innovation Corps site. The I-Corps site grant  will support programs to match students and faculty with teams of experienced professionals who can teach, guide and mentor them as they pursue startup endeavors. Neighborhood Health has received a $175,000 grant from the Health Resources and Services Administration (HRSA). Funds will be used to expand Neighborhood Health’s SOS program, which provides counseling and treatment for those addicted to opioids, heroin, or prescription medications. Last month, Make-A-Wish® Middle Tennessee officially closed out its fiscal year with a 139 wishes granted to local children, a record for the chapter. “Healthcare professionals from The Children’s Hospital at TriStar Centennial and Monroe Carell Jr. Children’s Hospital at Vanderbilt and the local community are referring children and helping us get closer to our vision of granting a wish to every eligible child,” said Beth Torres, president and CEO of the local organization.


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GRAND ROUNDS STMP Opens Lennox Village Care Center

Last month, Saint Thomas Medical Partners opened a new full-service care center at Lenox Village on Nolensville Pike. The new center offers primary care, family medicine, cardiology, endocrinology, gastroenterology, neurology, pulmonary medicine and sleep medicine in one location. Same-day and walk-in appointments are available through Express Care, and patients can schedule appointments online. The center is open Mon.-Fri. 7 am-7 pm, and Sat. 8 am-2 pm.

ship in geriatric medicine at Vanderbilt. Sloan previously practiced in Atlanta.

Done Deals

Nashville-based HealthTrust, HCA’s group purchasing organization, recently landed a contract with Dallas-based Christus Health, a large Catholic health system with more than 60 hospitals and 350 clinics and outpatient centers. The GPO will begin servicing Christus Nov. 1. Vanderbilt University Medical Center and Bayer have agreed on a fiveyear strategic research alliance to evaluate new drug candidates for the treatment of kidney diseases, with the goal of

Charles, Sloan Join STMP

Saint Thomas Medical Group recently welcomed two new physicians. Lorraine Charles, MD, specializes in family medicine with particular interests in women’s health and geriatrics. She is board certified in family medicine. Charles received her medical degree from Meharry and completed Dr. Lorraine her residency in family Charles medicine at the University of Texas Health Science Center in Tyler. Lada Sloan, MD, is board certified in geriatric medicine and internal medicine. She received her medical degree from Dr. Lada Sloan Mahidol University, Siriraj Hospital, in Thailand and undertook two internships in Thailand before completing her internal medicine residency at the University of Hawaii followed by a fellow-

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. NEW IN OCTOBER: James Hildreth, PhD, MD, worldrenowned researcher and president of Meharry Medical College, discusses the legacy of Historically Black Colleges and Universities in the field of research and highlights how these institutions are at the forefront of science and innovation. NHC shares thoughts on the ways that continuum-of-care companies are responding to the specialized health issues of the nation’s senior population. The article focuses on the growing demand for memory care services.


accelerating the translation of innovative approaches from the laboratory to preclinical development.

Congregational Health & Education Network Board

Congregational Health and Education Network (CHEN), a new network that partners with the faith-based community to launch outreach initiatives addressing health disparities in Nashville, recently announced its charter board of directors, including: Forrest E. Harris, Sr., MDiv, ThB – President of American Baptist College Joseph Webb, DSc, MSHA, FACHE

– CEO, Nashville General Hospital James E.K. Hildreth, PhD, MD – President and CEO, Meharry Medical College Glenda Baskin Glover, PhD, JD, CPA – President of Tennessee State University Shawn Joseph, EdD – Director of Metro Nashville Schools Kevin D. Rome, Sr., PhD – President of Fisk University By aligning the mutual strengths and assets of churches, schools and hospitals, CHEN hopes to collectively address education and educational attainment as the primary social determinant of health.

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