Page 1

FOCUS TOPICS ORTHOPAEDICS/SPORTS MEDICINE/PHYSICAL THERAPY • INFORMATION SECURITY

Your Middle TN Source for Professional Healthcare News

PAGE 3

Brandon Downs, MD ON ROUNDS

Regenerative Medicine in Orthopaedics Experts Weigh in on Stem Cells, PRP as Game Changers Few areas show more promise of completely revolutionizing healthcare than regenerative medicine, the process of creating living, functional tissues to repair or replace damaged tissue or organ function ... 7

Change in Mindset Necessary for Stronger Information Security in Healthcare

TriStar Centennial Opens Advanced Joint Replacement Institute By CINDY SANDERS

Thirteen months in building, 24 months in development and 30 years in the making – the new TriStar Centennial Advanced Joint Replacement Institute represents a dream come true for Michael Christie, MD, co-founder of Southern Joint Replacement Institute (SJRI) and a driving force behind the new ‘hospital within a hospital’ that opened last month. Located on the eighth floor of TriStar Centennial Medical Center, the $96 million, 50,000-square-foot center includes 18 pre-op areas, 10 surgical suites, 17 PACU bays for recovery, a learning center and bioskills lab, state-of-the-art central sterile processing area, vendor storage, and 29 dedicated med-surg beds one floor below used solely for joint replacement patients.

A Growing Need

“In 2013 in the U.S.A., there were 300,000 hip replacements performed, 700,000 knee replacements,” said Christie. (CONTINUED ON PAGE 6)

@NashMedNews

ONLINE: NASHVILLE MEDICAL NEWS.COM

Dr. Michael Christie

Playing it Safe

Unique Program Works to Reduce ACL Injuries

Compliance is king, but that’s not how it should be. Since the introduction of HIPAA in 1996, the healthcare field has centered data privacy and security efforts around compliance. If all the boxes were checked and organizations received a passing compliance report, everything was “all good.” ... 10

Follow us on Twitter

PEYTON HOGE PHOTOGRAPHY

PHYSICIAN SPOTLIGHT

September 2018 >> $5

By CINDY SANDERS

Wearable technology helps evaluate movement before starting the ACL Play-It-Safe protocol.

SHAPE THE FUTURE OF HEALTH CARE.

It’s news no athlete wants to hear … a torn anterior cruciate ligament most always means the season is instantly over with surgery and months of rehab to follow. “The scope of the problem is there is anywhere between 250,000 to 300,000 ACL injuries every single year,” said Trent Nessler, PT, MPT, DPT, the founder and developer of the ACL Play-It-Safe Program™. “Right now it’s about a $5 billion healthcare cost for the primary injury only, and 79 percent of those who tear their ACL will have osteoarthritis within 12 years,” he added of the impetus to identify and reduce risks. For athletes at the high school, collegiate and professional level, an ACL injury comes with long lasting effects, including increased risk of re-injury. Nessler noted a (CONTINUED ON PAGE 4)

Applications for the 2019 Nashville Health Care Council Fellows class open September 4.

AN INITIATIVE OF

Apply online at healthcarecouncilfellows.com

PRINTED ON RECYCLED PAPER

PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357


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 Vice President Medical Private Banking ph: 615-514-6055 email: mrharrison@ftb.com

Glenn Bradley Vice President Medical Private Banking ph: 615-514-6054 email: gmbradley@ftb.com

James Nicholson Vice President Medical Private Banking ph: 615-514-6056 email: jlnicholson@ftb.com

Selisa Beeler Vice President Medical Private Banking ph: 615-661-7451 email: sjbeeler@ftb.com

Shelby McFadden Vice President Medical Private Banking ph: 615-514-6053 email: slmcfadden@ftb.com

©2018 First Tennessee Bank National Association operating as First Tennessee Bank and Capital Bank. Member FDIC.

FTB_WEA_7810_MedPrivBankingPrint_38518_10x13_4c_DocChild.indd 1

2

>

SEPTEMBER 2018

8/10/18 1:18 PM nashvillemedicalnews

.com


PHYSICIAN SPOTLIGHT

Brandon Downs, MD

Providing Concierge-Level Orthopaedic Care in Middle Tennessee By MELANIE KILGORE-HILL

For Brandon Downs, MD, FAAOS, the path to medicine was blazed early on. The Nashville native and founder of Orthopaedic Specialists didn’t hesitate to follow in the footsteps of his father and grandfather – both local physicians. “I was exposed to medicine at a young age by going on rounds with my father,” Downs said of his early years. After attending Belmont University as a full Presidential Scholar and graduating magna cum laude, he continued his education at Loma Linda University School of Medicine, where he was named the AMA Society Medical Student Researcher of the Year. Downs went on to an orthopaedic surgery residency at the Campbell Clinic in Memphis, followed by an orthopaedic sports medicine fellowship at the Cleveland Clinic Foundation in Ohio. Following fellowship training, Downs achieved Board Certification and a Certificate of Added Qualification in Sports Medicine from the American Board of Orthopaedic Surgery and the American Orthopaedic Society for Sports Medicine. He has been practicing orthopaedic surgery in Nashville since 2006.

