FOCUS TOPICS CMS • SENIOR HEALTH
Your Middle TN Source for Professional Healthcare News
Harvey J. Murff, MD, MPH
COA of Middle Tennessee Releases Eldercare Report In August, the Council on Aging (COA) of Middle Tennessee released “The Case for Caregiving: Why Middle Tennessee Employers Should Support Employee Caregivers.” ... 5
CEO Insights: Paul Kusserow, Amedisys The demographics are undeniable – America is aging, with the fastestgrowing group being ages 75 and up. Enter Amedisys with its business model of home health, hospice and personal care services to help seniors age in place ... 8
Healthcare Leaders Respond to Block Grant Proposal Reactions are pouring in after the release of Gov. Bill Lee’s TennCare Block Grant Proposal, with two of the state’s leading healthcare organizations cautiously supportive of the idea ... 11
Governor Rolls Out TennCare Modified Block Grant Proposal By CINDY SANDERS
projections each year for core medical services. The modified block grant excludes administrative costs, In mid-September, Governor Bill Lee and the uncompensated care payments to hospitals that Deputy Commissioner and Director of TennCare is supported by an annual hospital assessment, preGabe Roberts unveiled the state’s plan to gain more scription drugs that will continue to be covered as flexibility in managing Tennessee’s Medicaid prothey are now with a state match to federal dollars, gram. Billed as an innovative modified block grant, costs for dual eligibles and services currently carved Tennessee is the first state to propose this type of out of the TennCare waiver. alternate financing to the Centers for Medicare & The difference between what TennCare spends Medicaid Services. If accepted, it would not only and what CMS projects would have been spent if allow the state to have great operational control of TennCare was a traditional state Medicaid proits Medicaid program but would also reward good gram … known as the budget neutrality cap … is financial stewardship with a percentage of shared the amount of shared savings. That pool of saved savings being returned to the program. dollars would be split at an agreed upon percentage “We’re encouraged about the opportunity we (Tennessee has requested a 50/50 split) between the have as a state to do something we think is going to federal government and the state. Governor Bill Lee significantly, positively impact both the TennCare While the governor was hesitant to put a dollar population that we currently serve and really be amount on the shared savings that might be returned positive for the state as a whole,” said Gov. Lee. to Tennessee before CMS has responded to the plan or agreed upon a Whereas a traditional block grant awards a set amount to a state, percentage split, it could be as much as $1 billion that the state could the hybrid approach proposed by Tennessee would allow for per then reinvest in enhanced services and programming to address not capita increases as enrollment increases and account for inflationary (CONTINUED ON PAGE 11)
Leadership Health Care Expands Programming to Boston PHOTO: DAVID FOX
October 2019 >> $5
By JESSICA WELLS
Recently, Leadership Health Care (LHC) led a group of delegates to Boston. As LHC’s first delegation outside of Washington, D.C., the trip promised to bring new insights and experiences for the group of Nashville’s emerging healthcare leaders in attendance. It did not disappoint. Throughout the events on Monday, Sept. 16, and Tuesday, Sept. 17, delegates got a crash course in Boston’s healthcare ecosystem and the interconnectivity of Boston’s healthcare stakeholders that fuel innovation. (CONTINUED ON PAGE 10)
ONLINE: NASHVILLE MEDICAL NEWS.COM
Coming in December:
HEALTH CARE 2020
For Advertising Rates & Information call 615.397.2836 or email firstname.lastname@example.org PRINTED ON RECYCLED PAPER
PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357
Mindful Meditation for Relieving Pain and Enhancing Recovery Today, medical providers increasingly recognize the benefits of mindful meditation for relieving pain and enhancing recovery. In a healthcare environment focused on reducing the need for opioid medications, mindfulness offers an effective mechanism for managing pain and the associated stress while giving the patient control over their own circumstances. Simply put, mindfulness can be described as awareness, the act of paying attention to the present moment with purpose. Based on an ancient form of By Catherine meditation that is proving highly effective in the clinical setting, mindfulness has been Harris shown in clinical trials to reduce chronic Board Certified pain by 57 percent and accomplished Art Therapist meditators can reduce it by over 90 percent. TriStar Centennial Mindfulness encompasses a series of Parthenon mental exercises that help one practice this Pavilion kind of focused attention to the present in a way that positively shapes how the mind and body function. In other words, we can exercise our minds in much the same way that we can exercise our bodies, strengthening both to perform at their best in any situation but especially when experiencing stress, illness, and discomfort. Many healthcare providers now prescribe mindfulness exercises to help patients cope with the pain that arises from a wide range of diseases such as cancer (and the side effects of chemotherapy), heart disease, diabetes and arthritis. It is also used for back problems, migraines, fibromyalgia, coeliac disease, chronic fatigue, irritable bowel syndrome and even multiple sclerosis. Anytime we can do something that helps individuals self-regulate, cope and manage their own stress, it is going to have a profound effect on some of those stress indicators such as blood pressure, heart rate, respiratory rate. Pain is one of the most pervasive, debilitating and expensive health problems faced by approximately 100 million Americans. Until recently, the go-to treatment has been opioid medications, which commonly produce adverse side effects, and are highly addictive. As doctors and patients alike are looking toward non-pharmacological ways to supplement current treatment options to reduce pain and the toll it takes on quality of life, mindfulness offers a resource that is entirely within the patient’s control. Numerous studies show that when we practice mindfulness exercises routinely five or six days a week for a couple of months, we experience actual changes in our brain structure that can be verified with MRI scans of the brain. Those changes in specific areas of the brain mitigate stress and change how we respond to situations presented to us, including chronic pain. Mindfulness can have profound effects on how our brain functions and how our brain responds to the stress that can magnify symptoms related to a host of medical conditions. At TriStar Centennial Parthenon Pavilion, we understand that patients admitted to the hospital for medical issues often also suffer from stress, depression and chronic pain that are mitigated more effectively when medical treatment and mental health therapies are combined. As a result, various service lines within the TriStar Centennial Medical Center campus are partnering with Parthenon to bring mindfulness practices to their patients, including oncology, joint replacement and weight management.
Anxiety, signs of depression, physical pain or a prolonged stay in the hospital are some of the primary reasons for the mental health team to be engaged in a patient’s care. Once we evaluate what the most pressing issue is for the patient, we are usually able to work with them through some simple meditation exercises or practices that help put them more at ease and alleviate their distress. Mindfulness exercises can be as simple as paying attention to one’s breathing, or it could be using focused attention to sounds that are around us, or the feelings we are experiencing in our body in the moment. It could be meditating on a place or something that brings us a sense of calm and happiness. Patients typically find that by focusing their attention on the present and by bringing openness, non-judgment and compassion to what they notice, they can experience a stressful or even painful moment without being overwhelmed by it. As a result, patients can then find ease and relief from the stress or pain they may be experiencing. We then teach patients how to take that practice and apply it to those medical stressors as needed to self-administer techniques that have an amazing ability to sooth, comfort and calm. Regular, daily practice of these techniques can significantly benefit an individuals’ mental and physical wellbeing. Practicing mindfulness has been shown to reduce physical pain, decrease depression and anxiety, improve sleep quality, strengthen the immune system, increase creativity and problem solving and calm the body’s automatic stress response. These benefits can be attributed to changes mindfulness actually brings about in the physical structure of our brain, by increasing grey matter in areas related to memory, compassion, and self-awareness and decreasing grey matter in areas responsible for the automatic physical and emotional responses to stress. With this in mind, practicing mindfulness helps us tap into our innate ability to manage pain, fatigue, illness, and stress and thus regain and maintain a higher quality of life both in the hospital and after discharge. For more information about Mindfulness exercises, go to TriStarParthenonPavilion.com.
More than Just a Number
The Nashville Medical News Blog features additional insights and information from a crosssection of industry leaders. The blog can be accessed directly through NashvilleMedicalNews. Blog or from the homepage of the main website.
Dr. Harvey Murff Urges Providers to Rethink Senior Care By MELANIE KILGORE-HILL
Growing older shouldn’t mean fewer options in care. That’s what Harvey J. Murff, MD, MPH, is trying to instill in medical students and staff, alike. The interim chief of Geriatrics at Vanderbilt University Medical Center arrived at VUMC in 2002 and has been instrumental in research and training efforts geared toward creating better outcomes for older Americans.
“Age alone shouldn’t be a cutoff. There are older individuals who are living very active lives and have many good years ahead of them. A doctor might base a decision solely on a number that might seem high, but we need better assessments of frailty,” he said. “Age can be a complicated variable, and there are objective and validated measures we can take to identify factors that would better feed into where patients are.”
A Memphis native, Murff majored in history at the University of Mississippi but grew interested in medicine at the encouragement of his pre-med roommate. He went on to attend the University of Tennessee Health Science Center in Memphis, followed by an internal medicine residency and a year of chief residency at The Mount Sinai Hospital in New York City. Following a fellowship at Brigham Young Women’s Hospital in Boston, he received his Master of Public Health from the Harvard School of Public Health before returning home to Tennessee.
A Growing Need
“I was hired for my interest in research, and Vanderbilt was really pushing their focus on patient safety and quality of care,” said Murff. “They want to train people who are leading healthcare into the future and are actively working to develop and educate a workforce in geriatrics.” Faculty in VUMC’s Division of Geriatric Medicine recently obtained funding to focus on training non-geriatric physicians and to provide focused geriatric training to a younger generation of medical students. “Geriatrics is such a huge demand, and we’re doing what we can to educate and meet that demand,” Murff said. Despite the growing need for geriatrictrained providers – courtesy of an aging baby boomer population – Murff said it’s a tough specialty to fill due to misconceptions and an often medically complex population. More diagnoses mean more cognitive work and clinic time – a challenge to providers already pushed to be more efficient and see more patients. And unlike most younger patients, who easily dress and cook for themselves, older patients often require more one-on-one time to ensure basic needs are being met. “We want to see more influx of younger medical students interested in geriatrics and who decide to pursue that as a career,” Murff said. “There have been more and more combined programs after residency and fellowship, and a growing aging population means there are healthy older folks not getting therapy they need because of preconceived notions.” However, Murff said working with older adults has distinct advantages, including an interest in their own health nashvillemedicalnews
not always found among younger adults. “They have wisdom because they’ve seen more and are familiar with their health at a deeper level, so you get a partnership that’s pretty rich,” said Murff, who also works with the Nashville VA Medical Center. “They’re usually well aware of things going on and interested in working with you to make sure they have the best quality of life.”
