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FOCUS TOPICS PAIN MANAGEMENT & ADDICTION • QUALITY & PATIENT SAFETY

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 2

Michael Genovese, MD, JD

ON ROUNDS

Addressing the Gap Between Need & Access in Treating Addiction Largely driven by opioid usage, there is a strong consensus on a local, state and federal level that substance abuse is at epidemic proportions in the United States ... 3

Keeping the Focus on Quality & Safety Quality and patient safety are benchmarks for any healthcare organization. In Middle Tennessee, LifePoint Health is redefining expectations through their innovative National Quality Program, a structured process for ensuring consistent, high standards of quality and patient safety ... 7

The War Against Opioids in Pain Management Nashville Specialists Offer Insight, Alternatives to Curb Abuse By MELANIE KILGORE-HILL

The governor’s TN Together plan, which went into effect this past July, impacts both the dosage and duration of opioid prescriptions (see Nashville Medical News, May 2018). Last month, Blue Cross Blue Shield of Tennessee announced they would no longer cover OxyContin beginning in 2019. While the state’s largest insurer will cover other pain medications that are less likely to lead to abuse, the announcement underscores the seismic shift in pain management. From Emergency Room initiatives to community practice to academic institutions … providers and educators are rethinking ways to curb addiction while adequately managing pain.

Addiction and the ER

Allison Bollinger, MD, chief of Emergency Medicine at Saint Thomas Midtown Hospital, said narcotic users in the ER typically fall into two groups: chronic pain patients (CONTINUED ON PAGE 6)

Designed to Disinfect

The Relation Between Interior Design & Infection Control By REBECCA DONNER

About one in 25 patients in America has at least one healthcare-associated infection (HAI) on any given day, according to the most recent statistics from the Centers for Disease Control and Prevention. In 2011, more than 720,000 patients suffered from an HAI and about 75,000 of them died from it. Types of HAIs include central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia. Surgical site infections can also occur.

Time for Nashville to Get a Checkup

City Launches First Health Survey in Nearly 20 Years Last month, Mayor David Briley joined officials with NashvilleHealth and the Metro Public Health Department (MPHD) to announce the launch of the Nashville Community Health + Wellbeing Survey ... 11

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PHYSICIAN SPOTLIGHT

Changing Minds

Genovese Challenges Status Quo in Addiction Medicine By MELANIE KILGORE-HILL

Medicine/North Shore University Hospital in Manhasset N.Y. “When I was choosing residency programs I thought I’d do internal medicine and cardiology like my dad, but there was a lot of interesting crossover between law and psychiatry,” he said. “So many patients are being involuntarily committed, and there was nowhere else in society where we hold someone without due process. I feel like the mind is the most interesting part of the patient.”

The road to medicine was seemingly inevitable for Michael Genovese, MD, JD, chief medical officer at Acadia Healthcare, the publicly traded developer and operator of behavioral health facilities that is headquartered in Middle Tennessee. His journey, however, was less than typical.

Finding His Way

Raised on Long Island by a physician father and nurse mother, healthcare was simply in Genovese’s genes. “In the 1970s, Dad would take us to the hospital and introduce us to patients, sit on the bed and talk about football, then start the exam,” he said. “It was really cool to see that interaction, and I’ve always had a lot of respect for doctors and nurses.” But life at the University of Pittsburgh brought new interests, and the English major headed to his alma mater’s School of Law with plans to focus on medical malpractice. “It’s easy to make good medicine look bad, and New York was such a litigious state,” he said. “I wanted to defend those doctors.” Following graduation, the junior partner found himself frequently researching medical

Filling a Need

conditions for his firm’s senior partners – and enjoying it. Before long, Genovese was pursuing medicine and training at the University of Connecticut, where he completed a residency program in psychiatry. In 2015 he completed a fellowship in child and adolescent psychiatry at New York School of

Back in Long Island, Genovese opened a general psychiatry practice focused on mood and anxiety disorders, but he soon stumbled into the world of addiction medicine. “I had a patient who was a teacher and a great guy but was addicted to Oxycontin,” Genovese said. “He had seen several doctors and done everything he could, and was at risk of losing everything he had.” Genovese knew of a medication that might offer hope, but he couldn’t find an addiction specialist in the county accepting new patients. Ever innovative, Genovese decided to obtain the prescription waiver and treat the patient himself. Soon,

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the former attorney was working six days a week as Long Island’s sole “de facto addiction doctor.”

Acadia Healthcare

After referring multiple patients to Sierra Tucson Recovery Center (now an Acadia Healthcare facility), the company presented Genovese with an opportunity to reach more patients on a larger scale. In 2016 he accepted the role of chief medical advisor over Sierra Tucson’s Recovery Division. One year later, he was promoted to chief medical officer for Acadia Healthcare. The international company provides behavioral health and addiction services to patients in inpatient psychiatric hospitals, specialty treatment facilities, residential treatment centers and outpatient clinics. Acadia operates a network of 585 behavioral healthcare facilities, with approximately 17,900 beds in 40 states, the United Kingdom and Puerto Rico.

Changing Minds

Now with a global platform, Genovese is even more passionate about the delivery of psychiatry and breaking stigmas. Through education of medical providers, the public, patients and their families, Genovese hopes to spread awareness that treatment of mental illness or addiction is no different than treatment of illness or injury. “Psychiatry is a part of healthcare, and we shouldn’t look at mental health as something different since your brain is an organ, like your heart or lungs,” he said. “A policeman shouldn’t be afraid to go to the doctor because he can’t un-see something he saw on the street. That’s an injury, and it needs treatment.” He also hopes to change minds about the addiction recovery process. “Some people think medications are only a treatment and don’t really represent recovery, and there needs to be education around that,” he said. “That’s like saying if you’re taking insulin for diabetes you’re not doing a great job managing it and assuming you’re not exercising. There needs to be more coming together around addiction medicine.” Genovese also wants to create awareness of the need for more options in medical therapy for addiction: There are currently three medications available for substance abuse and nothing for meth and cocaine addiction. “There’s been this thought that addiction is a moral failure, and you need to pull yourself up by the bootstraps,” he said. “Fortunately, more and more people are seeing and hearing the neuroscience behind it and recognizing that addiction really is a disease. Psychopharmacology is so sophisticated and we can do so much to treat people with mood disorders and substance disorders. I’m glad I chose this path.” NASHVILLEMEDICALNEWS

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Addressing the Gap Between Need & Access in Treating Addiction By CINDY SANDERS

Largely driven by opioid usage, there is a strong consensus on a local, state and federal level that substance abuse is at epidemic proportions in the United States. Numerous interventions have been rolled out across America – from equipping law enforcement officials with the opioid antagonist naloxone to efforts aimed at keeping opioid naïve patients from being introduced to highly addictive pain medications. However, a major stumbling block remains for those tasked with treating substance abuse disorders … need far outstrips capacity.

Barriers to Care

Lawrence Weinstein, MD, ABHM, is chief medical officer for American Addiction Centers (AAC), a national treatment provider headquartered in Middle Tennessee. In his role, Weinstein has oversight of medical staff and operations for the publicly traded com- Dr. Lawrence Weinstein pany’s more than 30 locations across the United States. Triple board certified in psychiatry and neurology, addiction med-

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icine, and holistic medicine, Weinstein joined AAC in August after previously serving as CMO for Humana Behavioral Health. When discussing the gaps between need and effective intervention, Weinstein said there are multiple issues to be considered. First is the sheer volume of individuals in need of help. “It is upward of 20 million people, and we know that only one in 10 receives treatment,” he said. Then, there are resources allocated to addressing addiction. “There is only 1 percent of total medical spend that goes into substance use treatment,” Weinstein added. On the access side of the equation, Weinstein said there are roughly 12,000 treatment centers across the country with about 40 beds on average per facility … leaving a huge access gap for inpatient services. “Right now, about 90 percent of all addictions centers are outpatient facilities,” he continued, “and we know that 55 percent of all U.S. centers experience a shortage of behavioral health providers.” Weinstein added the provider shortage is even more ominous when drilling down a little deeper. Many of today’s providers are nearing retirement age. “Coupled with that, you have a shrinking number o residents going into psychiatry.

We’re coming into a perfect storm,” he noted. With the growing opioid crisis, he anticipates additional investment in the $35 billion treatment industry. “You will see over the next three to five years expansion in treatment facilities, but you will not have enough providers to see folks,” he predicted. In addition to affordability and access issues, substance abuse continues to be viewed by many in a pejorative manner so that those impacted by the disease feel equal parts shame and discrimination. In an effort to encourage treatment while shielding patients, Title 42 CFR Part 2 was enacted in 1987 to address the confidentiality of alcohol and drug abuse patient records. While care models are increasingly focused on the whole person, Weinstein said the federal law – which includes tighter restrictions than required by HIPAA – has made it very difficult to provide integrated care, particularly for those dealing with substance abuse and comorbid medical conditions. “By virtue of having these additional restrictions, you make this kind of a discriminatory experience,” he said of the regulations. “Really, they stem from the old belief that substance abuse is a moral failing rather than brain disease,” Wein-

stein continued. “Our notion of the disease has evolved over the last 10 to 15 years, but the policies have lagged.” Last year, for the first time in three decades, 42 CFR Part 2 regulations saw some updates. However, the American Psychiatric Association noted the relatively minor changes intended to align better with HIPAA and allow more providers to take value- and team-based approaches lacked the technological solutions to implement significant change. “Until this issue is fully addressed, various components of Part 2 may continue to act as a barrier to integrated care efforts,” the organization stated on its website. A lack of standardization has also exacerbated already fragmented care. Weinstein said there is disagreement across the specialty as to what even constitutes success in a disease that is prone to relapse and requires lifelong self-management, along with professional care, to address addiction.