Orthopaedic Specialists

Several years ago, with a stated goal of providing the finest orthopaedic care in the region, Downs launched Orthopaedic Specialists. His first office opened in Dickson in 2015, and an Ashland City practice soon followed. In early 2018, Downs opened the Nashville office of Orthopaedic Specialists, located at 1912 Charlotte Ave. Downs and his staff provide conciergelevel care from his Nashville office, where patients enjoy downtown views, front door parking and same day appointments. Convenience is a major focus with patients having the ability to receive physician-supervised care alongside onsite medical imaging, physical therapy and occupational therapy.

Additional Services

Downs, who specializes in orthopaedic sports medicine and minimally invasive joint replacement, frequently uses custom designed implants and performs computer-navigated total joint arthroplasty. He also offers regenerative medicine, performing platelet rich plasma injections and stem cell injections onsite. “Regenerative medicine is still early science but is such a promising field,” Downs said. “It offers a non-surgical approach to care for many of the problems we see in orthopaedics. I have lengthy discussions with my patients, especially those with orthopaedic medical issues or degenerative joint disease, who nashvillemedicalnews

.com

of-the-art imaging and therapy services with the care and a personal touch that people enjoy.”

Teaching & Designing

have daily pain but desire non-surgical treatments.” Overseeing a comprehensive orthopaedic center is big undertaking, but Downs said the value added to patient care and experience makes it all worthwhile. “I’m excited about the level of care we are able to provide for patients,” Downs said. “We provide outstanding care for the patient needing medical orthopaedic care, the candidate for sports medicine surgery and the candidate for minimally invasive joint replacement. I’m pleased that we are able to provide state-

Downs also is a consultant and instructor for orthopaedic manufacturers such as Arthrex and Exactech, with a focus on computer-assisted navigation. “Navigated orthopaedic surgery is a quickly growing area, and manufacturers are moving strongly forward with this technology,” Downs explained. “We’re developing and placing personalized implants based on the unique needs of a particular patient.” Navigation-guided surgery helps surgeons avoid poorly positioned implants, which provides increased stability, less pain and better patient outcomes. Through these partnerships, Downs performed the very first computer-navigated total shoulder arthroplasty in Tennessee in 2017. “It’s great to be on the cutting edge of what’s happening in orthopaedics and to make sure my patients are getting top quality care,” he noted. “It compounds that effect if you’re able to design the next generation implants and help other surgeons in the process.” Considering the rapid evolution of orthopaedic technology, Downs is committed to staying ahead of the curve. “In my early training, reverse total shoulder

arthroplasty wasn’t readily practiced, and now it’s frequently used,” Downs said. “Seeing that transition in such a short time over my career, I wanted to make sure I was a part of developing better techniques and software to improve outcomes and decrease revision rates for surgery patients. I enjoy helping to ensure we’re advancing the craft forward for future patients.”

In & Out of the Office

Downs maintains surgery center privileges at TriStar Centennial Medical Center, Saint Thomas Midtown Hospital and Indian Lake Surgery Center in Hendersonville, where he lives with his family. An avid snow skier and triathlete, Downs serves student athletes as team physician for Davidson Academy, Creek Wood High School and Dickson County High School. With continued growth, Downs expects to add other specialists when the time is right. However, he said he doesn’t envision Orthopaedic Specialists becoming so large that the practice loses what makes it special. “In this practice, all patients are family … so when they call they don’t have to ask for a specific nurse,” Downs said. “Everyone here is already familiar with your treatment, because we’re all dedicated to your care.”