Geriatric Research & Care
Offering older patients a better quality of life means asking the right questions, and that’s just what Murff and his team are doing behind the scenes. Current research efforts include investigating the use of fish oil to combat a number of health problems, from heart disease and colon cancer to nicotine addiction. That’s because smokers are shown to have decreased levels of omega 3, which can drive up anxiety, depression and addictive tendencies. Murff also oversees clinical activity of VUMC’s 24-bed inpatient Acute Care of the Elderly (ACE) unit. “When you‘re dealing with issues of dementia and cognizant rapid decline, it’s helpful to have a very specific geographically localized unit with nurses and staff trained in preventing common hospital-based geriatric problems,” Murff said, noting prevalence of pressure ulcers and delirium in older patients. “ACE units are focused on achieving the highest level of functional status,” he continued, adding Vanderbilt’s internal medicine residents rotate through the ACE Unit and receive geriatric-specific training in VUMC’s outpatient clinics. Researchers also are collaborating with colleagues in other departments to address long-standing age limitations in clinical trials and high-risk procedures, such as transplants. “Age doesn’t necessarily account for functional status and frailty,” said Murff, who’s urging investigators to consider how pre-transplant geriatric assessments might improve the selection process and outcomes for seniors.
The division also is leading a study investigating the need to deprescribe medications for seniors. “We see older patients in the hospital taking medication upon medication, and doctors are often hesitant to stop them although we don’t know where the meds came from or if they’re doing any good,” Murff said. “Let’s send them out with less meds rather than more. Gigantic medication lists are a very common problem; and as doctors, we don’t do as good a job as we should to see what patients do or don’t need anymore. There’s a great opportunity in the hospital to get pharmacists and their entire team involved, and we believe this research could be very promising,” Murff concluded.
NEW IN OCTOBER:
Jim Easter, ACHE, MArch, principal, Easter healthcare Consulting (Ehc), looks at rural health from the planning and operational lens to discuss a transformational response to diminishing access and the relevance of senior care, prevention and wellness in these communities. Christian Heuer & Brandon Sanslow, senior manager for healthcare valuation services and healthcare audit manager (respectively) at LBMC, share insights into CON process changes in light of a shifting healthcare environment. Rylie Webber, MT-BC, a board certified music therapist and owner of Marigold Music Therapy, explores the ways music therapy in hospice care can be employed to meet individualized goals.
The Hallmark of Our Practice
NASHVILLE VA S CU L A R & V EIN INS T IT U T E Now offering screenings for • Peripheral Vascular Disease • Stroke Prevention • Aneurysm • Varicose Veins DR. PATRICK C. RYAN
We have invested heavily in That’s why NVAVI is the only the Vascular Quality Initiative™ vascular surgery practice in sponsored by the Society for Middle Tennessee that fully Vascular Surgery. The VQI is a participates in VQI. database that measures our results But more than just measuring and compares them with quality, the experienced vascular surgeons and team led by Dr. Patrick practices around the United Ryan uses data to States. We continually believe to be enhance best really serious practices about quality, and improve www.nvavi.com you must measure it. outcomes.
In addition to seeing patients in Nashville, Dr. Ryan is now seeing new and established patients in Pleasant View 330 23rd Avenue North, Suite 100 | Nashville, TN 37203 | 615.321.6100
The Challenges of Identifying, Treating Behavioral Health Issues in the Geriatric Population By CINDY SANDERS
Is it dementia, a psychotic break or a UTI? Has pain medication use become an addiction? Is that a normal amount of sleep or an indication of depression? Identifying and treating behavioral health and substance abuse issues is made all the more challenging by the host of comorbid conditions that often accompanies elderly patients. Michael Genovese, MD, JD, chief medical officer for Nashville-headquartered Acadia Healthcare, shared insights on addressing special considerations in the geriatric population. Genovese, a clinical psychiatrist and addiction specialist, said onset of behavioral health conditions and substance use disorder can occur at any point in a person’s life. The goal, he continued, is to recognize behavioral changes and to intervene to improve quality of life … no matter what a patient’s stage in life.
Dr. Michael Genovese
“We have to be really careful with diagnosis. There are a lot of things in the geriatric population that can mimic psychiatric symptoms but have a medical etiology,” said Genovese. “It’s absolutely essential you provide a thorough physical exam so you can rule out an underlying medical condition. One of the things I always ask medical students is, ‘What’s the first thing you should think of when an elderly patient presents with delirium?’” The answer, he continued, is to check for a urinary tract infection. While physical health issues might mimic behavioral health conditions, Genovese said it’s equally important not fall into the opposite trap of thinking new psychiatric symptoms won’t arise as someone ages. Just because a patient hasn’t exhibited signs of depression in the first seven decades of life doesn’t mean they might not in their eighth decade. “Age does not confer immunity to depression,” said Genovese. “It’s important to observe and also to listen. If an older patient tells you they feel sad or depressed, it’s important not to dismiss that.” Genovese said the most common disorders among geriatric patients are anxiety disorders, mood disorders including major depression, suicidal ideation, destructive anger, bipolar disorder and failure to thrive. Alcoholism and prescription drug abuse are other issues providers should consider. “Substance use disorders do not discriminate based on age,” Geno4
pain medication prescriptions, there is a heightened possibility for abuse … even if it’s accidental. Genovese shared the story of a woman prescribed an opioid with a label that said, ‘use three times a day as needed for pain.” Trying to be a good patient, she took the medicine three times a day, every day, until she became addicted. “We see a lot more iatrogenic addiction in older patients,” he added. vese pointed out. “Alcohol Use Disorder is a chronic, progressive disease,” he continued, noting those who were able to maintain some sort of functionality when younger find it increasingly difficult to do so with age. For others, abuse begins in later years. “People can get started because they’re trying to numb the emotional pain they didn’t have before,” he said of the grief that comes from losing a spouse, child, friends and independence. Clear communication, he added, is critically important for both older patients and their caregiver support systems. Because older patients are more likely to sustain falls or have illnesses that lead to
Comorbidities & Treatment
“The complexity of geriatric patients can differ from that of younger patients,” said Genovese. “Older patients often present with complex medical comorbidities with the constellation of issues ranging from diabetes to heart conditions and stroke.” Because of that, he continued, “The pharmacology can be a lot more complex.” For example, Genovese noted, lithium is widely used in treating bipolar disorder but would not be a viable option for an older patient with renal disease. Similarly, geriatric patients are often on a blood thinner, which impacts prescription decisions for treating a number of mental
health disorders. Genovese said close supervision is required, particularly on the front end, when an elderly patient starts a new regimen. “They need daily medical monitoring while receiving behavioral health treatment, so it’s much more staff intensive,” he said. Marveling at the myriad conditions primary care providers manage, Genovese said it’s always good to know when to call in reinforcements. “When they start to feel this might be beyond their purview for managing disease, really good doctors have a really low threshold for requesting consultation. Collaboration is key in medicine.” For some patients, the solution is an acute care admission to a facility like Acadia’s TrustPoint Hospital in Murfreesboro, which has a senior psychiatric unit. With a typical stay of 10-14 days, patients are evaluated, begin a treatment regimen and are closely monitored. Once stabilized, patients return to the care of their community provider and hopefully to a prior level of function. “You certainly don’t want to dismiss how they feel, but you really want to observe functioning as a hallmark of treatment,” said Genovese. Just as psychiatric disorders can occur at any age, so too can help and healing.
Senior Living Solutions Evolve to Meet Resident Needs By CINDY SANDERS
“Senior living started more as a hospitality model,” said Kim Elliott, RN, MSN, senior vice president of Clinical Services for Brookdale Senior Living. “Today, we’re caring for a higher acuity resident with more chronic conditions.” Elliott was quick to note that housing options continue to offer hospitality-influenced amenities and Kim Elliott activities. However, many of today’s residents need more in terms of care management and health and wellness options in order to allow them to more fully enjoy what their senior living community offers. Elliott said Brookdale has taken a population health approach, frequently aligning with physician partners, particularly to drive preventive care. For example, she noted, “We do offer immunization clinics. We protect our residents from flu, shingles and pneumonia.” Similarly, residential communities will bring in providers to help with diabetes,
COPD or other chronic care management and often coordinate with physicians for onsite well visits. “We want to surround our residents with the care and services they need. That collaborative approach continues to strengthen,” she explained, adding this increased focus on collaboration with community providers is a new direction for the senior health industry. “Every community has a health and wellness director,” Elliott said of a licensed nurse who drives programming for a specific community. However, she continued, that person isn’t on an island but instead has support tools and resources from the corporate level. As a company, Elliott said Brookdale has adopted a holistic approach to care through the Optimum Life program. “It’s the six dimensions of wellness – not only their physical health, but we look at their social, we look at their spiritual, intellectual, purposeful and emotional health,” she said. “It’s a whole person view.” The foundation of the Optimal Life program is to maximize functional abilities through a variety of activities. Under that umbrella, one popular option is the Fitness B-Fit program, which draws on research and guidelines to incorporate elements of
Tai-chi with movements that challenge the brain and meditative relaxation to exercise body, mind and spirit. Elliott noted that even though Brookdale is increasingly focused on population health and outcomes of the larger group, that doesn’t mean classes and activities are customized to meet residents where they are. “It’s very much a personalized approach,” she noted. Increasing the focus on health and wellness and partnering with providers … both on-site and in the community … is a win/win/win, said Elliott. For providers, she said it lets them know their patients are being supported in chronic condition management or preventive health measures between appointments. For residents, they have increased access to resources and expertise without having to leave the community. For Brookdale, the approach increases client satisfaction and maximizes the opportunity for residents to live their best life. “As the residents continue to evolve, we continue to evolve with them in the care and services we provide. It’s a holistic approach that nurtures every aspect of their lives,” Elliott concluded.
COA of Middle Tennessee Releases Eldercare Report Agency Hopes to Spur More Employee Caregiver Support By CINDY SANDERS
In August, the Council on Aging (COA) of Middle Tennessee released “The Case for Caregiving: Why Middle Tennessee Employers Should Support Employee Caregivers.” The report was the culmination of an 18-month journey by the organization to better understand the impact of eldercare on employees and the needs of working caregivers. The research began as part of COA’s participation in the Center for Nonprofit Management’s Innovation Catalyst program and was conducted in partnership with Vanderbilt’s Center for Quality Aging through a Community Engaged Research grant.