Potential Solutions

While there are plenty of issues impacting access to evidence-based, high quality care, Weinstein said there are also several potential solutions being explored. “It’s a multifactorial disease that will (CONTINUED ON PAGE 4)

OCTOBER 2018

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News of Note in Addiction Rx Opioids Most Common Drugs Linked to Overdose Deaths in State

Tennessee Department of Health data show 1,776 Tennesseans died from drug overdoses in 2017 – the highest annual number of such deaths since reporting began – with prescription opioids leading the way. “More Tennesseans died last year from drug overdoses than from automobile crashes. Few of us have escaped a direct impact of this crisis in experiencing the tragic death of a family member, loved one or friend,” said TDH Commissioner John Dreyzehner, MD, MPH. “The good news is this has spurred us collectively to more action than ever before, and while prescription drugs still account for the majority of deaths, there is new hope on the horizon in many areas. Prevention works, stigma is decreasing, treatment is effective and people get better.” The recently released TDH data show almost three-fourths of drug overdose deaths in Tennessee in 2017 were associated with opioids. There were 1,268 overdose deaths associated with all opioids; of those, 644 were associated with prescription opioids for pain, which accounted for more overdose deaths in 2017 than any other group of drugs. “Our analysis of Tennessee drug overdose deaths underscores the need for our aggressive efforts led by Governor Bill Haslam to end the opioid crisis in our state by focusing on prevention, treatment and law enforcement,” Dreyzehner said. “Legislation to place reasonable limits and appropriate exceptions to the supply of prescription opioids to new patients, provide additional treatment resources for those struggling with substance abuse and implement new teaching and training protocols for healthcare providers will make a positive difference in the lives of Tennesseans.” Also of note, deaths related to “street” drugs obtained without a prescription were a key driver of the increase in overdose deaths last year. There has been a dramatic increase in deaths related to fentanyl. Heroin was associated with the deaths of 311 Tennesseans in 2017, a 20 percent increase over the previous year. Fentanyl was associated with 500 deaths, a 70 percent increase since 2016.

JourneyPure Accelerates Growth, Opens 10 New Outpatient Centers in Southeast

Nashville-based JourneyPure, a leading provider of addiction treatment services for patients from across the nation, recently announced a significant expansion of its treatment network with the addition of 10 outpatient centers during 2018. Through a combination of inpatient facilities, outpatient centers and proprietary coaching services and technologies, JourneyPure delivers a full continuum of integrated services. “JourneyPure specializes in treating individuals suffering from co-occurring 4

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mental illness and substance abuse disorders and recognizes that most people can be treated effectively and efficiently on an outpatient basis,” stated JourneyPure CEO and co-founder Kevin Lee. “The addition of these 10 outpatient addiction treatment centers reinforces our commitment to the long-term recovery of our patients by providing a full continuum of services to support their needs.” The new outpatient centers include six locations in the state of Tennessee: two in Nashville, two in Knoxville and one each in Clarksville and Franklin. Additionally, two centers were opened in Kentucky (Louisville and Lexington) and two in Florida (Fort Walton Beach and Orlando). With these 10 new centers, JourneyPure now operates a total of 19 outpatient centers.

Aegis Sciences Launches AcuRiseID™ Tool for Behavioral Health Medication Adherence

Last month, Aegis Sciences Corporation, a leading national healthcare testing and consulting service headquartered in Nashville, launched AcuRiseID™. The new tool offers informative medication monitoring testing for those being treated for mental illness and substance use disor-

ders. The test provides clinicians with objective insight to help identify whether a patient is being consistent with their course of therapy and monitor dosing effectiveness. Dr. Frank Basile One in five adults in the U.S. experience some form of mental illness each year, and one in 25 experience a serious mental illness. Similarly, it is estimated that one in 12 – more than 20 million Americans – have a substance use disorder. While medication can be effective in treating mental illness and substance use disorders, research shows that less than 50 percent of people take their medications as prescribed. The non-invasive AcuRiseID can be administered during regularly scheduled appointments with doctors, clinicians, therapists and counselors. Once the urine sample is collected, it is sent overnight to Aegis’ clinical laboratory where scientists test for medications within two distinct profiles – mental health and substance use disorder. Extensive results are ready within 96 hours and are reported via fax, a web portal or electronic medical records. Clini-

cal pharmacists are available to interpret results and answer questions. The AcuRiseID mental health profile tests for more than 40 medications including those used to treat schizophrenia, ADHD, anxiety, bipolar disorder, and depression. The substance use disorder profile includes more than 30 drugs including amphetamines, benzodiazepines, and opioids. It helps clinicians know if their patients are taking substances – prescribed or illicit – that may hinder their recovery. Clinicians can personalize testing orders for different use-cases to best fit their needs, which is especially important when treating individuals with co-occurring mental illness and substance use disorders. “There are incredibly effective therapies for even the most serious mental illnesses, but no medication can be effective if it isn’t taken. Similarly, recovery from substance abuse can be derailed by taking the wrong medications,” said Aegis CEO Frank Basile, MD, MBA. “AcuRiseID is a valuable tool for clinicians working with those with behavioral health disorders. It takes conjecture out of conversations about therapeutic adherence, helping people and their providers have more productive conversations about their challenges and concerns.”

Addressing the Gap, continued from page 3 require a complex approach … a multipronged approach … to address these issues,” Weinstein said. Certainly, he noted, efforts are underway to try to increase interest in the field and encourage more medical students to consider psychiatry and addiction medicine as a specialty. However, he pointed out, this is only one part of the overall strategy and would likely take years to have any real impact considering attrition from retiring providers. “You can certainly try to influence policy on the state level to allow midlevel providers and extenders to assume more responsibility in a patient’s care,” he added of more immediate efforts to expand the workforce by allowing other providers to practice to the full scope of their profession. Technology, Weinstein continued, is a disruptor that holds significant possibilities to expand access … particularly the use of telepsychiatry. Utilizing telehealth protocols that are already in place for other specialties offers a relatively quick way to reach underserved populations. “We’ll need to work with medical boards and regulatory agencies to standardize processes by which providers are allowed to monitor, evaluate and prescribe via telepsychiatry,” he added. Weinstein said the Centers for Medicare and Medicaid Services have only allowed telepsychiatry to be used in rural areas with provider shortages. However, he noted, there are also shortages within metro areas that could potentially be addressed through telehealth platforms.

He added, CMS is considering changes to the current policy to expand use. Weinstein said technology has the potential to not only impact accessibility but also overall affordability to the system. A patient discharged from the inpatient setting still needs outpatient care. If the first available appointment isn’t for two or three weeks … or two or three months … the risk of relapse dramatically increases, resulting in either a visit to the ED or readmission into an inpatient facility. “Not only is it a costly event but a disruptive event in a person’s recovery,” he said. Addressing standardization and quality of outcomes is another area where Weinstein believes technology could play a role. A patient who travels to another state for inpatient treatment should expect continuity of care on an outpatient basis when returning home. “Ideally, we would like to have continuation of treatment regardless of where you came from or are going back to. Currently, you have inconsistent approaches and inconsistent outcomes. Technology can be used to address that fragmentation and inconsistency,” Weinstein said. Broader use of Cognitive Behavioral Therapy (CBT) is also being explored. CBT, which was pioneered by Aaron Beck, MD, in the 1960s, has the benefit of numerous validating studies over the last 50 years. American Addiction Centers, for example, uses CBT to help individuals identify and address self-defeating thoughts and behaviors that often drive addiction. A group out of the University of Louisville has developed a computerized

version of the therapy (CCBT) and is currently working toward commercialization. Weinstein said a number of other companies are developing similar wearable technologies to validate medical adherence, serve as virtual breathalyzers, and support those in recovery. “All of this is on the horizon and will improve access and availability,” he said, adding that deploying this type of technology also leads to standardization of protocols. “With that, the treatment will become less costly by moving out of the inpatient, high acuity setting. It will be more standardized and produce improved outcomes, and that should lead to less readmissions and utilization of the Emergency Department,” Weinstein said. The next step in technology-enabled disruption is the use of artificial intelligence and big data to pinpoint those at risk for relapse, what interventions work best in various populations and how comorbid conditions impact outcomes. “American Addiction Centers will have available data that will be able to identify populations at risk,” Weinstein noted of work that has already begun. “We know early intervention leads to much better outcomes.” Finally, Weinstein said research has led to a better understanding of the human brain and a more comprehensive view of the impact of psychoactive substances. “Those studies and that improved understanding of our brains will lead to improved pharmacologic interventions so drug research is another important part of the solution,” he concluded. nashvillemedicalnews

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Physicians, Healthcare Organizations Convene to Combat Tennessee’s Opioid Crisis Physicians and other healthcare professionals from across the state met in Nashville Sept. 14 and 15 for the second annual TriMED Healthcare Education Summit. The conference focused on the opioid epidemic, Tennessee’s number one public health crisis, and presented 20 hours of accredited continuing medical education. Partnering organizations included the American College of Physicians - Tennessee Chapter, Count It! Lock It! Drop It!, Tennessee Department of Mental Health and Substance Abuse Services,  Tennessee Medical Association, Tennessee Pain Society and the Vanderbilt Center for Quality Aging, in partnership with the Veterans Administration, Tennessee Geriatric Society and Tennessee Association of Long Term Care Physicians. Courses featured a variety of CME topics including mental health, primary care, pain management and geriatrics. Attendees learned best practices for non-opioid pain management therapies and got updates on new state laws restricting initial opioid prescriptions.

PHOTO CREDIT: JULIA COUCH

BY JULIA COUCH

TriMED’s multispecialty opioid panel discussion on Saturday, Sept. 15, brought together different thought leaders on the crisis.