Total Therapy Takes Care of YOU so You Can Take Care of PATIENTS From outfitting large orthopaedic institutes and hospitals to working with independent clinics and athletic trainers across the U.S., Total Therapy represents a broad range of orthopaedic, rehabilitation, strength and conditioning manufacturers to suit your specific needs. Services Provided Include: Facility Space Planning & Clinic Setup Consultation • DME & Supplies Inservice Training • Equipment Repair • Local Contact for Assistance

For a quote or more information, James Sanders: 615.397.2837 totaltherapynash@icloud.com • totaltherapynash.com

SEPTEMBER 2018

>

3


Vanderbilt Bone & Joint Franklin Expands Staff, Adds Pediatric Services Vanderbilt Bone and Joint Franklin has expanded its staff with 20 new providers and added pediatric services. The clinic, located on Bedford Way, has also extended its after-hours clinic, giving patients access to a provider without an appointment from 8 am-8 pm MondayFriday and on Saturdays from 8 am until noon. “Vanderbilt Orthopaedics has now brought its brand of nationally recognized specialists in musculoskeletal care from downtown Nashville to Franklin directly,” said Herb Schwartz, MD, the Dan Spengler, MD, Professor and Chair of Orthopaedics. “For the convenience of Williamson County Dr. Herb Schwartz and surrounding counties’ residents, it is possible to see same-day

experts who only care for specific orthopaedic subspecialties such as hand, sports medicine, spine, hip-knee joint preservation, arthritis and muscle-joint-bone problems unique to children and adolescents. The practice of evidence-based medicine and documented quality outcomes are now an everyday experience.” Gregory Mencio, MD, leads the clinic’s new Pediatric Orthopaedics Division. Because their skeletons are growing and dynamically changing, children are not just small adults, Mencio noted. Their orthopaedic problems are different and often demand nuanced Dr. Gregory Mencio approaches to treatment. Pediatric orthopaedists treat both complex musculoskeletal problems in children, such as congenital bone deformities,

clubfeet, hip disorders, scoliosis and other spinal deformities, as well as more common conditions like sprains, strains, fractures and sports injuries. “Our pediatric orthopaedic providers have extensive training and years of experience in treating orthopaedic problems from newborn through teenage years,” said Mencio, the Neil E. Green, MD, Professor and Chair of Pediatric Orthopaedics at Vanderbilt. “The pediatric orthopaedic clinic at Vanderbilt Bone and Joint Franklin has on-site x-rays, casting services and full access to all of the resources at Monroe Carell Jr. Children’s Hospital. From broken bones and sports injuries to the most complex orthopaedic conditions, our team can provide children with the region’s most advanced musculoskeletal care in an easily accessible, familyfriendly environment.” Another new clinic at Vanderbilt Bone and Joint Franklin is the Hip Pres-

ervation Clinic. It offers patients a unique care model in which pediatric and adult reconstructive surgeons collaborate to avoid or delay a total hip replacement. Other services include the spine program at Vanderbilt Bone and Joint Franklin, led by Byron Stephens, MD, which brings a team approach to care. The team physician of the Nashville Predators, John “Jed” Kuhn, MD, who is director of Sports Medicine, treats patients with shoulder injuries. Others staffing the Franklin clinic include Andrew Gregory, MD, who served as team physician for both the men’s and women’s volleyball teams in the 2016 Summer Olympics, Paul Rummo, DO, another physician for the Nashville Predators, and Warne Fitch, MD, the head team physician for Vanderbilt Athletics. Douglas Weikert, MD, one of the nation’s top hand surgeons, who has repaired the hand injuries of professional athletes, also staffs the Franklin clinic.

Playing it Safe, continued from page 1 study published earlier this year that focused on NFL players with torn ACLs found athletic performance was reduced for up to two years after the athletes returned to play. “In addition,” he said, “they reduce their professional career by two years on average.” Nessler also noted ACL injuries have a high re-injury rate of 20-30 percent within twofive years after primary reconstruction. Nessler – who is based in Nashville and is the national director of Sports Innovation for Select Medical, one of the largest rehabilitation companies in the nation with 1,600 centers across the United States and more than 800 athletic trainers on staff –said the vast majority of ACL injuries don’t happen as the result of a direct hit. He pointed out 70-80 percent of ACL injuries are non-contact, typically occurring when a rapid change of direction ruptures the ACL.

Program Development

His quest to create an effective ACL injury prevention program began 18 years ago when he had a physical therapy practice in Phoenix, Ariz. In a fairly short span of time, Nessler had 21 kids come to his office to rehab torn ACLs. “I was seeing certain patterns that I knew intuitively were putting them at risk for re-injury,” he recalled. “I knew if I could assess it, I could treat it.” Nessler began videotaping specific movements including a single leg squat and single leg hop. “If an athlete’s knee moves in towards midline too much, we knew that was a risk factor. We suspected that if the knee had major movement, faster, there was greater risk.” To quantify the magnitude of movement, Nessler’s research led him to dorsaVi™ , an Australian company that makes wearable sensor technology. “We basically integrated our movement assessment with their technology,” Nessler said of the part4