Scope of the Issue
According to the 2011 GallupHealthways Well-Being Index, more than one in six Americans reported caring for an elderly or disabled family member while working. The 2017 Long Term Services and Support Scorecard ranked Tennessee 49th for support of family caregivers and 32nd for support of working caregivers. The ongoing toll on productivity, turnover and costs faced by employers and caregivers is anticipated to increase over the coming years as 10,000 baby boomers turn 65 on a daily basis. Additional statistics from Pew Research, AARP and the National Alliance for Caregiving underscore the magnitude of the issue with an estimated 40 million unpaid caregivers helping with adults 65 and over. Of that group, 61 percent work and nearly half work full time while spending an average of 24.4 hours per week providing care. As an organization tasked with identifying and addressing unmet needs of seniors and their families, COA sought to better understand the impact of eldercare on both employers and caregivers. In conjunction with Vanderbilt, COA hosted caregiver focus groups to assess the benefits of the organization’s available online tools and surveyed human resource and employer groups about supports for employees. “Tennessee ranks near the bottom of the list for supporting working caregivers,” said Grace Smith, COA’s executive director. “While we knew elder caregiving in the workplace was an issue, it wasn’t until we dug deeper that we understood the disconnect between the needs of working Grace Smith caregivers and benefits and support offered by employers.” nashvillemedicalnews
Cost to Employers
A recent Harvard Business School study estimated employers lose $6.3 billion annually related to workplace disruptions tied to eldercare, and this figure doesn’t count the billions spent to replace employees who leave to devote more time to care. With adults ages 45 to 64 being the most likely group to serve as a family caregiver, employers often find workers in mid-to-high levels of the organization are heavily impacted. If those employees leave, it causes an additional talent and knowledge drain for the employer. For those employees who stay on the job, studies estimate a lost productivity amount of $2,110 per working caregiver per year. Additionally, healthcare costs are 8 percent higher for employees who serve as caregivers.
Mitigating the Costs
Citing the work of Harvard’s Joseph Fuller and Manjari Raman, the COA report noted, “Despite 32 percent of employees departing the workplace to care for an older adult, fewer than 10 percent of employers offer eldercare benefits.” Yet, the report continued, the benefits to companies that support caregivers are demonstrable. “Research has shown that programs that support caregivers pay for themselves. A study funded by the Alfred P. Sloan Foundation found that employers could anticipate a $3 to $13 return for every dollar spent on eldercare benefits. Additionally, for each eldercare benefit, businesses have reduced turnover intention by 5.9 percent.”
Middle Tennessee Lessons
“The Council on Aging recognizes that most caregivers of older adults are working professionals often sandwiched between caring for aging parents and raising children. They’re overwhelmed juggling work and family, and they need help figuring out options and next steps,” said Smith. Indeed, local caregivers who participated in the focus group outlined their top unmet needs as information, expert guidance on available options, emotional support and a caregiver-friendly workplace culture. The good news is the COA tools were deemed to be easy to use and informative. However, information was not reported on the general awareness level of the COA resources prior to participation in the focus group. The focus group members did suggest adding information to identify possible funding options to help cover the costs of care. The human resources survey found 61 percent of respondents said they were aware of the eldercare/caregiving issue but that it wasn’t a current priority, 15 percent said it was a top 10 pri-
ority, and 63 percent agreed it would become an increasingly important issue in the next five years. On the plus side, most employer respondents did indicate they have employee assistance programs (EAP), work/life programs, telecommuting options and flex time opportunities to help working caregivers. Asked what they thought would help employers be more supportive to working caregivers, human resources professionals said: • Guidance for how to be a caregiverfriendly workplace, • Access to information for employees, • Online tools and links to resources, and • Printed materials and onsite education. Based on the findings, COA said the organization has made it a priority to partner with employers to fill the gaps and increase awareness of existing resources. The organization was already hosting programs at some area employers and looks to expand upon that to address this community need. “Whenever we offer on-site ‘Lunch
and Learns,’ employees line up to talk with us about their particular situation. That’s why as a trusted non-profit, we’re committed to consulting with employers in Middle Tennessee and supporting employee caregivers by delivering onsite education, online tools and caregiver phone consultations,” said Smith. An advisory board has been assembled to help guide the development of additional tools to support employers and working caregivers. Smith added COA welcomed the opportunity to partner with physicians and other providers to connect patients and caregivers to much-needed resources. “Healthcare providers are a vital link between older patients, family caregivers and community resources, yet they’re often pressed for time,” noted Smith. “An easy solution is to refer to the Council on Aging of Middle Tennessee for trusted information and help finding the most appropriate services and care options.” More information is available online at coamidtn.org.
Your Advocate & Expert For Practice Management Annual Medicare Update & Fall Social OCT. 29 4-7 PM
Palmetto GBA Presentation: One Hour ACMPE CEU
Food • Drinks • Live Music • Door Prizes • Networking
222 Second Avenue S.
Burr & Forman Oﬃces • Check-in required at NMGMA table in lobby Free onsite parking (please bring garage ticket for validation)
REGISTER BY OCT. 25 AT WWW.NASHVILLEMGMA.ORG OCTOBER 2019
Improving Senior Care across the Continuum naviHealth Focuses on Transitions for Medically Fragile Seniors By MELANIE KILGORE-HILL
tion from acute care hospitals to skilled nursing facilities, there’s a lack of information exchange and data to evaluate the Ensuring a seamless continuum of quality of care, the risk of readmission and care for medically fragile seniors can the progression to indebe complicated. Enter pendent living at home,” naviHealth, a national he explained. leader in care transitions. LaBine said misFounded in 2011, the aligned industry incenNashville-based healthtives are also to blame: care company works with Hospitals are financially health plans and riskincentivized to move bearing health systems patients out quickly, while to provide an improved post-acute care facilities experience for seniors as are typically paid on volthey move from acute care ume. “naviHealth bridges to post acute and back to that fragmentation by givindependent living. ing caregivers, patients and families a better idea Bridging Gaps Dr. Jay LaBine of what to expect in post“In healthcare, there’s acute care,” LaBine said. a movement toward valuebased care, and we enable that for payEvidence-Based Support ers and providers,” said naviHealth Chief The naviHealth approach is simple Medical Officer Jay LaBine, MD. – the company works with Medicare LaBine joined the company in 2018, Advantage plans, more than four million but he previously spent five years as a covered lives, using real people embednaviHealth client while serving as CMO ded in facilities in more than 47 states of a Michigan-based health plan. “We (and growing). Their 1,000-plus local care brought naviHealth in because we wanted coordinators work alongside patients, paya solution for improving care in nursing ers and healthcare organizations, utilizing home facilities and improving efficiency of naviHealth’s propriety, evidence-based care for our member patients,” he noted. care planning tools. The database of over “From a patient perspective, the four million patients lets clients know industry is extremely fragmented, causing what to expect in terms of each patient’s significant frustration. During the transi-
recovery and long-term trajectory once at home. The decision support tool provides clinicians with a better data-driven choice for each patient and has been shown to be highly accurate. “We’re unique in that we have a differentiated solution in the way our clinical care coordinators work with data around the functional gain of patients and set performance benchmarks for skilled nursing facilities, so we’re able to show customers how well facilities are doing based on individual patient-adjusted benchmarks,” LaBine said.
satisfaction rating of over 90 percent. “We’ve demonstrated gains in daily activity and mobility, and we’re giving patients extra days at home each year because we’re helping to choose the right setting of care,” LaBine said, noting that the right setting of care decreases costs and ensures more efficient transition through the system. “We’re also financially aligned with risk-bearing health systems, and we get paid when outcomes are better for patients and share that value with our customers.”
naviHealth’s care transition platform is utilized by large health systems, health plans and post-acute providers across the nation. naviHealth has experienced yearover-year growth and now has almost 500 employees based in the Greater Nashville area. In fact, the company was recognized as the third largest area healthcare IT company by the Nashville Business Journal in April 2019. LaBine credits growth to the company’s mission of continually improving health and lives for seniors. “We’re redesigning post-acute care,” said LaBine. “We work closely with providers in the sweet spot of health plans and risk-bearing health systems. Our patients consistently show functional improvements that decrease the length of stay required to get them back to full function.”
From a payer perspective, LaBine said naviHealth provides solutions - and medical cost savings – in response to Medicare requirements demonstrating patients are receiving the right care in the right setting. “We’re fully delegated the authorization process to get patients into the right setting of care,” he said. “Health plans and all our customers get a detailed report card on who’s doing a good job of taking care of seniors in post-acute care and use that report card to develop a highperforming network. We have a patientand provider-centric model that takes into account each patient’s local environment.” The company’s commitment to local care has earned naviHealth a patient
Tivity Health Conference Part Two: The Call for Connection In August, Donato Tramuto, CEO of Tivity Health and cofounder of Health eVillages, spearheaded the 2019 Connectivity Summit on Rural Aging in partnership with the MIT AgeLab and Jefferson College of Population Health. The third annual event drew nearly 250 attendees to Nashville to focus on the impact of social determinants of health on Dr. Bill Frist with Joe Coughlin of MIT AgeLab. aging. Stakeholders represented community and idea that zip code is at least as important faith-based organizations alongside governas genetic code is increasingly being conment agencies and representatives from sidered when looking at health and wellacademia to pool knowledge and resources. ness interventions. On average, there is More than 10,000 people a day age a 15-year difference in life expectancy into Medicare coverage, with 25 percent between the nation’s most and least living in small towns or rural areas. The advantaged residents. 6
“The time is now to explore solutions to improve our healthcare system as a whole, and to acknowledge the critical role that social determinants of health play in the health of individuals and communities,” said Senator William Frist, MD, one of the conference’s featured speakers. “Our daily behaviors, where and how we live, work, eat and play, have a greater impact on our health outcomes and long-term wellbeing than the medical care we receive, yet our health spending is disproportionately concentrated on the latter.” According to the Kaiser Permanente 2019 Social Needs Survey, one-third of Americans are dealing with stress that is tied to meeting basic human needs including adequate food, reliable transportation and stable housing. More than two-thirds reported experiencing at least one unmet need in the past year. COPYRIGHT SARA KAUSS PHOTOGRAPHY 2019
By CINDY SANDERS
Tramuto noted geographic isolation begets social isolation, which he called the chronic condition of the 21st century. He added that in an era when we claim to be the most connected, the very technology that links people together also leads to increased isolation. “Physical contact is one of the best ways to lessen feelings of loneliness and isolation,” he added of one simple solution. He pointed out that while Tivity’s signature program Silver Sneakers improves health through exercise, it’s the shared laughter, stories and connections made among the group that is the best medicine. “Take the time to listen to the stories of others,” he stressed. “Each time we fail to take the time to hear each other’s stories, we are helping to fertilize and nurture the epidemic of loneliness, particularly in rural America.” However, Tramuto noted isolation and loneliness can happen in urban areas, as well. He cited recent statistics that show about one in three people 65 and older (CONTINUED ON PAGE 13)
Moving the Science Forward IACRN Helps Prepare, Support Clinical Research Nurses By CINDY SANDERS
A relatively young organization, the International Association of Clinical Research Nurses (IACRN) was founded 11 years ago to support and advance the specialty practice of clinical research nursing. Later this month, members will gather in Philadelphia for the annual conference focused on education, best practices and key issues impacting the field. “It is the only conference and only organization dedicated to and run by research nurses specifically,” said 2019 IACRN President Mary E. Larkin, RN, MS, CDE. Larkin, the nurse manager and assistant director of the Massachusetts General Hospital Diabetes Mary Larkin Research Center, said the organization was founded by a group of nurse managers from general clinical research centers who recognized the research environment was beginning to change. “They realized they needed to branch out to other areas, so they broadened their mission and founded the IACRN,” Larkin explained. “We have 370
members now, and they represent 21 countries,” she continued. From its inception, the chief goals of the organization have been to define the role of research nursing and support those practicing, as well as to spark interest for the next generation of clinical trial nurses to come. While many research nurses are still concentrated in large academic centers or regulatory settings, clinical trials increasingly are expanding into community settings, requiring trained professionals to manage implementation of the research protocol. Larkin noted that the basic qualification to become a clinical research nurse is to be a licensed or registered nurse (or the non-U.S. equivalent in other countries). “Research nurses bring to the clinical arena their skills as a nurse, then they learn a whole new body of knowledge, which is all about research,” said Larkin. “They are the key members of the research team who bridge those two disciplines.” Larkin said the most important quality is to “first and foremost be a skilled nurse.” Additionally, she said research nurses need to learn and understand the science of the research protocol, be meticulous in implementing and following that protocol precisely and in collecting quality data, focus on clinical care and safety first, and advo-
cate on behalf of patients enrolled in the trial. Without an eye to detail, Larkin said it’s far too easy to miss data points or wind up with poor quality data. As with many medical specialties, there is a shortage of practitioners. “By highlighting the awareness and contribution of research nurses in the scientific community, we are on our way to helping new nurses choose this as a field,” said Larkin. IACRN is currently developing new educational programming to provide to undergraduate nursing programs that introduces the research specialty to nursing students earlier in their studies. While there are some graduate courses in research nursing, Larkin said most of today’s professionals have honed their skill with on-the-job training. “In 2016, we published the scope and standards of practice for clinical research nursing. That makes IACRN the ‘go to’ place for resources and education,” said Larkin, adding that while there are other clinical trials-based organizations, none are solely focused on the role of nurses in the process. The professional association is also in the process of creating a certification program to signify excellence in the field. The upcoming conference is another opportunity to enhance knowledge by addressing issues from query resolution to
mitigating risk and by sharing best practices. In addition to a focus on clinical skills, Larkin said the conference also includes sessions on trials administration and data collection methodology. Connie M. Ulrich, PhD, MSN, RN, FAAN, professor of bioethics and nursing at the University of Pennsylvania School of Nursing, is delivering this year’s keynote address: “Ethical Issues in the Recruitment and Retention of Patient-Participants in Clinical Research.” Additionally, the conference includes 37 on-site posters and, new this year, virtual poster presentations from international colleagues unable to attend in person. “We are really working toward building an international community of research nurses learning about research nurse practice throughout the world,” said Larkin. With a quest to continue to grow the organization and raise awareness of the field, she added non-members working as research nurses or those interested in the field are welcome to register for the threeday conference. Information is online at IACRN.org. “Research nurses have the ability to impact the outcomes of clinical trials and really move the science forward,” Larkin said of the profession. “We think clinical research participants all deserve to have a nurse at their side.”