Nashville-area residents joined the fight against prescription drug abuse and misuse by dropping off unused or expired medication during TriMED’s Drug Takeback Program, hosted by Count It! Lock It! Drop It! Representatives also provided a session for conference attendees on how to effectively coordinate drug takeback programs in their local communities. Tennessee Department of Health Chief Medical Officer David Reagan, MD, PhD, led a session on the rollout of Tennessee’s

Senate, House Reach Consensus on Opioid Legislation Both the U.S. House and Senate passed bipartisan measures to address the nation’s opioid crisis. In late September, Senator Lamar Alexander (R-Tenn), who leads the Senate Health Committee, announced the legislative bodies had reached consensus to reconcile the two measures. Alexander called the SUPPORT for Patients and Communities Act, “landmark consensus opioids legislation,” that is the product of bipartisan bills, which passed the House of Representatives by a vote of 396-14 and the Senate by a vote of 99-1. “The consensus legislation includes the STOP Act to help stop the shipment of synthetic opioids, extends support for Medicaid patients seeking treatment from 15 to 30 days, covering all substance use disorders, and permanently allows more medical professionals to treat people in recovery to prevent relapse and overdoses,” said Alexander. “The bill also allows the FDA to require prescription opioids to be packaged in set amounts like a three- or seven-day supply in blister packs, and will help spur the development of a non-addictive painkiller. There is bipartisan urgency for both of our chambers to pass this consensus legislation so the president can sign it as soon as possible.” Alexander also noted the Senate had separately appropriated $8.5 billion this year towards fighting the opioid crisis, after the FY2018 Omnibus Appropriations bill Congress passed in March included $4.7 billion to fight the opioid crisis and the FY2019 Health and Human Services Appropriations bill the Senate passed in September included $3.8 billion to fight the epidemic. 10 Key Provisions of the Legislation: • STOP Act—to stop illegal drugs, including fentanyl, at the border, • New non-addictive painkillers, research and fast-track, • Blister packs for opioids, such as a 3- or 7-day supply, • Extended support for Medicaid patients seeking treatment from 15 to 30 days, covering all substance use disorders, • TREAT Act, which permanently allows more medical professionals to treat people in recovery to prevent relapse and overdoses, • Prevention of “doctor-shopping” by improving state prescription drug monitoring programs, • More behavioral and mental health providers, • Support for comprehensive opioid recovery centers, • Help for babies born in opioid withdrawal and for mothers with opioid use disorders, and • More early intervention with vulnerable children who have experienced trauma.

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new prescribing laws, which took effect July 1. TMA produced proprietary resources for doctors and other healthcare providers, including a new two-hour online course to satisfy the Board of Medical Examiners’ requirement for safe and proper prescribing education for all licensed physicians in Tennessee, available at tnmed.org/opioids. The TriMED partner organizations also hosted a multispecialty opioid panel discussion on Saturday featuring experts in pain management, pharmacy and mental health. Panelists included Reagan, along with Commissioner Marie Williams, LCSW, and Wes Geminn, PharmD, of the Tennessee Department of Mental

Other TriMED Highlights Included: • A luncheon discussion with Democratic gubernatorial nominee Karl Dean to learn where he stands on healthcare issues, • A wellness course to help doctors better understand and address high rates of physician stress, burnout, substance abuse and suicide, • A risk management course hosted by SVMIC, and • Additional breakout sessions on mental health, internal medicine and geriatrics.

Health and Substance Abuse Services; John Schneider, MD, MBA, and Stephanie Vanterpool, MD, MBA, of Tennessee Pain Society; and Nita Shumaker, MD, of the Tennessee Medical Association. Recorded videos from select TriMED sessions will be available online at tnmed.org/cme-library. Julia Couch is a communications specialist with the Tennessee Medical Association. For more information on TMA, go online to tnmed.org.

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The War Against Opioids in Pain Management, continued from page 1 or substance use disorder patients. “Sometimes narcotics are appropriate for chronic pain patients, but you really want to try to decipher if there are alternatives that could help with the pain and reach for those first,” said Bollinger, who often recommends overthe-counter painkillers Dr. Allison Bollinger in lieu of opioids. Because pain is a withdrawal symptom, it can also be difficult to know if patents are actually in pain or if they’re experiencing withdrawal, also characterized by nausea, dizziness, anxiety and flu-like symptoms. New prescription drug laws limit opioid usage to 72 hours or less and require providers to jump through hoops for an extension. Fortunately, awareness of the opioid addiction epidemic has trickled down to the general public, many of whom understand the risk. According to the Centers for Disease Control and Prevention, one in 40 opioid patients become addicted. “We’re in a new era,” Bollinger said. “We used to say pain needs to be a zero on the scale, and people were preoccupied with the fact they still hurt. Now, patients are recognizing that it’s okay to hurt sometimes … and with some, you have to convince them to take pain meds at all because they’re so nervous about

repercussions.” However, Bollinger still regularly addresses misconceptions about substance use disorder – namely that it’s a “one size fits all” problem limited to one population or demographic. “The reality is, this is rampant in all areas of society,” Bollinger said. “I’ve seen it in CEOs, soccer moms and everyone in between.” She also encourages primary care providers to play a more active role in sorting out a patient’s medical nuances and to provide ERs with a heads-up about patients at risk of substance use disorder.

Alternatives for Back Pain

“The opioid pendulum has swung from one end of the spectrum to the other so rapidly,” said Son D. Le, MD, FAAPMR, DABAM, DABPM, founder and CEO of the Center for Spine, Joint & Neuromuscular Rehabilitation in Nashville. Le – who is board certified by the American Academy of Physical Medicine and RehaDr. Son Le bilitation, American Board of Addiction Medicine and the American Board of Pain Medicine – has a special interest in comprehensive pain management that includes advanced and minimally invasive procedures. “I tell patients they live in a good time

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for pain,” Le said. “Today’s patients have so many options.” Countless back pain patients have found relief through spinal cord stimulators, which can simply be explained as “an epidural to go.” Stimulators include two electrodes implanted in the epidural space to block pain with nerve stimulation and can be used to treat neck or lower back pain. Prior to permanent placement, patients undergo a five to seven day trial to determine efficacy. Thanks to improvements in waveform stimulation and frequency, the permanent implantation rate in Le’s clinic from 2016 to present was 99 percent. Spinal cord stimulators have proven most successful in patients with failed back syndrome, complex regional pain syndrome, neuropathic and phantom (amputee) pain. Regenerative medicine also is proving effective for soft tissue and joint pain relief and joint pain relief – but for a price, as insurance providers typically don’t cover platelet rich plasma (PRP) and stem cell injections, requiring patients to pay minimally $600 and $1,500 out of pocket per injection, respectively. But for many patients who’ve suffered with chronic pain for years, it’s a small price to pay for relief. Patients with chronic arthritis pain in the neck and back often turn to rhizotomy, or radiofrequency ablation. The procedure uses a specialized needle with an exposed tip that vibrates the nearby tissues and heats them up. “Under live X-ray, you guide the needle parallel to the nerve, heat it up and lesion it to take away pain,” Le explained. One treatment typically lasts 9 to 12 months. Le also manages intrathecal pain pumps, which allow pain medication like morphine to be administered directly to the spine. While the complex procedure is often considered a last resort in pain control, it virtually eliminates the risk of opioid misuse and diversion since no oral pain pills are involved in the treatment. Thanks to relatively new technique using very small doses of intrathecal morphine, patients can have their pain managed with minimal risk of developing tolerance or overdosing since one milligram of intrathecal morphine is estimated to be equivalent to 100-300 milligrams of oral morphine. “The pump was once considered taboo and scary, but with microdosing it’s virtually impossible to overdose,” Le said. “You can treat chronic pain with very little intrathecal morphine and never have to increase the amount.” In addition, the Center for Spine & Joint also dispenses a range of complementary approaches to pain management including behavioral therapy, physical rehabilitation, nutritional guidance and general fitness education to attack the problem on multiple fronts.

Addiction Services at Meharry

“There’s no question the opiate crisis affects individuals from all walks of life and socioeconomic levels,” said Lloyda Williamson, MD, DFAPA, chair of Psychiatry at Meharry Medical College School of Medicine. Williamson is an

administrator and a provider for addiction treatment programs, which provide care for many individuals seeking treatment, including African Americans. “African AmeriDr. Lloyda cans tend to seek treatWilliamson ment later for medical disorders, as well as substance use disorders compared to other populations,” Williamson said. Contributing factors for this difference include lower employment rates, decreased access to insurance coverage and fewer available treatment options. Across the board, Williamson said there also simply aren’t enough addiction treatment providers. “Even if everyone who has an opioid use disorder wanted care, there aren’t enough providers or treatment centers,” she said. “While the rate of providers is increasing slightly, it’s more on the flat side compared to increases in other specialists. There’s a huge shortage of providers overall.” In keeping with the historically black college’s inclusive mission, Meharry provides addiction treatment services for the poor and uninsured through the Lloyd C. Elam Mental Health Center. Statefunded grants allow the Elam Center to provide an intensive residential treatment program, a special program for women who are pregnant and postpartum, and an intensive outpatient program that meets for three hours, four days a week. “We provide care for all, regardless of background,” said Williamson, who also serves as executive director and medical director for the Elam Center. “African Americans and other groups tend to see addiction as a weakness or character flaw rather than a medical problem. Correct information really isn’t out there in the community.” Changing that stigma requires changing conversations, and that begins with primary care providers screening patients and learning to better distinguish between dependence and addiction. “Anyone who gets prescribed an opioid for pain in appropriate use post-surgery will be dependent if you suddenly stop meds,” Williamson said. “That doesn’t mean they’re addicted, and many providers don’t understand that.” By weaning patients to a more appropriate medication rather than cutting them off, patients are less likely to turn to street drugs. She also encourages providers to be more aware of community resources so patients can receive support and treatment they need and to become more informed of the role of medication-assisted treatment (MAT). “One problem for people who start recovery is that when they come out of treatment facilities, many group homes and providers don’t recognize buprenorphine as appropriate treatment,” she said. “As providers, we need to reach out to the recovery community to help educate them that medication-assisted treatment is appropriate treatment and not a substitute.” nashvillemedicalnews

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Keeping the Focus on Quality & Safety LifePoint Health Efforts Recognized & Shared Nationally By MELANIE KILGORE-HILL

Quality and patient safety are benchmarks for any healthcare organization. In Middle Tennessee, LifePoint Health is redefining expectations through its innovative National Quality Program, a structured process for ensuring consistent, high standards of quality and patient safety. In fact, in March, the company became the first investor-owned health system to receive the John M. Eisenberg Award for Innovation in Patient Safety at the Local Level. Presented annually by The Joint Commission and the National Quality Forum, the prestigious Eisenberg Awards acknowledge major achievements in healthcare quality and patient safety. Created in partnership with Duke University Health System, the LifePoint program has led to significant enhancements across the hospital company’s network, including a more than 60 percent improvement in aggregate patient safety.