>

SEPTEMBER 2018

nership that led to ViPerform AMI™ – the 3D wearable technology now used for the ACL protocol. Over time, the assessments have grown to include a number of additional exercises to gauge quality of movement on both the left and right sides. “In total, the test consists of 83 reps and three vertical tests. It’s very physically challenging, but we’re testing athletes,” he said. The idea, Nessler continued, is to see how the athlete moves when fatigued since many non-contact ACL injuries occur as the athlete tires. The wearable technology allows trainers to evaluate an athlete’s movement and put them on a strength and conditioning protocol from level one to four … with four being for athletes who move really well and level one for those with the highest risk of injury due to engrained patterns of incorrect movement. “When you improve the biomechanics of the lower kinetic chain, what you see is the kinetic energy transfer across the system is much better,” Nessler said. “When we identify those athletes who are at greater risk and put them on the program, we found we not only reduce ACL injuries but all noncontact lower extremity injuries – ankle, knee, hip and low back,” he continued. Even the best movers have benefitted from the exercise protocol and seen enhanced vertical jump and sprint speed, both measures of explosive power that are particularly appealing to athletes. Nessler said improving performance also prevents injuries to create a win/win for athletes and coaches. Having been around sports medicine his entire career, Nessler knew it was key to keep the protocol short. “If a program is greater than 20 minutes in duration, coaches won’t do it,” he noted. ACL PlayIt-Safe incorporates a five-minute warm-up

Researching Effectiveness

Nate Bower works with an athlete on a series of exercises tailored to improve quality of movement and lessen risk for ACL injury.

followed by the normal practice led by the coaching staff and then about 15 minutes of a series of seven exercises specific to the Play-It-Safe level assigned to each individual athlete. Other unique attributes include having a video, which is available via an app tied to the program, to show exact technique for each movement at every level. “It creates a standardized instruction in the individual exercises,” Nessler said. Each athlete also has their own equipment that comes in their personalized bag so that someone at one level doesn’t grab a stability trainer, cuff or resistance band meant for someone at a different level.

“To date, we’ve done over 8,000 assessments nationwide on athletes and put over 4,000 kids on the ACL Play-It-Safe Program,” Nessler said. Despite amassing plenty of field evidence the program worked, he recognized the need to study the impact of the program in a more methodical way. To measure data and quantify outcomes, Nate Bower, PT, DPT, SCS, served as lead physical therapist in the ACL PlayIt-Safe study with the women’s soccer team at Samford University in Birmingham, Ala. Bower, who is residency trained and a board-certified clinical sports specialist, serves as market manager for Champion Sports Medicine, part of the Select Medical Outpatient Division. He noted that over the last five years, the soccer team had averaged three to four ACL tears per season. “That’s pretty high when considering the team has about a 20-woman roster,” he said. “The athletic trainer came to me and asked, ‘Do you know of any programs we can implement now to hopefully prevent these injuries in the future?’ That’s essentially where we started.” He added the ACL Play-It-Safe protocol focuses on strength, flexibility, balance and plyometrics. “All of the exercises are targeting areas that should be part of any injury-prevention program,” Bower pointed out. Working closely with the athletic trainer, he said the first step was to get a baseline performance measure on each specific movement test in July 2017, about six weeks prior to the start of the soccer season. After identifying areas where there was room for improvement, such as poor landing mechanics, the athletes were assigned to a level and provided education to improve areas of weakness throughout the season. (CONTINUED ON PAGE 8)

nashvillemedicalnews

.com


exceptional on every level. This dynamic

Our experience with Burr & Forman has been partnership creates an environment of fluid ideas and open communication that makes for a great team.

Elizabeth Miller, Senior Relationship Manager, CapStar Bank Pictured with Tucker Herndon, Burr & Forman’s Nashville Managing Partner

300 Attorneys. 12 Offices. Southeastern Strong.

We collaborate with clients, working with them as business partners, advising them step-by-step. Being able to take care of our clients’ multiple legal needs in one place is part of what makes our client relationships successful. From health care, construction and lending, to real estate, financial services, cybersecurity and 222 Second Avenue South Suite 2000 Nashville, TN 37201 Visit Burr.com

more, we work across offices, practices and communities to serve our clients as one team.

615.724.3200

n

AL DE FL GA MS NC TN n

n

n

n

n

n

No representation is made that the quality of services to be performed is greater than the quality of legal services performed by other lawyers.

nashvillemedicalnews

.com

SEPTEMBER 2018

>

5


TriStar Centennial Opens Advanced Joint Replacement Institute, continued from page 1 “They are estimating by 2030, there will be three-and-a-half million joint replacements a year.” With aging baby boomers driving demand … and demanding a high level of quality and patient experience, HCA committed to creating a facility that would meet those expectations. The chance to build out such a technologically advanced joint replacement center is what drew the physicians and staff of SJRI to TriStar Centennial Medical Center several years ago. “What surgeon gets this opportunity in a career?” asked Christie, who is medical director for the new Advanced Joint Replacement Institute. “This is a dream come true.”