PUT THE LAW TO WORK FOR YOUR CAREER LEGAL TRAINING FOR HEALTH CARE PROFESSIONALS Gain the legal knowledge and skills to navigate complex regulatory environments,make informed decisions, and assess risk. Advance your career with the Juris Master degree by enhancing your knowledge of business law.
Online and On-Campus Options Scholarship Opportunities Available
“I chose the JM program to complement the degrees that I already have in public health and health policy and management and to gain an in-depth understanding for more application in my current field.” KERI NORRIS, PHD, MPH, MCHES
CHIEF OF HEALTH POLICY AND ADMINISTRATION THE FULTON DEKALB HOSPITAL AUTHORITY
Learn more: law.emory.edu/jm Email: JMadmission@emory.edu
CEO Insights: Amedisys A Conversation with Paul Kusserow By CINDY SANDERS
over rates. Kusserow isn’t satisfied. “We’re still trying to get lower and lower, because I believe that anybody who is in this business who comes to work for us should want to work nowhere else.”
Paul Kusserow – CEO of Amedisys, one of the nation’s largest providers of home health, hospice and personal care services – sat down with Nashville Medical News this summer to discuss the foundational principles that drive the mission and have led to substantial growth.
The Right Tools
Launched as a home health company in 1982 by the late Bill Borne, the company went public in 1994 as Analytical Nursing Management Corporation before changing its name the following year to Amedisys, Inc. “It’s a classic garage tale,” said Kusserow. “It literally started out of his garage in Baton Rouge and quickly built up.” Paul Kusserow Kusserow, who was previously with Humana, was named CEO in late 2014. At that point, he said Amedisys’ primary focus was still home health with a small hospice line that has since grown tremendously. Today, he said the home health and hospice lines of business are almost equal in terms of earnings, and the company has added personal care to its services. “We’ve also been expanding on our palliative care business,” Kusserow added. “There’s a very high demand for palliative care.” Seniors make up the vast majority of the company’s clients across all service lines. Kusserow estimated 90+ percent of those being served are elderly with the federal government being the largest payer. “We do have some small commercial business in hospice and home health,” he noted, but added it was relatively minor. “Most of home health and hospice and personal care is covered by Medicare and Medicaid in some way or another so that’s largely where we play.” Although founded and headquartered in Louisiana, Amedisys moved their executive offices to Nashville in 2015. Today there are nearly 65 working from the offices in Cummins Station with plans to expand to 100. Kusserow said creating an executive location to attract and retain the talent to support new initiatives was a key factor in the decision to plant roots in Nashville. In addition to the city being a center for healthcare, he said the entrepreneurial climate was also very attractive. “And recruiting to Nashville has been extremely positive and easy,” Kusserow noted, adding the typical response has been: “When do you need me there?” While people have been willing to move, Kusserow said another perk of the Nashville office is being able to tap into local talent with a depth of healthcare experience to continue to move the company forward.
Amedisys partners with more than 3,000 hospitals and 65,000 physicians to delivery post-acute care. Currently, the 8
company is in 38 states plus the District of Columbia with 21,000 employees in 475 locations serving more than 376,000 clients across all lines of business. “We’re largely strong in the Southeast and the East in general,” said Kusserow, adding they also have a presence on the West Coast in Washington, Oregon, California and Arizona. Although the hands-on care is similar across the nation, Kusserow said drive times are a major differentiator among markets. “If you’re located here, you’ll do six visits a day. If you’re located in Montana, you might do two,” he pointed out. “It’s very, very hard to do home health in remote, rural areas.” That said, he added the company does a lot of home health business in rural Tennessee but noted the geographic span between residences in rural areas of Montana, Wyoming or Idaho is a very different proposition and a factor in why the company hasn’t spread as quickly in that section of the country. Still, Amedisys covers a lot of territory. Kusserow noted caregivers drove about 80 million miles last year. The company delivers care in the home 50,000 times per day, every day, across the nation. On the clinical side, Amedisys utilizes a range of nursing and therapy disciplines. In hospice, they also employ bereavement counselors, social workers and chaplains. On the personal care side, the aides take on non-clinical work to assist with activities of daily living (ADLs). With strong familiarity of their senior clients, Kusserow said personal aides are often the ones who recognize early predictors of oncoming health issues.
Despite years of experience in management consulting and strategic planning, Kusserow began his tenure with Amedisys by assuming he knew nothing. He spent three months interviewing patients, employees and referral sources on a listening tour where he spoke to several thousand people across more than 20 states. “It became very apparent to me that our employees, our patients and our referral sources should define what this business should be,” said Kusserow. He added those with whom he spoke defined the business in three ways: provide the best quality, find the right people, and ensure the best tools
are available to support the care mission and staff.
“We focus maniacally on quality,” he said of the top mandate. “We’ve grown our star ratings from when we first started to measure them in home health, that’s where the stars are, from 3.2 stars to now about 4.4 stars.” He added that of 320 home health centers, 90 percent are four stars and above. “First of all, it’s the right thing to do. You shouldn’t be in this business if you aren’t here to deliver the best quality you can, and you shouldn’t be big like us unless you can deliver the best quality,” Kusserow noted. “We’re taking care of really vulnerable people in their homes so high quality is essential.” He added delivering quality care does two other things: referral sources like it, and good people want to work at high quality organizations. Kusserow pointed out physicians and hospitals are sophisticated clients who want what is best for their patients and look at quality measures before referring. On the employee side, he said the company reputation helps attract and keep people who believe in the mission.
Kusserow pointed out Amedisys doesn’t own equipment or facilities. Instead, their biggest asset is the 21,000 people who make up the team. “People vote with their feet,” he said of attracting and keeping good employees. “In a full employment economy like what we’ve got now, it’s hard. We have fundamentally infinite demand, and the only thing that’s restricting us is our ability to be able to go find, hire and train people.” He continued, “We want to make sure if we find them, that they are really happy.” Kusserow added the company works hard to keep employees engaged. “And if we don’t keep them, we need to know why – and then we need to fix it,” he continued. “We’ve reduced our turnover since I’ve been here by more than half of what it was, so now we’re down to about 17 percent, which is the best in the industry. It was around the low 40s, so we’ve fought that very hard.” Despite the success in lowering turn-
At the corporate level, Amedisys has invested time and talent to build analytic, knowledge, training and software tools to ensure those in the field have what they need to do their jobs effectively and efficiently. “We’re constantly working to make sure the best people have the best tools so they can deliver the highest quality,” said Kusserow. In addition to in-house tools, Amedisys has partnered with outside tech providers that complement their business model. Last year, the company invested in Nashvillebased Medalogix, a predictive analytics firm in the home health and hospice space. The technology helps Amedisys craft care plans and pathways and alerts the company to red flags that might require a change in direction. More recently, Amedisys announced a partnership with health technology company ClearCare to better coordinate communications between personal care and skilled home health providers along the continuum.
“If we do all these things really well, we grow … fast, and that’s what we’ve been doing,” Kusserow said. In the five years since he joined Amedisys, the company has seen growth in value in the 500-600 percent range, while also paying down debt. The first half of 2019 has continued that positive trend. According to second quarter reporting released at the end of July, the first six months of this year saw increases in financial metrics across the board compared to 2018, including increases in net service revenue and adjusted EBITDA. The first half of 2019 resulted in a net service revenue increase of just under $150 million compared to the same time frame last year. It’s also been a busy year for expansion and forging new partnerships. So far in 2019, the company has expanded services into more counties in New York, closed on acquisitions of hospice providers in New Jersey and Oklahoma, and entered the partnership with ClearCare.