Setting a Goal

“One of the most important and pivotal moments for LifePoint was in 2011, when we were selected by the CMS Innovation Center to participate in their hospital engagement network (HEN),” said LifePoint Chief Medical Officer Rusty Holman, MD. LifePoint was among 26 organizations tasked with reducing patient harm in hospitals by Dr. Rusty Holman 40 percent in three years – and the only for-profit system in the mix. “We were already aligned very closely with where CMS was going in patient safety and quality and that enabled us to work with CMS as a partner to share results, learn from other organizations and spread best practices,” Holman said. “We also have a unique, non-urban footprint, and CMS is interested in how to advance healthcare in rural communities.” LifePoint not only rose to the challenge … but exceeded the CMS goals nine months ahead of schedule. So how does a 54-hospital system* spread across 19 states make that kind of impact across its footprint? Very intentionally, Holman said.

Making it Work

Their results-driven model, now being used as a catalyst for health systems nationwide, was based on three elements – defined leadership, evidencebased performance methods (i.e. not reinventing the wheel), and developing a culture of safety – objectively measured nashvillemedicalnews

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with validation surveys used to create a better environment for front line workers and physicians. “We’ve not only seen massive improvement in patient safety through reduction of complications, but we’ve seen a progressive year-over-year statistically significant improvement in a culture of safety across the entire enterprise,” said Holman, noting implementation of the plan in every department and unit of every LifePoint hospital. Holman believes their results are possible for any organization – for-profit or not – with an unequivocal commitment from executive leadership. Companies also need a reliable framework for improvement across the entire organization. LifePoint’s framework was developed through a partnership with Duke Health System, which helped develop a sustainable model built to outlast their CMS partnership. “You need a scalable model, because you can’t just expect a single facility to figure it out on their own and do things their own way,” Holman said. The third pillar of success is that LifePoint didn’t separate quality and patient safety accountability from dayto-day operations. “We embedded quality and safety into every part of the operation of the company,” Holman said. “When our operators and financial teams get together and do monthly operating reviews, they spend as much time on quality and safety as they do on operations. That sends a clear signal as to what’s important, and it’s managed with as much rigor as financial operational metrics.” That’s no small task, particularly in an organization with 46,000 people. And while big changes inevitably yield pushback, Holman said it’s absolutely doable. “The hardest thing to do in an

organization this size is get everyone on the same page,” he said. “It’s not easy, but it’s not rocket science either.” For LifePoint, that meant being unequivocal about the importance of quality and safety objectives. Underscoring that importance requires being unapologetically repetitive and taking every opportunity to communicate the message at every level of the organization. They also made heroes of those who helped advanced their quality and safety agenda and hired to those standards, as well.

Community Coalitions

Seven years later, LifePoint continues to push their quality and safety message to ensure their baseline as goals are met and standards improved. “We’ve shown that we can make rapid improvements in the hospital setting in a short period of time, because we’re responsible for nearly all variables within the hospital,” Holman said. Outside the hospital, leaders realized that controlling social determinants of health like access to medication, healthy food and transportation was a different challenge altogether. Soon, they began reducing readmission rates by working with local resources and agencies to create community coalitions – health programs that address challenges unique to each community. “In community coalitions, our hospitals take on a new role in serving as a convener of a wide variety of community resources,” said Holman. “We’re an anchor for bringing those diverse organizations together and discussing the most pressing community health needs. By working together, we’ve found that we’re able to achieve things better and do it faster.”

Now, LifePoint Health is looking at innovative ways to take the lessons learned and improve outcomes in outpatient physician practices.

Sharing their Story

Holman also is committed to sharing LifePoint’s success with other healthcare organizations, and encouraging them to start the process. “Create a vision for where you want to go and make it tangible,” he said. “Our CMS partnership was invaluable because it gave us clear goals in a clear time frame and served as a rallying point for us.” He urges executives to take a hard look in the mirror and ask if quality and safety are something they’re absolutely committed to focusing on, both personally and for their organization. Executives also should examine the organization’s capabilities and identify where they need to reorganize, reinvest and make improvements. For LifePoint, that meant making significant investments in people and data systems within the first two years. “Without the right people and good information, this is just an idea that will sit there,” Holman said. Finally, he encourages leaders to find a realistic way to act on opportunities and choose a framework that will resonate with everyone in the organization. “We don’t have a proprietary approach, and our model isn’t unique to us, although we made it ours by requiring very specific behaviors and expectations,” he said. “This is not a linear undertaking but a winding road where you’re constantly looking at improving and learning.” *Total number of LifePoint hospitals when the company first participated as a hospital engagement network.

Just what the doctor ordered Less stressed and more focused employees. 81% of workers say worries about financial problems have affected their productivity. 40% of employees want help achieving financial security. Research from the Consumer Financial Protection Bureau

Contact our Financial Care Team to see what Life CU can do for you. 615-230-LIFE • info@lifecu.org • LifeCU.org

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New Tech Solutions to Improve Medication Adherence By LARRY McCLAIN

A health system can make remarkable strides in patient safety and quality only to see those results squandered when patients fail to properly adhere to a medication regimen. A recent study by the Council for Affordable Healthcare Coverage found that a shocking two-thirds of patients in the United States do not adhere to their medication treatment plans. It’s a problem that’s costing the nation’s healthcare system an estimated $100 billion annually. At this year’s Health:Further conference, two innovators shared their thoughts on how technology can help solve this vexing problem. Bruce Greenstein, former CMS chief technology officer and now an executive at The LHC Group, urged providers to prioritize outreach efforts to the top 5 percent of health system utilizers who account for 50 percent of all spending. “The top 5 percent of Medicare utilizers spend an average $43,000 each annually, while those in the bottom 50 percent only spend an average of $234 each,” he said. “It’s really important to focus our resources where they’ll have the most impact.” Greenstein added that about onethird of patients who go to a skilled nursing facility (SNF) following hospital discharge could instead go home, providing they had someone there to assist with medication adherence. He noted that even at SNFs, medication adherence isn’t always handled properly. “SNFs have star ratings for excellence, but a lot of low-quality SNFs are still getting referrals,” he said. “Cost and health literacy remain two distinct barriers to improving the outlook on medication adherence,” said Miriam Paramore, president of OptimizeRx. “There is a significant opportunity to positively impact medication adherence rates Miriam Paramore by embedding cost savings opportunities, education materials and refill transparency directly into EHR workflows.” OptimizeRx makes it much easier for physicians to monitor medication adherence. “This direct line of communication allows physicians to access key information on patient follow-through,” said Paramore. “For instance, once an order for a medication is made with an e-prescribing workflow, data is sent back to the physician regarding whether the patient has picked up the medication from a retail pharmacy. Information on refill followthrough is also available. Armed with this important insight into patient activity, physicians can then get ahead of the medication non-adherence problem by proactively reaching out to patients to determine the reasons for non-compliance.” The high cost of medications remains 8

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one of the principal reasons why people quit taking prescribed drugs. A recent report from the National Center for Health Statistics found that about 8 percent of adult Americans don’t take their medications as prescribed because they can’t afford them. For those with incomes below the federal poverty level, that percentage rises to almost 14 percent. OptimizeRx aims to reduce those percentages by automatically alerting patients to savings they might otherwise not know about. “As physicians conduct a patient encounter, available co-pay coupons and vouchers appear within their existing EHR workflow and can be immediately printed, texted or emailed to help bridge the knowledge gap regarding patient savings opportunities,” explained Paramore. “Physicians simply search for a brand name drug within the EHR, and in real-time, they’re alerted to available offerings for a specific patient. The patient

can then present the coupon or voucher to a retail pharmacy provider. By improving medication affordability, ongoing adherence and desired clinical outcomes are more likely to be sustained.”

Digital Alerts On The Rise

A recent Pew Research study revealed that more than 90 percent of Americans now own a cell phone – and 64 percent of them are smart devices. Providers are increasingly texting medication reminders because patients are accustomed to receiving information that way. Nearly 40 percent of these digital reminders actually go to caregivers, not the patients themselves. Getting a timely text helps them ensure that the medication schedule is being followed.

Complicating Factors

Even when drug costs and provider communication aren’t an issue, medica-

tion adherence can still be challenging. Here are some factors that add to the complexity: CMS estimates that 75 percent of Medicare-age patients have multiple chronic conditions that require multiple medications throughout the day. Many patients still try to “be their own doctor,” quitting a medication when they either feel better or don’t like the side effects. The severity of the condition doesn’t always ensure medication adherence. One study showed that fewer than half of the patients who survived a major heart attack were adherent to their medication plans in the months following the attack. Technology tools like OptimizeRx are providing timely education to combat these misconceptions and scheduling issues. “We can engage patients more fully and help them achieve better outcomes,” said Paramore.