Expansive Surgical Suites

Having given plenty of thought to an ideal surgical suite over a career spanning more than 30 years, Christie had plenty of input into the design of the 10 operating rooms. Each surgical suite has tinted windows that can be automatically dimmed on bright days or lightened on dark days, and each is outfitted with the latest technology and equipment. Physicians and nurses can pull up all the necessary information on a patient with the touch of a few buttons on the monitor. With large windows overlooking the downtown skyline, HCA headquarters, or the Parthenon … the views aren’t bad, either. In addition to equipment choices, processes also have been carefully considered in the design. Each operating suite has sub-sterile rooms attached. After the patient enters the operating room, Christie said no one comes in or out the main door, with staff utilizing side entrances from the sub-sterile areas instead. “It’s designed so you’re not allowing the outside environment to go back into the room,” he explained. But the best part of the surgical suites has to be “the size … it’s exactly right,” Christie noted of the large, 660-square-foot rooms. Brandon Hollis, administrative director for SJRI and the Advanced Joint Replacement Institute, echoed Christie’s sentiment on size, noting the large rooms comfortably allow for all the equipment that comes with joint replacement, including the MAKO robotic technology.

comfortable waiting area sense of a team. Most includes concierge service hospitals – most big and is decked out with a companies – are orgalarge television, fireplace, nized in silos,” Christie and coffee bar. Radiosaid. “Here, it’s a team frequency identification … one single team. (RFID) tracking is utilized You’re all doing the and each patient assigned same things together to a number so those waittake great care of these ing can follow the progpatients,” he added. ress through surgery and After all, Christie recovery. pointed out, “It may be Christie noted care our third knee that day, begins long before the but that’s your only knee. first incision. “The blessThe whole goal here is to ing we have with joint remind us all every day replacement is it’s electhat we have to cherish tive in it’s timing so that our patients.” allows the surgical team to get that patient optiStill More to Learn mized to successfully get To deliver the best through the operation,” care, Christie noted it’s he said. important to keep learnHe continued, “They ing. Continuing educastart therapy before the tion, therefore, is another surgery so there is a ‘preimportant theme of the hab’ patients go through. eighth floor. We know that if you’re Originally, the space stronger going into the called for 20 pre-op operation, you do better. rooms, but Hollis said The bioskills lab allows interns, fellows, and visiting physicians to perfect joint replacement And since we have conthe surgeons wanted an surgical techniques. trol over timing … it’s area to train interns and not an emergency … it’s fellows so two of those all about getting you ready for surgery.” rooms became a learning center and to the eighth floor, where they are greeted Patients and caregivers attend a class bioskills lab. and taken to pre-op. before the joint replacement, as well, to “What we can do in here is set it up Once surgery is complete, the first explain the process and set expectations just like a surgery, but it’s non-sterile, and steps toward successfully rehabilitating for the surgery and recovery. They are we buy these synthetic bones – they’re the joint begin. Early ambulation is key given a phone number and assigned a called sawbones – so we can train surgeons to positive outcomes. “About 90-95 pervalet who will park the car on the day of on how to do the joint replacements,” he cent of our joint replacement patients are surgery and direct the patient and family explained. ambulating the same day,” Hollis said. He The nearby conference room outnoted a therapist would fitted with a whiteboard, microphones come up to the eighth and cameras for presentations, video floor for same-day disand phone conferences also facilitates charge patients. Othercontinued learning as surgeons, hospiwise, patients are seen on talists, anesthesiologists and other clinithe dedicated inpatient cians connect to discuss cases and best floor below about two practices. hours after surgery. “We collect data on every patient, we “We know patients analyze that data, and we modify what get home sooner and get we’re doing in terms of our treatment better faster if they walk based on that analysis,” said Christie. He day of surgery so that’s added that type of continued analytics the goal,” Christie conover the last few years has led to a change curred. in the way anesthesia is delivered to better enable early ambulation. Interdisciplinary

Patient-Centered Care

While there is much for physicians and staff to appreciate about the new space, the center’s design was driven by a patient-centric focus on quality, comfort and care. Family members and caregivers were given careful consideration, too. The 6

>

SEPTEMBER 2018

The spacious surgical suites feature advanced technology to the benefit of both clinicians and patients.