Right care, right time, right place has become the healthcare mantra, and Kusserow believes Amedisys has a big role to play in this new value-based era. He noted baby boomers, as they have throughout their lives, are once again changing the business trajectory of healthcare. Kusserow said they don’t want institutionalization and believe the technologies are out there to allow care to come to them at home, which bodes well for Amedisys. “Our aim is to be an aging-in-place company,” Kusserow concluded. “Anybody who wants stay home, we want to offer all the services and coordinate all the services that are available.” nashvillemedicalnews
Trifocal Cataract Replacement Lens Makes U.S. Debut By CINDY SANDERS
On Aug. 27, the U.S. Food and Drug Administration approved Alcon’s AcrySof® IQ PanOptix® Trifocal Intraocular Lens (IOL) for commercial use. While the lens has been successfully used in more than 70 countries, the recent FDA approval marks the first time a trifocal IOL – correcting for near, intermediate and distance vision – has been available to patients in the United States outside the clinical trial setting. Nashville ophthalmologist Jeffrey D. Horn, MD, founder of Vision for Life, was one of a dozen clinical investigators across the country, and the only one in Tennessee, who participated in the study that led to FDA approval. Prior to launching the lens trial, investigators helped develop a survey tool to Dr. Jeffrey Horn benchmark vision improvement from a patient satisfaction viewpoint. “We were one of eight to 10 study sites that helped Alcon develop the first FDA-validated patient questionnaire that would tell us how the patient was seeing from their perspective rather than our measurements,” he explained. Although the patient interview trial delayed the U.S. investigation of PanOptix, it led to an important new evaluation tool. Horn noted the PanOptix not only became the first trifocal IOL approved by the FDA but also the first to “pass muster with a validated patient questionnaire.” More than 99 percent of PanOptix patients in the clinical study said they would choose the lens again. While Horn is obviously pleased with the outcomes he has seen with the
trifocal option, he noted the right choice of lens can vary by patient. “Cataract surgery is lens replacement pure and simple,” he pointed out. “My job is to figure out which lens is the best fit for the patient.” He added patients need to be reeducated so that they quit thinking of the surgery as cataract removal and instead put the focus on lens replacement. “They need to pay attention to what lens they get because that is going to determine how well they see.”
The Trifocal Diﬀerence
“The multifocal lenses that are still available today have been out since about 2005, but they are bifocal … so you could correct two of the three distances,” said Horn. “We were missing out on the trifocal lens, which had been available in other countries for several years.” Horn said being able to correct for near, mid-range, and far vision allows patients to not only read and see the road but also to view computer screens, car dashboards and mobile devices in a range of lighting conditions … all typically without the need for any type of glasses. The new lens uses a proprietary design to optimize middle vision without degrading vision on the near and far ends of the spectrum and is available in a spherical and toric design. “Not only is the lens superior – providing optimal range of vision correction at near, arm’s length and distance – it also does so with exceptionally good quality of vision because it transmits light more effectively,” Horn explained. “The more light that makes it through the lens to the retina, the better the vision,” he continued. In the clinical study of 243 patients across the 12 investigative sites, 129
patients were implanted with the PanOptix lens and 114 with a control lens. Six months post-implantation, the average best corrected distance with clear vision in one eye was 20/20 in both study groups. For intermediate distance, clear vision in on eye was approximately 20/25 in the PanOptix group compared to 20/40 in the control group. For near distance correction, the PanOptix lens was also 20/25, compared to 20/63 in the control group. Like other multifocal lenses, PanOptix utilizes diffractive rings to bend light and create focal points. “All lenses that have diffractive rings will create rings around lights at night, but PanOptix seems to have the lowest incidence of bothersome night vision rings,” said Horn. “In the U.S. trial, it actually had contrast sensitivity the same as a monofocal lens … no one was expecting that.”
Horn began implanting the PanOptix lens in November 2016 as part of the clinical trial. The last lens he implanted in the study before data was submitted for FDA approval was, to say the least, quite memorable. That specific lens replacement procedure was for his fiancée, who suffered from congenital cataracts and was 47 years old at the time of the trifocal implant. “I wouldn’t have put that lens in my fiancée’s eye if I didn’t think it was the very best for her,” he stated simply. Horn, who originally came to Nashville as a cataract specialist for Vanderbilt University Medical Center in 1997, has been a prolific clinical investigator throughout his career and involved in a number of trials that have led to breakthroughs in multifocal implants. “I’m doing three trials at the moment,” he said, adding he’s involved in a post-market study for the new Alcon lens, a Novartis eye drop study for presbyopia, and a new trifocal trial for Baush + Lomb. “I’ve probably done more vision correction clinical trials in Tennessee than any other cataract surgeon over the last 15 years,” Horn noted of his quest to help move the field forward to improve vision and enhance quality of life for patients.
Does your practice need a
Court Honored for Senior Citizens Project The Davidson County Chancery Court Part III was recently recognized for its contributions to the lives of older Tennesseans during a conference of the Southeastern Association of Area Agencies on Aging. The Association bestowed its 2019 Outstanding Community Service Award on the court in recognition of a $36 million program aimed at helping senior citizens that arose out of the settlement of two cases in Davidson County. In its first year, the court program has delivered dental, transportation, housing, and legal services to more than 17,174 elderly Tennesseans, and has resulted in the production of senior-focused programs on Nashville Public Television that have attracted over 1 million viewers. Davidson County Chancellor Ellen Hobbs Lyle administers the program with a team consisting of Tennessee Commission on Aging and Disability Executive Director Jim Shulman, General Counsel Charles Ferguson, attorneys for the receiver Paul Davidson and Tera Rica Murdock, receiver William C. Matheney, and representatives of five nonprofit agencies across the state: West End Home Foundation, HCA Foundation, Assisi Foundation, United Way of Greater Knoxville, and the Memorial Foundation.
Tell us where it hurts.
Our experienced healthcare team can help alleviate current financial pains and prevent future issues, so you can continue to focus on what matters most: providing excellent patient care.
615-782-4292 • krafthealthcare.com Practice Management • Reimbursement • Operations Coding • Compliance • Audit • Tax • Accounting OCTOBER 2019
Final Rule Updates CMS PACE Program By CINDY SANDERS
CMS recently updated regulations for Programs for All-Inclusive Care for the Elderly (PACE) to strengthen protections for participants and allow more operational flexibility for providers. PACE seeks to provide comprehensive, whole person care to some of the nation’s most vulnerable citizens, allowing them to stay in their homes. Although still a small part of overall senior care from the Centers for Medicare & Medicaid Services, PACE organizations (POs) have doubled over the last decade from 63 to 124. Today, more than 45,000 older adults are enrolled in programs across 31 states, including Tennessee. PACE programming combines medical, social and long-term care services for frail individuals, allowing them to continue living in their homes and communities instead of being institutionalized. PACE organizations provide services in the home, community and PACE center. Participants might be required to use a physician in the PACE network, but the PO contracts with numerous area specialists and support service providers. Most PACE participants are dually eligible for Medicare and Medicaid benefits. To qualify, an individual must be age 55 or over, live in a service area where there is a PACE organization, be eligible for skilled nursing care but be able to live safely in the community with some sup-
ports in place. A capitated program, the interdisciplinary team of providers can use the fixed amount of funding to deliver whatever type of services an individual might need instead of only providing those reimbursable under Medicare or Medicaid fee-for-service plans. A recent final rule, released at the end of May, made the first updates to the program since 2006. According to a CMS spokesperson, the National PACE Association (NPA) and POs have requested updates and changes to the PACE program for more than a decade. Their comments have focused primarily on providing more administrative flexibility and ensuring that PACE requirements align with today’s standards of care and practice.
“This rule is the first major update to the PACE program since 2006 and reflects updates to best practices in caring for frail and elderly individuals, as well as changes in technology,” said the spokesperson. For example, the update allows for the use of electronic communication and the automation of certain processes. Additionally, the rule revises and updates PACE requirements for application and waiver procedures, enforcement action and administrative requirements, participant rights, quality assessment and performance improvement, participant enrollment and disenrollment, federal and state oversight and monitoring, data collection, and reporting requirements, among other issues. “The finalized changes provide greater operational flexibility, remove redundancies and outdated information, and codify existing practice,” said the spokesperson. “For example, we are implementing a more flexible approach to the composition of the interdisciplinary team that is central to the coordinated care participants receive from PACE organizations in order to allow the team to better meet participants’ needs. Now, one individual will be able to fill two separate roles on the interdisciplinary team in certain circumstances, which will strengthen the ability of the PACE organization to provide more seamless care and better tailor care to individual participants.” Prior to the final rule, team members could
only fulfill one role on the care team. In order to expand access to PACE, the spokesperson said CMS is finalizing a number of other flexibilities, including allowing certain non-physician primary care providers to deliver some care in place of a physician where appropriate. Other regulation changes are focused on increasing participant protections by: • Clarifying POs that are offering qualified prescription drug coverage must comply with Part D requirements unless the requirement has been waived, • Implementing changes to enforcement action authority to enable CMS to hold POs accountable for non-compliance, • Increasing transparency and making the regulations more comprehensible for participants and providers, • Adding language to help ensure individuals with a criminal conviction for offenses related to physical, sexual or substance abuse or use could not be employed in any capacity where their contact might pose a potential risk. Additionally, the final rule codified an existing practice by CMS of relying on automated review systems for processing initial applications to become a PACE organization or for existing POs to expand. For more information on the PACE program or how to apply to become a PACE provider, please go online to NashvilleMedicalNews.com and click on the PACE Fact Sheet.
Leadership Health Care Expands Programming to Boston, continued from page 1 Medical History
One of the novel elements of this delegation was a trip through medical history with a tour of Massachusetts General Hospital’s Russell Museum of Medical History and Innovation, including the Ether Dome. The Ether Dome provided delegates the ability to tour the historical medical teaching amphitheater that housed the first successful use of ether as an anesthetic for surgery. While touring the Russell Museum, delegates viewed historical surgical tools, interactive exhibits about the evolution of healthcare, and tried their hands at laparoscopic surgery through simulation. Experiencing the
history of medicine reminded delegates of how far we have come as a nation in providing innovative care to our communities.
After the museum, delegates departed to MassChallenge for a brief tour of this non-profit program that invests in highpotential businesses and an afternoon interacting with healthcare entrepreneurs and technology innovators. In addition to meeting representatives from MassChallenge, delegation programming featured Stephen Konya, senior innovation strategist with the Office of the
NEW Medical Office Space FOR LEASE From 1,600 SF to 8,900 SF Available
7216 Nolensville Rd | Nolensville ,TN. 37135 | Williamson County • Highly Visible Location Next to Nolensville City Hall • Signed Tenants Include: Franklin Synergy Bank, Dental Group, Coffee Shoppe
Asking $25 NNN Per Square Foot | Ready 4th Quarter of 2019 Contact Ron Taylor, Broker
615.513.6168 cell, email@example.com
National Coordinator (ONC) for Health IT, talking about ONC priorities and progress around innovation. Konya discussed ONC’s multi-pronged approach to supporting innovation, including direct challenge competitions such as the Move Health Data Forward Challenge focused on helping consumers consolidate and share their health data. Delegates also heard from representatives from the Massachusetts eHealth Institute at Mass Tech, the Digital Innovation Hub at Brigham and Women’s Hospital, Harvard Pilgrim Health Care, the Massachusetts Health Policy Commission, and the leaders of successful Boston startups Wellist and Medumo. Impressively, these entities work collaboratively to engage with technology entrepreneurs in an effort to rapidly accelerate the development and deployment of novel ideas. The engaging keynote panel on Monday evening featured private equity leaders, Payal Agrawal of .406 Ventures and Aneesha Mehta of Bain Capital Ventures, talking with LifePoint Health’s former Chairman and CEO Bill Carpenter about healthcare investing and what startup leaders can do to make their businesses attractive to investors. The speakers noted it’s usually the company leaders, not just the business idea, that attract a private equity team to an investment. Investors are looking for companies led by strong operators who can steer a business through growth and multiple iterations of
its business model.