Designed to Disinfect, continued from page 1 How can we lower these numbers? In addition to hand washing reminders for doctors, nurses and visitors, encouraging and reminding staff to use gloves and proper protective clothing, and covering coughs and sneezes, it’s also important to consider infection control when planning a medical facility’s initial design. Facility management should consult not just a commercial interior designer but one who specifically specializes in healthcare interior design and knows which materials and furnishings to use to lower the risk of infection. Below are three items to consider while designing medical facilities that will help fight the spread of infections: • Furnishings Furniture should not impede the cleaning process. Many different people will sit on or touch the furniture countless times throughout the day, so it must be durable enough to withstand daily cleanings with harsh products, such as a bleach solution. Germs and dirt can collect in small crevices if rips, tears or cracks have formed due to daily cleanings. Sofas with solid surface arm caps make them easier to disinfect, while tandem seating with less legs or a bar system is easier to clean underneath. At Saint Thomas West Hospital, for example, siting areas incorporated single and tandem seating from Spec Furniture that features polyurethane, easy-to-clean arms, along with taller, thinner legs that are simpler to clean around. • Surfaces It’s even more important to consider the material(s) that make up the chosen furnishings. Most HAIs spread through contact – an infected patient spreads the infection to a surface or doctor who then

passes it on to the next patient. According to Healthcare Design Magazine, MRSA – a germ that is responsible for 63 percent of hospital-acquired staph infections – can survive for 11 days on a plastic patient chart and more than 12 days on a laminated countertop. Therefore, surfaces should be made of materials that can withstand a bleach and/or chlorine solution. In addition, furnishings made with natural antimicrobial properties, such as silver or copper, cause germs to die more quickly. • Upholstery Hospitals and clinics need to pay special attention to their choices for curtains, drapes and other upholstery, as fabrics can be more difficult to disinfect than hard surfaces. To be considered “bleach cleanable,” fabrics must not fade or weaken when exposed to bleach solutions. Fiber types such as acrylic, nylon and high-energy polyester are known for their ability to withstand these solutions while still maintaining their original colors. Many of these fibers are also naturally mildew resistant, helping to prevent the growth of mold, which can be problematic in hot and humid locations. Additionally, fabrics can be treated with an antibacterial finish to help protect them against bacteria and other microbes. Finishes that contain a silver ion that cuts off a bacteria’s ability to breathe tend to be the most effective. Mayer Fabrics’ Zen seating upholstery is one of our new favorite products that stood out at this year’s Neocon, the commercial design industry’s largest annual conference. The fabric is bleach cleanable, backed by 100 percent polyester and features a soil and stain resistant topcoat and abrasion and pilling resistance.

For something a little more daring and bright, KnollTextiles’ Between the Lines collection was also a Neocon favorite. With bright color and stripe options and featuring bleach cleanable upholsteries that are made from vinyl and polyurethane, as well as non-phthalate vinyl wallcoverings, this collection serves a dual purpose of adding pizzazz to a room and keeping it easy to clean and disinfect – perfect for pediatric spaces. In addition to fabrics, one element to not overlook is privacy curtains that must be as durable and cleanable as other items throughout the room. After all, with doctors, nurses and visitors pulling on the curtain multiple times throughout the day, it’s bound to get germs on it. MRSA can survive on cloth curtains for up to nine days, and a survey conducted in 2008 by F. Trillis, EC Eckstein, R. Budavich, et al. found 42 percent of hospital privacy curtains were contaminated with Vancomycin-Resistant Enterococcus (VRE), an antimicrobial-resistant bacterium, and 22 percent with MRSA. Some of our favorite brands of privacy curtains include Momentum and Architex, to which we can add an Impact Technology treatment to help prevent the spread of infection. With patients now researching a hospital’s infection rates before scheduling surgeries, it is in a hospital’s best interest for both its patients and bottom line to invest in smart interior design that reduces the risk of infection. Rebecca Donner is the owner and founder of national healthcare interior design firm Inner Design Studio, based in Nashville. For more information, visit innerdesignstudio.com.

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The Quest for Quality in Clinical Trials By CINDY SANDERS

GIGO – or ‘garbage in/garbage out’ – was coined as a computer science term for the flawed output that comes from inputting flawed data. Over the years, the GIGO principle has been broadly applied to other areas of analysis where flawed logic impacts outcomes. Perhaps nowhere is that more evident than in a poorly designed or improperly executed clinical trial. Earlier this year, Jody Black, deputy director of the Office of Extramural Research at the National Institutes of Health, introduced the acronym ‘SCT’ at the annual meeting for the Association of Clinical Research Professionals. Although the NIH has supported their fair share of ‘small, crappy trials’ over the years, the national funding source has spent the last decade enhancing oversight, monitoring, reporting and transparency to improve the quality of trials, which in turn improves the quality and credibility of research findings. While some poorly designed, executed or reported trials are simply a waste of dollars, others have deadly consequences. Faulty ‘research’ published in 1998 linking vaccines to autism is still widely disseminated online. To this day, there are a significant number of fearful parents who refuse to vaccinate their children, which has led to the reemergence of several serious infectious diseases.

Developing Skills

While there have been a number of advances in technology and processes to improve the quality of trials, Kremidas said the people on the frontlines are often overlooked. Outside of major academic centers, those doing the heavy lifting on clinical research often aren’t specifically trained in the exacting tasks that come with being a principal investigator or study coordinator. “There hasn’t been historically any standards set for who can be a clinical researcher,” he explained. “Study coordinators … most of them just fell into the job. It’s been total serendipity how people came into the field.” He continued, “About half of the doctors who do a clinical trial only do it once. Clinical practice is not the same as clinical research.” To drive the organization’s mission of research excellence, Kremidas said much of the ACRP’s focus has been on education and development. “We’re trying to grow the workforce, and we’re also trying to help individuals keep up with changes in the industry,” he explained. “If you’re going to be a principal investigator, you need to be trained appropriately … you need to have certain competencies,” Kremidas pointed out. To that end, the organization has created a competency framework. “We think it

will help people transition into better clinical researchers if they know what they’re getting into,” he said. Kremidas continued, “We also do certification of clinical researchers. We’re now offering subspecialty designations. We just launched one this year for project management and had more than 200 sign up for the exam already.” Available certifications include ACRPCP (certified professional), CCRC (certified clinical research coordinator), CCRA (certified clinical research associate), and CPI (certified principal investigator).

Growing the Workforce

Another area of emphasis for the ACRP is on workforce growth. As science explodes, so does the need for qualified researchers to oversee clinical trials. “We just recently announced a new initiative – Partners in Workforce Advancement (PWA),” he said of the effort to raise awareness of clinical research as a career path by reaching out to medical students and nursing students about the importance of field.

The PWA motto is: In clinical research, people are everything. The literature associated with the initiative points out that without an adequate pipeline of qualified, competent professionals, the clinical trial community will fail to both sustain the workforce and improve the efficiency and quality of medical discovery. “Medical technology is advancing so fast,” noted Kremidas. “There’s an exponential growth in clinical trials, but there’s only a linear growth in PIs, CRCs, and CRAs … the people who actually do the trials.” Without a robust workforce, he continued, “That leads to slower introduction of new therapies to the market, and that … in my opinion … is a public health problem.”

More Information

Founded in 1976, the ACRP has 13,000 members who work in clinical research in more than 70 countries. For more information on the Washington, D.C.-based organization or any of its programming initiatives, go online to acrpnet.org.

Save the Date for ACRP 2019 in Nashville The premiere education and networking event for clinical research professionals is coming to the Southeast next spring. ACRP 2019 is scheduled for April 12-15 in Nashville. Registration for the 2019 conference opens online on Oct. 15, 2018 at 2019.acrpnet.org/registration.

Research GIGO

Jim Kremidas, executive director of the Association of Clinical Research Professionals (ACRP) said the not-for-profit organization works to enhance and improve the grassroots implementation Jim Kremidas of clinical research by supporting the individuals involved. “A poorly designed trial has a negative impact … but so does a poorly executed trial,” noted Kremidas. He added writing a protocol might seem simple, when in reality the wording has the potential to taint the entire process. “It’s so critical that you ask the question correctly so that you get an answer that actually means something,” he stressed. “We don’t want spin in science.” Operational concerns and execution can also derail a clinical trial. “You could have a brilliant, scientifically designed study, but operationally you couldn’t do it,” he pointed out. Kremidas said he has seen trials with such narrow inclusion criteria that it becomes difficult, to the point of nearly impossible, to find patients to enroll. Even with a trial that is well designed, he continued, “If the people executing the trial aren’t doing it correctly, you won’t get the data needed.” Kremidas added, “I think the key to getting rid of those SCTs is we have to have the right experience and expertise in the people designing and implementing these studies.”

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Keeping pace with an ever-changing industry

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: Robert C Allen, MD, FACS, RPVI, with Nashville Vascular and Vein Institute shares quality and outcome insights in his article, “Vascular Surgery Quality - It’s All About The Data.” George Buck, president emeritus, and Judd Peak, chief compliance officer and general counsel, with Frost-Arnett Company, take a vendor’s perspective to drill down on “Laws and Regulations Continue to Affect Patient Pay: The Fair Debt Collection Practices Act.” In part three of this six-part series, the authors look at the Telephone Consumer Protection Act. Britt Cumbie, CPA, director of Contract Accounting with LBMC Staffing Solutions, discusses how the evolving healthcare market has led to hiring challenges and new approaches to filling key roles.