Team

Christie said the new facilities support teamwork. Care begins with schedulers and staff in the practice helping prepare patients for surgery and continues from surgery to recovery with many hands impacting every patient. From administrative staff and techs to surgeons and nurses, successful outcomes are dependent on everyone pulling in the same direction. “The intent here was to establish the

Scheduling Surgery

Christie said the center is open to fellowship-trained surgeons who have privileges with HCA. He added the focus is on major joints with most replacements expected to be shoulders, hips and knees. Hollis said the goal is to have about 20 joint replacement surgeons using the new Advanced Joint Replacement Institute, and added it’s pretty straightforward to book a surgery. “We use the same scheduling system as the main hospital,” he noted. The first surgery was performed at the new facility Aug. 6. For more information, go online to tristarcentennial.com. nashvillemedicalnews

.com


Regenerative Medicine in Orthopaedics Experts Weigh in on Stem Cells, PRP as Game Changers By MELANIE KILGORE-HILL

Few areas show more promise of completely revolutionizing healthcare than regenerative medicine, the process of creating living, functional tissues to repair or replace damaged tissue or organ function. There’s no shortage of expertise in Middle Tennessee’s orthopaedic and sports medicine sector where a number of surgeons and researchers are utilizing the technology and moving the science forward.

Hughston Clinic Orthopaedics

Orthopaedic surgeon Gregg Motz, MD, of Hughston Clinic Orthopaedics located at TriStar Hendersonville, treats patients with stem cells and platelet rich plasma injections – the two most common forms of regenerative medicine. Most injections given at the practice Dr. Greg Motz are for arthritic knees, acute sprains or tendonitis, and are often given in conjunction with surgery. While the therapy is proving successful, its estimated cost of $800-$5,000 per injection isn’t cov-

ered by insurance, leaving both patient and surgeon to weigh the pros and cons. “Most patients are trying the traditional orthopaedic treatments of steroid injection, arthroscopy and/or physical therapy first due to insurance coverage of those issues and the expense of stem cells,” Motz said. “If those treatments don’t alleviate the problem, patients are frequently choosing stem cell treatment prior to considering knee replacement. We are also looking at using stem cells along with surgery in certain cases in order to try to improve outcomes.” On average, patients who undergo stem cell injections report a 90 percent improvement in pain symptoms. But there’s still a bit of mystery into exactly how injections work. “We speculate to some degree as to what occurs,” Motz said. “What stem cells are most likely doing are communicating with your cells in the joint and activating them to heal the surrounding area themselves.”

Nashville Regenerative Orthopedics

Today, stem cells are derived from multiple sources including bone marrow or fat from the patient. Amniotic, placental and umbilical tissues from live births are also common sources, as are tissue

banks. Orthopaedic surgeon Ethan Kellum, MD, of Nashville Regenerative Orthopedics, has injected thousands of patients in his four years postfellowship. For most of KelDr. Ethan Kellum lum’s patients, the protocol is a series of injections that happen over a week. These injections include a pre-injection, the same-day stem cell extraction and reinjection procedure, followed by a post-injection of multiple proprietary platelet mixes a few days later. “When I got out of fellowship, I saw how often this therapy kept patients out of the OR,” said Kellum, former assistant team physician with the NBA’s Boston Celtics. Today, his Franklin practice is 90 percent regenerative medicine, sometimes in combination with surgery. The two main categories within regenerative medicine are stem cells and growth factors, which include platelet rich plasma. While he uses both, Kellum prefers stem cells for patients with soft tissue, joint or arthritis damage. “Everyone’s different, and you really have to evaluate the patient and understand what’s going on and what their goals are,” said Kellum, who finds

that stem cells yield similar results as PRP but produce longer lasting effects. Patients at Nashville Regenerative Orthopedics typically receive stem cells from their own bone marrow, proven to be more effective than fat cells. Kellum urges patients to ask questions and really understand the product they’re receiving. “Sometimes patients think they’re getting stem cells but are really getting a growth factor or amniotic product off the shelf, and some providers think they’re giving stem cells when they’re really giving growth factors,” he said. “There’s a lot of misinformation out there among patients and providers.”