Value in Connections
In addition to the learning opportunities, one of the most valuable aspects of participating in an LHC delegation is the ability to create relationships and expanded networks. Delegate participants represented about 40 healthcare companies from Nashville in multiple facets of our industry — from hospital operators and health insurance providers to digital health and addiction medicine — providing a depth and breadth of expertise from which to expand our perspectives. As the LHC board chair, I’m particularly heartened when our members are able to form lasting connections that expand the collective knowledge of our organizations.
Next year, the LHC delegation will head back to its Washington, D.C. roots. By that time, election season will be nearing completion, providing our delegates the opportunity to gain valuable insights into federal health policy and the obligatory election predictions. Jessica Wells is the board chair of Leadership Health Care, an initiative of the Nashville Health Care Council, and assistant vice president of education & research, graduate medical education for HCA Healthcare.
Healthcare Leaders Respond to Block Grant Proposal By MELANIE KILGORE-HILL
Reactions are pouring in after the release of Gov. Bill Lee’s TennCare Block Grant Proposal, with two of the state’s leading healthcare organizations cautiously supportive of the idea.
Tennessee Medical Association
Russ Miller, CAE, chief executive officer of the Tennessee Medical Association, said the TMA supports the idea of flexibility for each state. “Federal rules and regulations on Medicaid programs tend to make some state do things that aren’t a good fit,” said Miller, who represents the state’s 9,000 physicians and medical students. “What works here might not be the right fit for MassachuRuss Miller setts, so the uniqueness of markets and people served is something to be considered. We’re always wrestling with cost, access and coverage.” While Miller recognizes validity of the proposal, he said implementation is what causes trepidation and understands a level of hesitancy until details reveal where savings would be made up. “Our caution is that haste can make even more waste in our healthcare system, so there needs to be methodical caution,” he warned, pointing to potential pitfalls that surfaced during previous TennCare changes. “It took years to adjust when we upped enrolment by 700,000 into a managed care program, so any changes need to be methodically cautious,” he said. Miller also hopes leaders will turn to providers for input as to how the pro-
posal would work and to set priorities and realistic expectations for savings. “We all want to control cost without compromising care,” he said. “We can provide more services, purchase more goods, or put more people in a program. It’s a delicate balancing act, because when your only answer is to put more people in, you have to limit services and people will scream about that, too. There are lots of mandates, and what the governor is asking for is relief to let us decide what’s best for our people. We have a very robust system to treat people, but how do we spread our resources?” He believes the proposed telemedicine focus could be an effective option for expanding resources, as would placing providers in an environment that would encourage more time with patients – and less with paperwork.
Tennessee Hospital Association
According to their Sept. 17 media statement, the Tennessee Hospital Association leadership is “encouraged that the Medicaid block grant proposal for the TennCare program will not reduce benefits, remove individuals from the rolls and has the potential for shared savings.” “Right now, we like what we’ve heard,” said THA President and CEO Craig Becker. “We’re intrigued and interested in shared savings, which has the opportunity to do different things.” In the statement, Becker emphasized Craig Becker that ensuring adequate funding for the program in the future is criti-
Governor Rolls Out, continued from page 1
only healthcare but also proactively address prevention and health. With the modified block grant proposed, Gov. Lee noted, “We think we have crafted a waiver that is going to really mitigate the risks that Tennesseans have but actually give us an opportunity to benefit from the efficiencies.” He added the federal government recognizes the efficiencies of the TennCare program and is interested in incentivizing programs that save taxpayer dollars while providing quality care as a model for other states. “We think it’s really good for Tennessee, but it’s also a win for the federal government,” Gov. Lee continued. Although it’s possible TennCare rolls might eventually expand to a larger population (think years down the road), the administration was quick to say that isn’t what this proposal addresses. Its focus is specifically on better serving those who qualify for TennCare under current rules. However, by potentially using shared savings to reinvest in community programming that promotes health and prevention, nashvillemedicalnews
a larger sector of the population could see some residual benefit. Rural health transformation is a priority. Additionally, having more flexibility with demonstration projects might allow the state to more quickly identify best practice interventions that could then be replicated by other payers and providers outside of TennCare, as well. A 30-day public comment period is underway and will end on Oct. 18, 2019. Those who wish to submit points of consideration may do so by emailing comments to: firstname.lastname@example.org or mailing written comments to Gabe Roberts, Director, Division of TennCare, 310 Great Circle Rd., Nashville 37243. By statute, the state’s modified block grant proposal must be submitted to CMS by Nov. 20, 2019. If an agreement on the submitted waiver is reached between CMS and Tennessee, then it must go back to the General Assembly for approval prior to implementation. Links to additional information on the state’s proposal to CMS are available for review at NashvilleMedicalNews.com.
Caring for People
cal to continuing to care for some of Tennessee’s most vulnerable residents and is a strength of the proposal. “The potential for shared savings in recognition of TennCare’s historic fiscal responsibility also presents a great new opportunity for enhanced coverage for TennCare enrollees,” he said.
But Becker said Tennessee’s ability to run a trim program is what makes the proposal attractive. “We’re not talking about getting additional dollars as much as dollars we’ve already saved the federal government, and getting half of that back,” Becker said. “That’s a definite positive, because our costs have been so much lower than every other state. It sure makes a whole lot of sense.” Miller said Tennessee’s unique position as a healthcare industry leader only increases the proposal’s chance of success but recognizes the political nature of the decision. “This is another alternative to the Affordable Care Act – and when you have options, you have people on both sides,” he said. “Change is nerve wracking for anyone, because it’s always creating winners and losers. Right now we’ve got a lot of people without care. We understand the need to expand the program, which should be a goal, but starting there and putting everyone in a new program without support would only threaten it for everyone. We’ve got to stabilize the program first and then add more weight to the design. At the end of the day, it’s all about people taking care of other people, and we have to work in unison.”
Tennessee Justice Center
The Tennessee Justice Center has been a vocal opponent to the proposed block grant. Executive Director Michele Johnson said the proposal is a dangerous, untested approach to a vital safety net program, and that it seeks to save money “on the backs of the poorest children and most frail seniors.” Half of the state’s children and 65 percent of Michele Johnson nursing home residents currently rely on TennCare. “The fact is we’re already in a state with very little waste, that runs a very skinny program,” said Johnson, who blames much of rising healthcare costs on medical inflation. “Can they squeeze out more? Maybe, but the federal government wants to save money, and the state wants to save money, too. The math doesn’t work out.”
HEALTH EXPO Presented by
FREE LIC • 10 a.m. - 4 p.m. Saturday, November 16, PUB2019 T The Cal Turner Family Center Medical College EVEatNMeharry 1011 21st Avenue North, Nashville, TN 37208
Saturday, November 16, 2019, 10:00 a.m. - 4:00 p.m. The Cal Turner Family Center at Meharry Medical College • FREE Health Screenings • Panel Discussions 1011 21st Avenue North, Nashville, TN 37208 F R E E Scheduled FREE Vendor/Booth LIC • Healthy Cooking • Vendors Events/Activities SCREENINGS PUB Space Available • Ask the Doctors? Demonstrations & Samples • Kids Activities EVENT • Blood Pressure • Healthy Food Demos & Samples Sign up by • Exercise & Fitness Activities • Door Prizes...and more • Blood Cholesterol • Fitness Activities September 15, 2019
Sponsorship Opportunities Available • Glucose Screening
& receive $100.00 OFF
• Raffles & Prizes
• Silent Auctions • VisionFor & Eyemore Screenings information, please
your space. send an email to 2019, 10:00 Saturday, November 16, Space is limited. email@example.com or call (615) 283-8281. & More
The Cal Turner Family Center at Meharry Med 1011 21st Avenue North, Nashville, TN 3 Scheduled FREE Ven Events/Activities SCREENINGS OCTOBER 2019 11 Spa • Ask the Doctors? >
sorship Opportunities A onPressure S•pBlood • Healthy Food Demos & Samples
• Blood Cholesterol For more information, visit www.dorothymariekinnardfoundation.org or call (615) 283-8281. • Fitness Activities • Glucose Screening
• Raffles & Prizes
• Vision & Eye Screenings
• Silent Auctions
Septe & rece y
CMS Announces New Affiliations Authority Last month, the Centers for Medicaid & Medicare Services (CMS) released a final rule that will grant it broad new revocation and denial authority for providers and suppliers who are “affiliated” with previously-sanctioned entities. CMS describes this new authority as a “first of its kind action” that “marks a critical step forward in CMS’ long-standing fight to end ‘pay and chase’ in federal healthcare By J. MATTHEW fraud efforts and KROPLIN replace it with smart, effective, and proactive measures.” The new “affiliations” provision – which is part of the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC) that will go into effect Nov. 4, 2019 – will allow CMS to revoke Medicare, Medicaid, and Children’s Health Insurance (CHIP) enrollments of providers or suppliers who “pose undue risk of fraud, waste or abuse based on their relationships with other sanctioned entities.” Under this new rule, providers must disclose current or past affiliations with
any organization that has uncollected debt, has had a payment suspension under a federal healthcare program, has been excluded from a federal healthcare program, or has had billing privileges denied or rescinded. Failure to make these disclosures may result in the provider no longer being able to participate in Medicare, Medicaid, and CHIP. “For too many years, we have played an expensive and inefficient game of ‘whack-a-mole’ with criminals — going after them one at a time — as they steal from our programs. These fraudsters temporarily disappear into complex, hard-to-track webs of criminal entities and then re-emerge under different corporate names. These criminals engage in the same behaviors again and again,” said CMS Administrator Seema Verma. “Now, for the first time, we have tools to stop criminals before they can steal from taxpayers. This is CMS hardening the target for criminals and locking the door to the vault. If you’re a bad actor, you can never get into the program, and you can’t steal from it.” Notwithstanding broad consensus on the benefits of combatting fraud and reducing waste, the expansive reach of the new rule has generated significant criticism. Among key concerns is the definition of an “affiliation” in the new rule, which
includes: direct or indirect ownership of 5 percent or more in another organization; a general or limited partnership interest, regardless of the percentage; an interest in which an individual or entity “exercises operational or managerial control over, or directly conducts” the daily operations of another organization, “either under direct contract or through some other arrangement” when an individual is acting as an officer or director of a corporation; and any reassignment relationship. In addition to the “affiliations” component, the new rule also allows CMS to revoke or deny enrollment if a provider or supplier circumvents program rules by coming back into the program under a different name; bills for services or items from non-compliant locations; exhibits a pattern of practice of abuse of ordering or certifying Medicare Part A or Part B items, services, or drugs; or has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department. CMS will also be able to bar re-application in the program for up to three years if the initial application contains false or misleading information and to block revoked providers and suppliers from re-entering the program for up to 10 years. The new rule will likely result in an increased compliance burden for both providers and suppliers. In fact, CMS esti-
mates an annual cost to providers and suppliers of $937,500 in each of the first three years of implementation to collect all of their affiliation documentation. Nevertheless, CMS believes that the rule strikes a balance between preventing fraud, yet not driving away participating providers. “This new rule builds on CMS’ previous accessible efforts to protect beneficiaries and taxpayer dollars while limiting burden on our provider partners without whom we could not deliver high quality care to the millions of people we are honored to serve.” Only time will tell if that is in fact the case. The final version of this new rule includes a “phased-in” approach, targeting first certain providers and suppliers that CMS determines have at least one applicable affiliation. However, because CMS has stated its intension to expand the scope, all providers and suppliers should be considering how they can determine and track whether their affiliations will require disclosure. Matthew Kroplin is a partner in Burr & Forman’s healthcare section. His experience includes the representation of a broad range of healthcare industry clients, as well as to product manufacturers and suppliers and other business entities in regulatory, compliance and operational issues. Kroplin is Certified in Healthcare Compliance. For more information, email firstname.lastname@example.org or go online to burr. com.