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PRRB Announces Significant Changes to Medicare Appeal Rules On Aug. 29, 2018, the Provider Reimbursement Review Board (PRRB) issued new rules containing both technical changes and substantial revisions to its appeal procedures. The 90-page PRRB Version 2.0 applies to both new and pending appeals as of the date of its release, and failure to follow the new requirements could result in a provider’s loss of appeal rights. By J. MATTHEW Among the key KROPLIN, JD, CHC changes in the new rules are front-loading the grounds for appeal and an emphasis on electronic filing. The PRRB is an independent panel created by Congress in 1972 and has jurisdiction over certain Medicare appeals by Part A providers. PRRB appeals stem from provider disagreement with reimbursement determinations by the Medicare Administrative Contractor (MAC) after its review of the provider’s annual cost report, assuming the requisite amount is in dispute. The PRRB’s goal is to “facilitate early resoluProject1_MedNewsAd 9/23/18 1:18 PM Page 1 tion of appeals and eliminate unnecessary

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filing burdens where appropriate.” The PRRB’s decision may be affirmed, modified, reversed, or vacated by the CMS Administrator. The new rules now require a full preliminary position paper, including exhibits, to be filed with the PRRB at the beginning of the appeal. By now having these materials provided to the PRRB from the outset, instead of just to the MAC, it effectively requires the appealing provider to set forth its formal position from day one. Commentary to the rules now explain that “preliminary position papers are expected to present fully developed positions of the parties and, therefore, require analysis well in advance of the filing deadline.” Reinforcing this expectation, the new rules explain that “[n]ew arguments and documents not included in the preliminary position paper may be excluded at hearing unless the parties demonstrate good cause.” In addition, the new rules eliminate the requirements for a final position paper in any appeal filed after Aug. 29, 2018 and for a post-hearing brief in all appeals. Going forward, both will be optional with the former potentially being used to narrow the issues prior to hearing and the latter being subject to the PRRB’s request. Another significant change is the new reinstatement option, which allows pro-

viders to preserve their appeal rights while attempting to resolve their Medicare payment decisions at issue with the MAC. If unsuccessful, the provider can reinstate the appeal to pursue it before the PRRB. In conjunction with the new rules, and to advance its stated goal of reducing unnecessary filing burden on providers, the PRRB is also shifting to an electronic filing system through the creation of the Office of Hearings Case and Document Management System (OH CDMS). The new rules state that, although “not currently required, the PRRB strongly recommends all parties utilize this new electronic case management tool.” As guidance, CMS recently released an external user manual for OH CDMS, and providers (or their representatives) may register for the OH CDMS online. During the transition period, the PRRB will con-

tinue to accept hard copy submissions by mail, but it will not accept submissions by email or fax. In addition to an emphasis on early position development, the new rules provide additional clarity, a new reinstatement option, and access to electronic filing. But they also create potential landmines for filing providers, who must be careful to satisfy the requirements of the updated rules to avoid risking significant money at issue on appeal. Matthew Kroplin is a partner in the Nashville office of Burr & Forman, LLP. Kroplin, whose work is focused in the firm’s healthcare and business litigation sections, is certified in healthcare compliance (CHC). He provides counsel to a broad range of healthcare industry clients, including providers, medical groups, hospitals, and surgery centers. For more information, go online to burr.com.

Meharry Launches Data Science Institute By CINDY SANDERS

Last month, Meharry Medical College announced the launch of a new data science initiative designed to accelerate the treatment and care of underserved populations. The Data Science Institute at Meharry will allow healthcare providers, researchers and students to mine more than 3.5 million medical and dental records to gain new and unique insights into medical, social and environmental issues and trends impacting the health of minority populations and those with few resources. Meharry Medical College President and CEO James E.K. Hildreth, PhD, MD, noted much of today’s standards of care are based largely on data from Caucasian patients. He said Meharry anticipates the Institute’s wealth of real-time, curated clinical data will fuel learning, discovery and improvements in the care for underrepresented populations for years to come. “This is a monumental day for Meharry and for the students and patients we serve,” said Hildreth. “Big data is shaping the future of healthcare education, innovation and delivery, and Meharry students, faculty and partners now have a diverse and deep well of medical, social and environmental data at our fingertips. This unique and growing database will inform and enhance our mission to identify, analyze and address the health challenges facing minority and underserved populations.” The Institute’s de-identified data will be pulled from 200,000 unique patients who visited Nashville General Hospital, Meharry Medical Group and Meharry’s Dental School clinics over the last 10 years. Patients represented in the data are 48 percent male and 52 percent female, and the age breakdown is as follows: 0-18

years (20.76 percent), 19-25 (14.53 percent), 26-34 (19.24 percent), 35-54 (29.9 percent), 55-64 (9.59 percent), and 65 and older (5.99 percent). The Institute, located on Meharry’s campus, will initially target its research on four chronic diseases that disparately affect poor and minority populations: cardiovascular disease, hypertension, diabetes and obesity. Raw data already indicates some potential trends that will drive additional investigation including a 16 percent increase over the last two years in patients with a diagnosis of type 2 diabetes. Amy M. Andrade, senior advisor to the president for Technology and Innovation and assistant vice president of Research at Meharry, has been tapped to lead the Institute. Clearsense, a Floridabased health data management company, has worked with Meharry for the past three years to build the data infrastructure for the Institute, which has a framework that should easily connect with other IT infrastructures or data sources to provide access to real data in real time. The Institute also plans to release quarterly research papers on its findings and recommendations, as well as host at least one annual conference. It also will support new areas of research and study at Meharry, beginning with the first Data Science Survey Class in January and a Certificate of Data Sciences, which will be offered in the 2019-20 academic year. Hildreth unveiled the Institute on Sept. 13 during the Global Action Platform’s Fall University-Business Showcase at ONEC1TY. Mayor David Briley gave opening remarks and was joined by Scott T. Massey, PhD, founding chairman and CEO of Global Action Platform, and other community leaders at the event. nashvillemedicalnews

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Time for Nashville to Get a Checkup City Launches First Health Survey in Nearly 20 Years

sity of Illinois at Chicago, the questions will be administered in both English and Spanish, and respondents will be able to reply via web or mail. The questions included in the survey were selected from the Centers for Disease Control & Prevention’s Behavioral Risk Factor Surveillance System and other national surveys to address Nashville’s unique health-related priorities and determinants. Surveys began being mailed in late September with a first round of data expected by the end of the year. Final data sets should be delivered the by early 2019. Once final, the data will be disseminated in multiple formats. “This project will provide comprehensive baseline health data for Davidson County – data that do not exist today,” said Sen. Bill Frist, MD, founder and chairman of NashvilleHealth. “These data will be critical to better understanding the health needs of our city and establishing a baseline from which we can all measure the effectiveness of our interventions and collective programs moving forward.” PHOTO CREDIT ALAN POIZNER

Last month, Mayor David Briley joined officials with NashvilleHealth and the Metro Public Health Department (MPHD) to announce the launch of the Nashville Community Health + Well-being Survey. Being sent to more than 12,000 residents, the countywide assessment looks to provide valuable data about health-related behaviors, chronic health conditions, preventive health practices and the impact of the local environment on well-being. The data from the survey will help create an accurate Mayor David Briley, Sen. Bill Frist and Dr. Bill Paul announce the launch of Nashville Community Health + Well-being Survey snapshot of the city’s overall health and be used to Nashville a healthier community,” said inform and enhance current efforts to Briley, mayor of Metropolitan Governimprove Nashville’s health status. ment of Nashville & Davidson County. The information is also expected to “Only with a comprehensive assessment play an important role in setting future like this will we know the challenges and population health priorities for metro opportunities to the health and well-being agencies and community partners. The of Nashvillians. This survey will give us plan is to implement a routine checkup so data to better serve our residents.” that this survey becomes the baseline from Conducted by the nationally recogwhich future findings can track progress. nized Survey Research Lab at the Univer“I’m committed to this effort to make

The Mayor’s Healthy Nashville Leadership Council has undertaken a multifaceted Community Health Assessment (CHA) this year in coordination with area hospitals, clinics and nonprofits. The new health survey coincides with the CHA to help highlight and prioritize health issues. Ultimately, the CHA will be used to inform Nashville’s Community Health Improvement Plan. “Just as a doctor needs to know vital signs, we need to take the temperature on Nashville’s health every so often,” said Bill Paul, MD, director of MPHD. “Ninety percent of health happens outside of hospitals and doctor’s offices, and the Nashville Community Health + Wellbeing Survey is an essential tool for us to size up the key elements of good health in our population.” Funding for the survey is being provided by Amerigroup, BlueCross BlueShield of Tennessee, HCA, LifePoint Health, The Memorial Foundation, Metropolitan Government of Nashville and Davidson County, NashvilleHealth, Nashville Health Care Council, Tivity Health, UnitedHealthcare, AMSURG, Nashville Area Chamber of Commerce, Change Healthcare, The Healing Trust, Live Nation, Vanderbilt University Medical Center, and Vector Management.