Tennessee Orthopaedic Alliance

Christian Anderson, MD, a sports medicine surgeon with Tennessee Orthopaedic Alliance, said PRP is more affordable than stem cell injections and more effective long-term than Dr. Christian Anderson traditional steroid injections, which have a rapid onset but equally rapid offset. Platelet rich plasma (CONTINUED ON PAGE 8)

Ready to Scrub In Today’s complex health system requires coordination across the continuum. What’s true for patient care is also true for the back office functions that keep industry participants compliant, efficient, effective and profitable. With more than 100 healthcare specialists serving clients nationwide, LBMC has the insight and experience to offer innovative solutions across the spectrum of professional services. 615.377.4600 www.lbmc.com/tennessee

nashvillemedicalnews

.com

SEPTEMBER 2018

>

7


Industry Leaders Announce Innovative Orthopaedic Partnership Last month, Saint Thomas Health, BlueCross BlueShield of Tennessee (BCBST) and Tennessee Orthopaedic Alliance (TOA) announced they have taken an additional step to further their strategic partnership, including plans for an expansion of the Saint Thomas Joint Replacement Institute. Additionally, Saint Thomas Health and TOA have signed a clinically integrated alliance agreement. Officials with Saint Thomas Health said the agreements align with the health system’s approach to serve as a partner of choice for independent physician groups and health insurance plans and to provide patient-centered services in clinically appropriate settings. The partnership includes plans to bring total joint replacement surgeries to outpatient surgery centers across Middle Tennessee to improve access to quality care. Officials said the collaboration allows for enhanced care coordination between the large orthopaedic surgery group, health system and state’s largest commercial health insurance carrier.  “We have collaborated with Saint Thomas Health on a number of initiatives over the past several years, and we are excited about this new endeavor, which brings options for high-quality and costeffective joint replacement care closer to

where our members live and work,” said Marc Barclay, vice president of provider network contracting for BlueCross. As an extension of this partnership, Saint Thomas Joint Replacement Institute (STJRI) is expanding from its current hospital-based locations at Saint Thomas Midtown, Saint Thomas West and Saint Thomas Rutherford Hospitals to ambulatory surgery centers across the region, working with BCBST leadership to identify the areas of greatest need across Middle Tennessee. Each patient’s qualification for total joint replacement surgery in the outpatient setting will be assessed based on medical selection criteria as defined by the program. “The distinctive program continues Saint Thomas Health’s efforts to serve as an innovative, early adopter bringing best practices in the country to Middle Tennessee communities, with a disciplined focus on convenient access, quality and Fahad Tahir affordability,” said Fahad Tahir, president and CEO of Saint Thomas Midtown and West Hospitals. The agreement will include shared strategy and clinical integration, provid-

ing opportunities for sharing patient data between the three parties for seamless care coordination and implementation of evidence-based clinical practice guidelines. Once fully implemented, the expanded program is anticipated to provide patients with a more cost-effective option of total joint replacement surgery in suburban and community settings throughout the region. 
“Our relationship will enhance access to affordable healthcare for those we serve in communities across Middle Tennessee,” said Gordon Ferguson, president and CEO of Saint Thomas Rutherford Hospital and president of Saint Thomas Regional Hospitals. “As orthopedic leaders in Middle Tennessee, TOA physicians consistently strive to provide the highest quality care to our patients. We view this collaborative effort with BlueCross and Saint Thomas Health as an innovative approach to continue that quality of care in a cost-effective, convenient and safe manner that best serves our patients throughout our serDr. Dan Phillips vice area,” said orthopaedic surgeon and TOA Board President Dan Phillips, MD.

Keeping Patients on the Move Physicians Specializing in: • Upper and Lower Extremity • Robotic-Assisted Surgery • Regenerative Medicine

• Joint Replacement or Resurfacing • Sports Medicine & General Orthopaedics • Spine & Trauma

Easy Referrals, Convenient Patient Locations: Dickson • Hendersonville • Hermitage • Lebanon Nashville (3 Locations) • Smyrna

8

>

SEPTEMBER 2018

When Experience Matters Referrals: 888-366-8894 hughston.com/tn

Playing it Safe, continued from page 4

Two of the key metrics being studied were any reduction in injuries and time lost from competition and practice. “A third thing we wanted to see is if we were able to reduce the medical cost associated with these injuries,” Bower noted. During last year’s season, there was one ACL contact injury. “We did not see any non-contact ACL injuries,” said Bower. “As far as lower extremity injuries, we saw a 50 percent decline. As for the amount of time loss from these injuries compared to previous years, it was 40 percent less, and there was almost a 40 percent reduction in medical costs.” While the data collected to date bears out what Nessler envisioned when he developed the program, there are more questions to be answered. Bower said the goal is to enroll another 100-120 athletes at the Division I level. “The soccer study is still ongoing. We want to collect long-term data. The second cohort of the Play-It-Safe protocol was just implemented,” he said. “In 2018, movement testing was done for women’s volleyball, women’s basketball, and men’s basketball,” Bower added of additional baseline assessments at Samford. In addition to long-term ACL outcomes, Bower said a future goal is to ascertain whether or not an assessment score is predictive of on-field performance or if there is a correlation to risk for injury.