Minimizing Risk New SVMIC Tool Helps Assess, Avoid Common Missteps By CINDY SANDERS
RiskView wasn’t developed as a replacement for In the highly regulated a personal consultation healthcare industry, it’s far – a service SVMIC has too easy for a medical pracoffered for many years to tice to accidentally overhelp reduce risk in medilook a necessary posting or cal offices – the technolupdated compliance manogy provides valuable date among the long list of information and updates requirements that stem from to reinforce onsite obsermultiple government agenvations and to provide cies ranging from CMS to guidance between visits. OSHA. Unfortunately, even Clark said the tool will small missteps can result in also serve to extend risk hefty fines. assessment and patient Enter RiskView by safety expertise to more SVMIC, a new virtual real- RiskView’s 360-degree virtual tour walks users through regulatory mandates and best practices by practices. utilizing audio scripts and links to downloadable resources to help practices stay compliant. ity tool that walks practice “Consultations cover managers through a tradia lot of ground,” Clark tional physician office with audio scripts ferent spaces typically found in an office pointed out. “You don’t remember everyand downloadable resources referencing or clinic, Clark explained purple dots on thing,” she added of the need to fill in gaps regulatory mandates the screen link to audio scripts describin notes. Can’t remember what the consuland best practices. ing requirements for specific areas – from tant said about the refrigerator or which Meghan Clark, learnpublic spaces like the front desk, waiting posting had to be put in the break room? ing systems manager room and exam rooms to behind-theRiskView can provide a quick reminder by for SVMIC, noted the scenes spaces including administrative logging in and hovering over the areas of new interactive, selfoffices and onsite lab space. Blue dots, she concern. guided tool is based on continued, link to downloadable resources Updated as regulations and requirethe same technology on the SVMIC website for additional ments change, it also serves as an ongoing real estate agents use detail and guidance. resource for all users, regardless of particifor virtual home tours “The idea stemmed from an internal Meghan Clark pation in an on-site consultation. Clark said and was created using employee,” Clark said of the impetus to RiskView’s goal is to reach a wide audience a 360-degree Matterport camera. make years of risk mitigation expertise more and to serve varying purposes to match As users navigate through the difreadily available to stakeholders. While needs. 12
She noted the virtual practice navigation platform has allowed SVMIC to take a large body of professional resources developed over time and to organize a large portion of that information in one, easy-t0-access place. Another benefit of RiskView is that it’s available at policyholders’ and their practice administrator’s convenience and can be referenced whenever needed. “The whole purpose is risk mitigation,” said Clark. “Our policyholders don’t have to pay for it … it’s just an added benefit.” While access to the full platform requires logging into the SVMIC member portal, anyone interested in seeing how RiskView works can sample the program by going online to home.svmic. com/#riskview (a link to the sample waiting room tour is also available at the end of the online version of this article at NashvilleMedicalNews.com). “RiskView is intended to assist policyholders with improving patient care and reducing liability exposure in an online format that is easily accessible,” concluded Clark. “We are excited to release this new tool and look forward to continuing our search for new and creative ways to share our professional resources and make risk mitigation an easier part of our policyholders’ day.”
Save the Date Tea & Conversations Oct. 12 • Matthew Walker Comprehensive Health Center This dynamic event brings together women for an afternoon of inspiration, information, and empowerment in recognition of Breast Cancer Awareness Month. In addition to a delicious selection of teas and tea sandwiches, the event includes a hat contest, guest speaker Dr. Andrea Willis with BlueCross BlueShield, a panel of cancer survivors and musical entertainment. The event is from 11 am-1 pm. For details, go to mwchc.org. Walk to End Lupus Oct. 13 •Nissan Stadium The Nashville 2019 Walk is part of the nationwide Lupus Foundation of America’s Walk to End Lupus Now™ programming to raise money for research and increase awareness. Check-in begins at 1 pm, followed by an opening ceremony at 2:30 and the one-mile walk at 3. For details or to register, go to chapters.lupus.org/Nashville2019. AJMC Institute for Value-Based Medicine® VB-Onc™ Meeting Oct. 24 • Hutton Hotel The American Journal of Managed Care® is hosting a regional value-based oncology meeting in Nashville on Thursday, Oct. 24 from 5:30-8:45 pm. The program includes a roster of national presenters and is co-chaired by medical experts from Tennessee Oncology: Stephen Schleicher, MD, MBA, medical oncologist, and Aaron Lyss, MBA, director of strategy and business development. “As the transition from fee-for-service to value-based medicine continues, it’s important to understand how alternative payment models can impact decision making in oncology,” said Schleicher. “This conference offers an important opportunity to share research and discuss lessons learned in value-based arrangements. For more information or to register, go to ajmc.com/meetings. Power of Prevention: Diabetes Awareness Health Expo Nov. 16 • Cal Turner Family Center at Meharry Medical College Presented by the Dorothy Marie Kinnard Foundation (DMKF), the free public event will be held 10 am-4 pm on Saturday, Nov. 16, and will feature healthy cooking demonstrations and samples, panel discussions, exercise and fitness activities, free health screenings, children’s activities and much more. For medical professionals and clinicians interested in participating as a vendor or sponsor, offering screening services, or getting more information to share with patients, please send an email to info@dorothymariekinnardfoundation. org, or call 615.283.8281.
Webb Appointed TDH Deputy Commissioner for Operations Tennessee Department of Health Commissioner Lisa Piercey, MD, MBA, nashvillemedicalnews
FAAP has appointed John Webb as deputy commissioner for operations. Webb joins TDH after serving as deputy commissioner for fiscal and administrative servicJohn Webb es with the Department of Intellectual and Developmental Disabilities. In his new role at TDH, Webb will lead six TDH divisions including Financial Management, Contract Review, Facilities Management and Capital Projects, Fiscal Services, Property and Procurement and Support Services and will manage the department’s annual budget of approximately $566 million. Webb comes to TDH with more than a decade of leadership and service in fiscal and administrative services in state government. Prior to joining DIDD in 2016, he served as capital budget coordinator in the Department of Finance and Administration and as legislative budget analyst for the Tennessee General Assembly. He began his state service as a budget analyst with the Department of Finance and Administration and also has prior service with TDH, having worked as director of financial management in the Division of Administration from 2010 to 2012. Webb earned his undergraduate degree from Lipscomb University and a master’s in political science from the University of Alabama.
Cumberland Pharmaceuticals Inc. recently announced FDA Orphan Drug Grant funding for a new Phase II clinical program. The company has initiated the clinical development of ifetroban for the treatment of cardiomyopathy associated with Duchenne Muscular Dystrophy (DMD). Based on pre-clinical findings, the FDA has cleared Cumberland’s application to study ifetroban in DMD patients, ages seven and older. In addition, Cumberland has been awarded just over $1 million in funding from the FDA through their Orphan Drug Grant program to support a Phase II DMD clinical study. It’s the first DMD clinical study approved for FDA Orphan Product Development funding. A Vanderbilt team led by a neurosurgeon-scientist and an engineering professor who specialize in techniques for analyzing functional neuroimaging data has received a $3 million basic research grant (R01) from the National Institutes of Health (NIH) to study disturbances in brain networks related to attention lapses and cognitive deficits in patients with temporal lobe epilepsy (TLE). Dario Englot, MD, PhD, assistant professor of Neurological Surgery and Electrical Engineering, Radiology and Radiological Sciences and Biomedical Engineering, and Catie Chang, PhD, MS, assistant professor of Computer Science, Electrical Engineering, Computer Engineering and Biomedical Engineering, hope understanding these brain network problems may lead to new surgical or
behavioral interventions to improve the quality of life for epilepsy patients
Center for Medical Interoperability Launches Industry-Wide Verification Program Last month, the Center for Medical Interoperability announced the launch of C4MI Verified™ – a testing program to accelerate the availability of connected technology solutions in the healthcare industry. Products entering the Center testing lab will face a series of robust tests to determine compliance with selected interoperability specification requirements. Working collaboratively with medical device vendors and its member healthcare organizations, the Center has created a trust platform architecture and
supporting specifications to facilitate the development of interoperable medical devices and systems. The Patient Vitals Program will be the first C4MI Verified™ program to launch, with more programs planned in other areas such as ventilators. The C4MI Verified™ program will help enable plug-and-play interoperability by improving data quality for the industry through semantic and syntactic conformance to the requirements in the Center’s specifications. By improving the mapping of patient vital sign data from multiple device vendors into core systems, data can become more easily usable by clinicians to improve treatment and outcomes. The program will also verify security and provisioning capabilities of the patient monitoring systems.