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NMGMATen Minute Takeaway

Insights from the National Organization By CINDY SANDERS

The second Tuesday of each month, practice managers and healthcare industry service providers gather for the monthly Nashville Medical Group Management Association (NMGMA) meeting at Saint Thomas West Hospital. During the September luncheon, Yvette Doran, MBA, FACMPE, national chair of the Medical Yvette Doran Group Management Association/American College of Medical Practice Executives Board of Directors, provided an update on trends impacting medical practices. Doran discussed current initiatives and available resources to support medical practices during an ongoing era of change in the healthcare delivery system. In addition to her national position, Doran has firsthand insight into the challenges facing physicians and administrators in the practice environment in her role as president and CEO of Saint Thomas Medical Partners/ Ascension Medical Group-TN. “Joining MGMA was the single best decision I made in my career … I just didn’t know it at the time,” she shared with a laugh. While Doran didn’t plan to go into healthcare, 26 years later she can’t imagine taking a different career path. After graduating from college, Doran took a job in an East Tennessee practice while she explored her professional options. “I knew nothing about healthcare, but it was exciting,” she recalled thinking. Making a move to Kingsport and a large multispecialty practice, Doran quickly realized she needed a resource to help her navigate the complex medical world. Landing in the local MGMA chapter, it didn’t take long before she was actively involved and taking on local leadership roles … which led to a larger state role … and ultimately national involvement and leadership. “MGMA offers technical, analytic tools and opens up an entire world of networking,” she told the audience, adding she didn’t think she would be in her current position with Saint Thomas Health/Ascension if it weren’t for joining a local MGMA chapter, getting involved, taking advantage of the educational opportunities and becoming connected to peers across the state and nation. Just as Doran was willing to be open to new challenges, she said the national organization has had to rethink their role in the healthcare ecosystem and be willing to make changes. “We weren’t nimble as an association. We were very static,” she said. “We knew we needed to change, but 12

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being willing to take that first step wasn’t easy.” Where MGMA had been product oriented, the changing practice landscape meant the organization needed to become more agile to meet members’ needs. “You need to be a service organization and add value to the people you’re connecting with … the key is connecting,” Doran stressed. Today, MGMA focuses on engaging members by offering relevant education and professional credentialing for career advancement, working collaboratively with other industry stakeholders and government officials to craft solutions to address key issues, using data to drive business intelligence and highlight trends, and sharing industry insights and expertise. “You can’t be all things to all people. Focus on what you do best,” Doran said. However, she added, it’s also important to recognize that members aren’t all in the same place in their own journeys. There has to be offerings to cover the range of experience from the very seasoned, multispecialty practice manager … to the next young graduate who finds herself in the strange but exciting world of healthcare. “I’m somebody who believes you get what you give, but I’ve certainly gotten more than I’ve given … I can’t tell you the many blessings and returns I’ve received from serving in MGMA,” Doran summed up. For practice administrators interested in becoming involved with the local Nashville MGMA chapter, contact Joy Testa at website@nashvillemgma.org for a guest registration to an upcoming event. Next month’s meeting (see box) features both a meeting and the fall networking social.

Special October Meeting & Event • Oct. 9 • 4-7 pm Mark the calendar for a special time and place as the Oct. 9 meeting and fall social will be held at the Burr & Forman offices at 222 Second Ave. S. From 4-5 pm, attendees will hear the latest from Medicare Part B Senior Education Consultant Paula Motes of Palmetto GBA followed by a networking event on the terrace from 5-7 pm. The event is sponsored by Burr & Forman, LLP and Kraft Healthcare Consulting, LLC. Go to NashvilleMGMA.org for more information.

GRAND ROUNDS Mark Your Calendars TSU Scholarship Gala • Oct. 19 • Music City Center Tennessee State University is hosting a gala dinner event to support the TSU Foundation, which awards scholarships to students across the university’s programming, including the large College of Health Sciences. Tickets are $150 per person with a reception a 6 pm followed by dinner and programming. For details or to purchase tickets, go online to tnstate.edu/gala. Music City AAHAM Fall Conference • Nov. 2 • Envision Conference Center Registration is now open for the Music City Chapter of the American Association of Healthcare Administrative Management fall educational conference. For details or to register, go online to musiccityaaham.org. Distributed:Health • Nov. 5-6 • Schermerhorn Symphony Center Join colleagues for the premier conference for healthcare and blockchain industries. Nashville Medical News readers can sign up with the code “NMN20” for a 20 percent discount off registration cost. For more information, go online to health.distributed.com. Crossroads, An Artia Solutions Conference • Nov. 7-9 • JW Marriott Artia Solutions, a national consultancy specializing in managing pharmaceutical access in the Medicaid marketplace, is bringing together Medicaid stakeholders to explore issues impacting patient access to medications in an inaugural conference in Nashville. In addition to Medicaid 101, the conference looks at the opioid crisis, Medicaid coverage policies, reimbursement, gene therapy, obesity-related conditions, and more. Former FDA Commissioner and CMS Administrator Mark McClellan, MD, PhD, will be the keynote speaker. Full agenda and registration is available online at artiacrossroads.com.

LifePoint Leader to Retire As Nashville Medical News was going to press, Bill Carpenter, who has led LifePoint Health since 2006, announced his intention to retire following the merger with RCCH HealthCare, which is expected to be completed by the end of the year. “It has been an Bill Carpenter absolute privilege to lead LifePoint for nearly 13 years and to be a part of the team since the company’s inception almost 20 years ago. I am incredibly proud of all the organization has accomplished during that time.” Carpenter said as part of the announcement. David Dill, current president and chief operating officer for LifePoint, will

take the helm as CEO of the merged company. Carpenter will have a seat on the merged company’s board of directors.

Bridge Connector Secures Funding, New Partnership It’s been a busy couple of months for Bridge Connector, an integration platform as a service (iPaaS) that delivers streamlined integration solutions for healthcare organizations. At the end of August, the startup completed a $5.5 million Series A round, led by Tampabased Axioma Ventures LLC, bringing the company’s total investment to $10 million in funding. In late September, the company, which has offices inn Nashville, announced a new partnership with PointClickCare Technologies, a cloudbased software vendor for the longterm and post-acute care (LTPAC) industry. The companies expect to accelerate seamless integration in HIT to solve the critical problem of transferring patient data across disparate systems. Bridge Connector will offer PointClickCare software developers a streamlined, integrated process to build on their platform and leverage third-party integrated solutions. “We will leverage our partnerships with the industry’s largest CRM and marketing platforms, including Salesforce, enabling faster integrations for PointClickCare facilities to connect disparate systems,” said Bridge Connector Chief Revenue Officer Andy Harlen.

CDW Opens Local Office Fortune 500 company CDW opened a local office in late August. With clients in the U.S., U.K. and Canada, the global technology company employees more than 8,900 and has a large presence in healthcare. Information provided by CDW noted more than 15,000 healthcare and senior care organizations, including 85 percent of U.S. hospitals, work with CDW to solve technology needs. The new office is located in Brentwood on Seven Springs Way.

Gold Skin Care Expands Team Gold Skin Care Center, which provides dermatology and aesthetic services, recently announced the addition of three to their Green Hills practice. Jody Coleman, CHCO, CAPPM, CMSR, EFPM, has been named practice administrator and COO. She brings more than 20 years of financial and operational experience to Gold Jody Coleman Skin Care Center. Board-certified Nurse Practitioner Collette Utley has also recently joined the staff. Utley graduated summa cum laude from the University of Louisville and received her master’s as a fam(continued on page 13)

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GRAND ROUNDS ily nurse practitioner from the University of Southern Indiana. Utley earned a post-master’s degree as a pediatric nurse practitioner from Northern Kentucky University and is current- Collette Utley ly completing doctoral work in atopic dermatitis from the University of Southern Indiana. Active in the community, Utley is a board member for the Middle Tennessee Advanced Practice Nurses. Caroline Bauknecht, a board-certified physician assistant, has also joined the staff. She graduated with a bachelor’s degree in biology from the College of Charleston and earned her master’s in physician assistant studies from Trevecca Caroline Nazarene University. Bauknecht Bauknecht has experience in both oculoplastic surgery and dermatology.

Hospitals have been recertified with The Joint Commission’s Gold Seal of Approval® for Chest Pain. The chest pain certification combines a review of acute myocardial infarction (AMI) and acute coronary syndrome (ACS) programs into one certification award. Tennessee Department of Health Medical Epidemiologist Mary-Margaret Fill, MD, had groundbreaking research on Neonatal Abstinence Syndrome published in the September issue of Pediatrics. “Educational Disabilities among Children Born with Neonatal Abstinence Syndrome” Dr. Maryreports findings of the Margaret Fill first research of its kind in the United States on whether NAS is associated with educational disabilities (link to the full article is online at NashvilleMedicalNews.com).

CleanSlate Welcomes New CFO Last month, Brentwood-based CleanSlate Outpatient Addiction Medicine announced healthcare veteran Robert Hutchison as the company’s new chief financial officer. CleanSlate helps patients achieve recovery from opioid use disorder and alcohol Robert Hutchison use disorder in 10 states through 47 outpatient addiction medicine centers. With more than 25 years of experience in healthcare finance, Hutchison has served as CFO in the urgent care sector for several organizations including FastMed Urgent Care and U.S. HealthWorks. He earned both a bachelor’s degree in accounting and a master’s in finance from the University of Alabama. Hutchison is also a graduate of the Harvard Business School Advanced Management Program for business, strategy and leadership.

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements In late September, HCA Healthcare announced a donation of $500,000 to the American Red Cross to help people affected by Hurricane Florence. HCA Chairman and CEO Milton Johnson, Senator Lamar Alexander (R-Tenn.) who chairs the Senate HELP Committee, LifePoint Health Chairman and CEO Bill Carpenter, and Community Health Systems Chairman and CEO Wayne Smith were recently recognized in Modern Healthcare as being among the healthcare industry’s 100 most influential people for 2018. Johnson and Carpenter have each recently announced plans to retire by year’s end. Saint Thomas Midtown and West

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TriStar Centennial Parthenon Pavilion has received The Joint Commission certifications for dementia and violence prevention. The Nashville facility is first in the nation to receive The Joint Commission certification in violence prevention, and first in Tennessee to receive certification in dementia. Female Urology of Nashville, the nation’s first all female, fellowship-trained

urological care group, celebrated their first full year as a practice last month. The practice is led by Marcy Abel, MD, Tara Allen, MD, and Harriette Scarpero, MD. Home Care Solutions was named a “Superior Performer” in the recently released 2017 SHPBest™ recognition program results – ranking in the top 20 percent of providers. The program is administered by Strategic Health Programs (SHP) to recognize home health agencies that consistently provide high quality service to patients and families. Professional staffing firm endevis Recruiting | Retention, which has offices in Nashville, was recently recognized in the 2018 iteration of HRO Today’s “Baker’s Dozen” rankings in the “Midsized Deals” category. This is the first inclusion on the list of top Recruitment Process Outsourcing firms for endevis.