Tivity Health Conference, continued from page 6 live alone, half of that group being over age 85. For seniors, the loss of a spouse, children growing up and moving away, and having car keys taken away, creates a cumulative effect of isolation and loneliness that takes both a physical and emotional toll. “According to the CDC in 2017, 47,000 suicides occurred in the United States. People 65 and over accounted for 20 percent of them,” he said. Just days before the Nashville conference, an elderly couple in Washington state died by a murder/suicide pact because they could no longer afford their medication. Research has shown the physical dangers for those with fewer social connections, as well, from interrupted sleep patterns to altered immune systems. “One study found isolation increases the risk of heart disease by 29 percent and stroke by 32 percent,” Tramuto stated. “The problems are clear,” he contin-
ued. “The solutions, however, are more complicated.” To continue the conversation about meaningful interventions, the conference highlighted community programming from across the country. Some solutions were low tech, but highly effective, including senior ride programs, food banks and companionship programs. Others relied on population health data to track barriers to care and deploy solutions. “It is no longer about innovation – we’ve innovated a lot over the last several decades,” said Tramuto. “it is about integration.” To that end, Tramuto said the conference wasn’t just an opportunity to become more aware of the social determinants keeping seniors from optimal health and well-being … but instead was a call to take immediate action. Repeating the sentiments of Hillel the Elder and Robert F. Kennedy, Tramuto challenged: “If not now, when? If not you, who?”
Moving the Needle on Senior Health In the past year, a number of steps have been taken to build awareness and implement actions to address rural health for seniors. As a follow-up to last year’s summit, Tivity Health worked with Grantmakers in Aging to publish The Power of Connection: Reversing Social Isolation in Rural America. Additionally, Tivity with the support of Health eVillages and the Rural Aging Advisory Council, released Aging Well in Rural America: Stories from the Heartland, which shares stories of initiatives and interventions that have been successful. Links to both publications are available at NashvilleMedicalNews.com. In July, the MIT AgeLab and Tivity Health hosted more than 50 thought leaders across research and business to discuss aging and how companies and organizations can deliver “better products, services, and experiences to the growing generation of older consumers.” In May, Aetna, Healthcare Leadership Council and Tivity convened a roundtable in Washington, D.C., with more than 75 national experts, business leaders and advocates from across the healthcare industry to discuss barriers to addressing social determinants of health “to developing a common understanding of the key areas for action to improve the health and wellbeing of elderly adults.” In July, Healthcare Leadership Council followed up with a white paper entitled Determined to Reduce Disparities: Solutions to Address Social Determinants of Health (link online at NashvilleMedicalNews.com). In addition, a number of pilot programs have recently launched. Jefferson College of Population Health has used a foundation grant to support rural scholarships for those entering the field. The National Council on Aging and Health eVillages launched a pilot aimed at increasing engagement of rural seniors in SNAP to address food insecurity. Other successful pilot programs have looked at intergenerational communication and engagement in physical activity and social programming to improve physical and mental health.
American Health Partners Adds Two Franklin-based American Health Partners has recently announced two new senior staff members to the team. Caleb Hemmer has joined as senior director of corporate development for the organization’s American Health Plans division, one of seven divisions offering post-acute healthcare to seniors. He is charged with helping grow the division, Caleb Hemmer which owns and manages Institutional Special Needs Plans (I-SNPs), a type of Medicare Advantage plan specifically for residents of nursing homes. Previously, Hemmer served in product growth roles at eviCore Healthcare and for MedSolutions Inc. He also served in the Tennessee Department of Economic and Community Development and was assistant to former Tennessee Governor Phil Brede-
sen. A graduate of the University of Tennessee, he earned an MBA from Tennessee Tech, serves on the membership committee of Leadership Health Care, is a commissioner for the Metropolitan Board of Fair Commissioners, and has been recognized for his leadership by several organizations. Jason Haney has been named vice president of operations for the American Health Plans division, which has I-SNPs available in more than 150 nursing homes throughout Kansas, Missouri, Oklahoma and Tennessee. Haney will oversee Jason Haney the management of ISNPs and develop new partnerships with nursing homeowners. He most recently served as market vice president for Optum Complex Care Management, an arm of UnitedHealth Group serving Missouri. Prior to Optum,
LBMC, NMN Host Women to Watch Alumni Event As the Women to Watch awards enter the 15th year in 2020, LBMC Healthcare and Nashville Medical News teamed up to recognize past award recipients during an alumni event in Brentwood. Held on the patio at Del Frisco’s Grille, the summer evening, delicious fare and signature W2W cocktail made for a relaxed evening of chatting and networking with colleagues from across the healthcare spectrum. Nominations for the Women to Watch Class of 2020 will be available online at NashvilleMedicalNews.com after the first of the year.
he was director of practice administration and business development for IPC Healthcare. Haney received his undergraduate degree from Washington University and his MBA from the University of Missouri in St. Louis.
Let’s Give Them Something to Talk About! Awards, Honors, Achievements Middle Tennessee is home of two members of the recently announced American Heart Association’s Southeast Affiliate Board of Directors for the 20192020 fiscal year. Local directors, both returning to serve for their second fiscal year, are: David Dill, president and CEO of LifePoint Health and Keith Wolken, chairman David Dill and CEO of SMS Holdings Corporation. During the upcoming year, Dill and Wolken will play an instrumental role in guiding efforts to reduce the incidences of heart disease and stroke. Keith Wolken Saghi Asgarifar has been appointed to the board of directors for Street Works, a non-profit organization providing education, prevention and care to those affected by HIV/AIDS and Hep C. Asgarifar is a clinical research associate with international pharmaceutical company ICON plc in Nashville. Sumner Regional Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines Target: Stroke Honor Roll Elite Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
Fourroux Prosthetics Opens in Nashville Founded more than 50 years ago in Huntsville, Ala., Fourroux Prosthetics recently opened their newest full-service patient care facility in La Vergne to provide prosthetic services to amputees in Nashville and surrounding communities. Fourroux uses state-of-the-art technology to custom fit patients, allowing them to be fitted and leave with a prosthesis in the same day. The company also provides free transportation, often a barrier to care for patients, to and from clinics. This newest location joins facilities in Birmingham, Atlanta and Memphis.
Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S
PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Maggie Bond Pam Harris Jennifer Trsinar MANAGING EDITOR Cindy Sanders email@example.com CREATIVE DIRECTOR Susan Graham firstname.lastname@example.org CONTRIBUTING WRITERS Melanie Kilgore-Hill Matthew Kroplin Cindy Sanders Jessica Wells CIRCULATION email@example.com —— All editorial submissions and press releases should be emailed to: firstname.lastname@example.org —— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 (FAX) 615.673.8819 or e-mailed to: email@example.com
Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials. All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.
NashvilleMedicalNews.blog NashvilleMedicalNews.com @NashMedNews
Top (L-R): Dr. Conchita Martinez, Dr. Beth Mallow, Claire Haltom, Katie Tarr, Lucy Carter, Rebecca Leslie & Lisa Nix. Pictured at Right (L-R): Dr. Jana Dreyzehner, Katina Beard, Katie Tarr
Franklin-based ObjectiveGI, an integrated research and technology services platform company, announced its 10th “Center of Research Excellence” last month. ObjectiveGI is a physicianpartnered model that integrates gastroenterology research services into local prac-
More Grand Rounds Online NashvilleMedicalNews.com
(continued on page 15)
GRAND ROUNDS tices, providing clinical research as a management option for specialists in support of patient care and practice enhancement. With this 10th center, the company is now partnering with more than 100 GI physicians across the country. Since launching the first “Center of Research Excellence” in 2018, ObjectiveGI and its partners have supported value-based care initiatives for more than 3,000 patients. Today, these centers can be found on-site at GI practices located in Alabama, Arkansas, Florida, Maryland, Michigan, North Carolina, South Carolina and Tennessee. Looking forward, ObjectiveGI plans to double the number of “Center of Excellence” sites by the end of 2020. With a shared commitment to fight breast cancer and support community health and wellness, Southwest Value Partners (SWVP), owner and operator of the expansive Nashville Yards development, and Susan G. Komen® recently announced a new multi-year strategic partnership to help elevate the nonprofit’s presence and activities in Nashville’s urban core. As part of the partnership, Nashville Yards will host future Komen events, including the Central Tennessee MORE THAN PINK Walk. “Thanks to a significant commitment from one of the most exciting development projects in Nashville, we will be launching a series of national and local events hosted at Nashville Yards over the next three years, providing a home for inspiring familyfriendly events that unite people behind a shared purpose,” said Susan G. Komen CEO Paula Schneider. Tennessee Gov. Bill Lee, Department of Economic and Community Development Commissioner Bob Rolfe and officials with Brentwood-based HCTec officials recently announced continued expansion of operations in Hohenwald. The healthcare IT workforce service provider will invest more than $500,000 and create over 100 jobs in Lewis County. HCTec helps hospitals nationwide reduce operating costs, improve quality and optimize labor forces with highly specialized healthcare IT skills staffing, project-based consulting and application-managed services support. AdvancedHEALTH, Middle Tennessee’s largest, independent, multispecialty practice, recently announced the addition of The Medical Group of Columbia to its growing group of providers. The practice is led by R. Douglas Kennedy, MD, who has cared for families in the Columbia community for over 19 years, and Gavin Pinkston, MD, who joined the practice in July.
specializes in hip, knee and shoulder, will primarily see patients at the new location. Dierckman comes to Elite from the Southern California Orthopedic Institute (SCOI) in Los Angeles. In addition to treating patients, he travels the country training surgeons in the newest technology and techniques of the hip. He received his medical degree Indiana University School of Medicine, followed by an orthopedic surgery residency at Emory University and an orthopedic sports medicine fellowship at SCOI.
Crushing the Crisis On Saturday, Sept. 7, TriStar Health joined more than 65 HCA Healthcare hospitals and local law enforcement agencies across the country to provide an opportunity for community members to properly dispose of unused opioid medications anonymously, with no questions asked. The TriStar Division hosted events at 13 locations across three states, including eight participating Middle Tennessee facilities. This year’s event collected more than 350 pounds of opioids, eclipsing the 2018 total by more than 125 pounds. Area TriStar facilities collected more than 110 pounds of the unused drugs, safely disposing of them and keeping them off the streets.
SEEING ALL THE DETAILS doesn’t always require a microscope. e.
As a mutual malpractice insurance company, SVMIC has developed a fast and easy alternative for accessing policy information online. This new web-based tool was designed to match the responsive service that our policyholders already experience with us over the phone.
Elite Sports Medicine + Orthopedics Expands Last month, Elite Sports Medicine + Orthopedics welcomed Brian Dierckman, MD, to their practice and opened a new office at Southern Hills. Dierckman, a board certified orthopedic surgeon who nashvillemedicalnews
See our new policy management platform
Dr. Brian Dierckman
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: firstname.lastname@example.org
Glenn Bradley Senior Vice President Medical Private Banking ph: 615-514-6054 email: email@example.com
Selisa Beeler Senior Vice President Medical Private Banking ph: 615-661-7451 email: firstname.lastname@example.org
©2019 First Tennessee Bank National Association operating as First Tennessee Bank and Capital Bank. Member FDIC.
6/17/19 3:38 PM
Nashville Medical News October 2019