TwelveStone Adds Two Murfreesboro-based TwelveStone Health Partners, a provider of comprehensive chronic care medication services, recently announced staff additions. Robert Kurtz has been named contract manager and will be responsible for negotiations with payers to achieve reimbursement terms and contract lanRobert Kurtz guage for company entities. Previously, Kurtz served as a provider contractor for Brentwood-based Prime Health Services. He is a graduate of Lindsey Wilson College in Kentucky. Hal Porter has joined the company as director of Information Hal Porter Technology and Infra-

structure. Previously, Porter was the founder and principal of Brentwoodbased Compliance and Security Professionals. Other prior experience includes serving as vice president of Information Technology at Ambulatory Services of America and as senior director of IT for BioMimetic Therapeutics. Porter, who served in the U.S. Navy for eight years, earned his degree from Harding University in Arkansas.

Horr Joins TriStar Centennial TriStar Centennial Medical Center recently welcomed board-certified interventional cardiologist Samuel Horr, MD, to its medical staff. Part of the Centennial Heart cardiology practice, Horr specializes in structural heart and complex coronary interventions, including TAVR, TMVR, MitraClip and Watchman. He is board certified in the fields of internal medicine, cardiovascular medicine and interventional cardiology. Horr is also board certified in nuclear cardiology and is a registered physician in vascular interpretation. He earned his medical degree from the University of Rochester School of Medicine. He completed his internal medicine residency at Duke University and a fellowship in cardiovascular medicine and interventional cardiology at The Cleveland Clinic.

Wagers Named CAO at Tivity Last month, wellness company Tivity Health announced the appointment of Ryan Wagers as chief accounting officer. Wagers, who will begin his new role on Oct. 15, previously served as senior vice president, CAO and treasurer of Sitel Worldwide Corporation. He fills the position left vacant when Glenn Hargreaves left in left the company in late August.

neuroCare Centers of America Opens New Clinic in Nashville Led by West

Last month, neuroCare Centers of America, part of an international network of brain health centers of excellence dedicated to non-medication neuro therapies for mental health disorders, announced the opening of its newest clinic, Nashville NeuroCare Therapy  in Franklin, led by Scott West, MD, a nationally recognized, boardcertified psychiatrist. The clinic delivers scientifically based therapies for depression, ADHD and sleep disorders leveraging the brain’s neuro-networks to provide clinical benefits without the use of medications. Nashville NeuroCare Therapy will focus on identifying the cause of disorders and then implementing patient treatment plans.  “As neuroCare researched U.S. market opportunities for new treatment center expansion, Nashville’s geographic location, healthcare-centric environment and growing need for safe and effective neuro therapy solutions sparked initial interest,” said Stanford Miller, managing director of neuroCare Group America, Inc. Located in the Cool Springs corridor, Nashville NeuroCare Therapy specializes in Transcranial Magnetic Stimulation (TMS) therapy and QEEG (quantitative elecNashville NeuroCare Therapy Medical Director W. Scott West, MD, is pictured with a troencephalogram) informed Neurofeedback for individTranscranial Magnetic Stimulation (TMS) Therapy chair. uals who have not benefitted from or are not interested in taking psychotropic medications. “The advent of these innovative non-medication techniques focused on addressing the core of a disorder instead of simply managing symptoms is changing the way we treat mental disorders. Our goal is to get patients truly well, not just better,” said West, who serves as medical director for Nashville NeuroCare Therapy. OCTOBER 2018

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GRAND ROUNDS Hargreaves to Quorum And in related news ‌ Glenn Hargreaves, formerly chief accounting officer for Tivity Health, has accepted the same position at Quorum Health. Hargreaves spent six years as CAO with Tivity, where he also served a brief stint as interim chief financial officer. The CPA earned his undergraduate degree and master’s in accounting from the University of Tennessee.

Stephens Named Chief Analytics Officer for Nashville General Nashville General Hospital recently named Eric Stephens, CAP, chief analytics officer. Stephens will serve as a key

member of the hospital’s executive leadership team, working to direct and implement population health initiatives and to form a robust data infrastruc- Eric Stephens ture to provide accurate, intelligent analysis. Previously, Stephens was manager of population health analytics at Vanderbilt University Medical Center, where he led a team of analysts and developers who created and implemented solutions to support population health management for both the hospital and the Vanderbilt Health Affiliated Network. He is an adjunct professor at Lipscomb

University and a member of the Nashville Technology Council Steering Committee. Stephens holds an MBA from Tennessee Tech, as well as a graduate certificate in applied statistics from the University of Tennessee.

Business BriefsÂ

Cumberland Heights Opens Spring Hill Center

PHOTO CREDIT EBONYE DILLARD

On Sept. 21, Cumberland Heights celebrated the grand opening of the Spring Hill Outpatient Recovery Center, bringing the organization’s outpatient centers to 11 across the state. Cumberland Heights CEO Jay Crosson noted, “Outpatient recovery programs are flexible to meet the needs of professionals and busy parents working through drug and alcohol addiction issues.� The outpatient centers feature a 12-Step based recovery program and offer education and support to practice a recovery lifestyle. Crosson added the offsite treatment centers serve as many as 2,500 clients and their families each year. He added another new outpatient recovery center is slated to open in Clarksville this fall.

Cumberland Heights CEO Jay Crosson (2nd from right) is joined by staff and Board Member Don Crichton (far right) to officially open the Spring Hill Center.

Clover Health has expanded to Middle Tennessee. The healthcare company that uses data and technology in an effort to improve outcomes, recently announced a significant national expansion by offering Medicare Advantage health plans in Davidson, Rutherford and Williamson counties. The plans are available during the annual enrollment period through Dec. 7 and go into effect on Jan. 1, 2019. The company also announced Saint Thomas Health will be a full and active participant in the Clover provider network upon market entry. Local investment bank Bailey Southwell & Co has launched an investment fund focused on healthcare services and technology companies. Nashville’s Healthcare Management Partners recently launched a joint venture with Modern Healthcare. Modern Healthcare Metrics, proprietary subscription service, is a data platform delivering insight into the financial and strategic position of healthcare facilities. HMP, a turnaround and consulting firm that specializes in helping healthcare organizations facing financial challenges, developed and honed the platform over a decade of practical application. Lucro, a healthcare technology startup backed by HCA, Nashville Heritage Group and Martin Ventures, recently sold to Texas-based Valify, a healthcare cost containment company. Brentwood-based QualDerm Partners, a company that creates (continued on page 15)

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GRAND ROUNDS market-leading dermatology practice partnerships through affiliations with physician-owned practices and de novo development, continues to expand their network. Recent announcements include the addition of Brentwood Dermatology, which was founded by Bill McDaniel, MD. Other additions include Dermatology of Southeastern Ohio and Zitelli & Brodland, PC, which marks QualDerm’s first entry into Pennsylvania. Nashville-based dental support organization Marquee Dental Partners recently acquired a ninth practice in Alabama, brining the total number of practices under the Marquee umbrella to 27 across the states of Alabama, Kentucky and Tennessee. Home health and hospice giant Amedisys, which has executive offices in Nashville, has taken a minority stake in local predictive analytics company Medalogix. PhyMed Healthcare Group, a physician-led and owned anesthesia and pain management service provider headquartered in Nashville, has acquired AAA Anesthesia Associates, a 37-physician anesthesia practice based in Allentown, Penn. Nashville-based Montecito Medical Real Estate, the nation’s top privately held buyer of medical office properties throughout the U.S., has had an active few weeks with several purchasing announcements include the acquisition of Retinal Consultants of Arizona and Retinal Research Institute medical office building in Phoenix, the medical office portfolio owned by Lancaster Neuroscience and Spine Associates in Pennsylvania and the medical office building of one of the largest primary care providers in Rhode Island.

Leonard Named Chief HR Officer for ChanceLight ChanceLight Behavioral Health, Therapy and Education, a national provider of behavioral health, therapy and education solutions for children and young adults, recently announced Emily Leonard as executive vice president and chief human resources Emily Leonard officer. Leonard will lead the organization’s HR department and will be responsible for developing, leading and guiding recruiting efforts; employee relations; performance management; training and leadership development and compensation and benefit strategies. She brings nearly 20 years experience to her new role having previously served as chief talent officer for Ampersand Health and senior vice president of HR for e+CancerCare. A graduate of Furman University, Leonard also earned a master’s in counseling from Trevecca Nazarene University.

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Nashville Healthcare Industry Grows Significantly The Nashville Health Care Council recently released results of the latest economic impact study, which highlighted significant growth in the city’s thriving healthcare industry. The study, conducted by The Research Center at the Nashville Area Chamber of Commerce, found the healthcare ecosystem contributes $46.7 billion to the local economy annually, a 20 percent increase since the last study in 2015, and is responsible for 273,000 jobs.

“This report reaffirms that healthcare is indeed the cornerstone of Nashville’s economy and solidifies our position as our nation’s healthcare epicenter,” said Hayley Hovious, president of the Nashville Health Care Council. “These remarkable numbers are a testament to Nashville’s entrepreneurial spirit and reveal unprecedented growth amid the dynamic changes in this transformative era in the American healthcare industry.” The city has seen steady growth in the industry sector since the founding of HCA in 1968. The most recent report

estimates more than 500 healthcare companies and nearly 400 professional services firms operate in Nashville. When looking beyond the borders of Middle Tennessee, the Nashville-based healthcare cluster, which includes 176 parent firms, contributes more than $92 billion in total revenues and employees more than 570,000 people worldwide. Nashville healthcare companies own and operate facilities at 3,453 individual locations across the United States, and there are sites managed by Nashville healthcare firms in 49 of the 50 states.

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GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS. In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Matthew Harrison Senior Vice President Medical Private Banking ph: 615-514-6055 email: mrharrison@ftb.com

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