Regenerative Medicine in Orthopaedics, continued from page 7

is a protein derived from a patient’s own blood. Platelets contain special substances called growth factors that play a critical role in the body’s natural healing processes, stimulating the repair and replacement of damaged tissues with new, healthy tissue. Because PRP comes from an individual’s own blood, there’s not a risk of rejection or allergic reaction. While outcomes speak for themselves, Anderson said the relative newness of regenerative medicine, or orthobiologics, is still causing trouble. “There’s no consensus on terminology or the definition of stem cells, and they tend to the lumped into the same category as PRP,” he explained. “In reality, most ‘stem cell’ treatments are better defined as ‘cell concentrates,’ which unfortunately only contain small fractions of actual stem cells.” To that end, the American Academy of Orthopaedic Surgeons has assembled a task force to better define terminology used in regenerative medicine. Regardless of their findings, all three surgeons agree that the field is completely changing the trajectory of orthopaedics. “Regenerative medicine has opened up a whole area of medicine totally unavailable before and has so much potential to cure diseases like arthritis,” Anderson said. “Researches spend billions a year looking for cures, and hopefully regenerative medicine can move us closer to that goal.” nashvillemedicalnews

.com


HEALTHCARE ENTERPRISE

Fighting the Good Fight

Fortified Health Security Arming Healthcare Systems in the Cybersecurity War By MELANIE KILGORE-HILL

If the thought of a cybersecurity breach to your bank is terrifying, imagine the fallout for a healthcare organization tasked with protecting the financial, personal and medical information of millions of patients. Cyber attacks can make or break a health system, shaking the confidence of patients and providers. That’s where Fortified Health Security comes in. Founded in 2009, the Franklin-based company is quickly becoming an industry leader, partnering with more than 100 health systems and hundreds of hospitals in 35 states.

The New War in Healthcare

“Cybersecurity is a battle, and it’s one that requires continuous engagement,” said Dan Dodson, president of Fortified Health Security. “Our healthcare clients need a partner that understands healthcare and cybersecurity, because there’s a uniqueness in healthcare that other industries don’t face.” Dan Dodson Dodson said a common misconception among healthcare executives is the perceived and actual value of their security program. Every day, a healthcare system gets hacked. Once detected, administrators typically drop big money on exceptionally pricey technology aimed at preventing future attacks. Problem is, it’s rarely used to its full potential. “Oftentimes, the technology is so advanced that no one really knows how to run it,” Dodson explained. “The perceived value of that investment and actual value is astronomically different, and that’s a gap we have to bridge.” He encourages executives to stop thinking about the next shiny box and instead make sure their investment in security technology is being maximized. Fortified staff members work with an organization’s existing technology to maximize results and walk alongside IT staff to provide training and ongoing support. “We’re an extension of the security team, as our role is to make sure people are leveraging expertise and best practices, and making sure the person on the ground is informed and making the best decisions for the healthcare organization,” he said.

Industry Challenges

When it comes to securing healthcare systems, complications can arise from a number of natural restraints. In any other industry, systems might be shut down briefly for updates. In a 24/7 hospital, temporary shutdowns can impact patient care and disrupt operations. Dodson said that not understanding how to manage temporary halts to clinical workflow creates a serious challenge for many big box security companies. nashvillemedicalnews

.com

Staffing poses an additional challenge, as healthcare companies compete to attract, train and retain IT talent. Dodson estimated 20 to 50 percent of a hospital’s IT staff are using the position as a career stepping stone, while the rest are in it for the long haul. Fortified works with IT leaders to train and increase retention rates among IT personnel. Another obstacle is the evolving dynamic among the physician, healthcare organization and patient. That’s because today’s patient-as-a-consumer model demands complete access to online health information. Likewise, physicians now access patient data on all their own devices – a tremendous cybersecurity concern that Fortified has worked to successfully tackle. The company recently won awards for addressing the unique technical challenges associated with securing medical devices, which requires technology, people and processes unique to healthcare. Outsourced billing – not often found under the same security umbrella – creates yet another threat. “As an administrator, you don’t want to restrict your physicians and mess with their workflow because they can go somewhere else, as can your fee-for-service patients,” said Dodson. “You have to understand how to make changes technically but also transform the organization’s culture through new processes.”

Cause & Effect

For many companies, that lesson is learned too late. Data shows hospitals that go public after compromising patient information in a data breach can lose up to 40 percent of their patients – a trickle-down effect impacting physicians, as well. That’s because today’s patient has a choice in where he or she receives surgery, radiology and imaging services – the moneymakers for most health systems. “Executives have to ask, can I afford a 40 percent drop in patient choice for high revenue and profitability areas?” Dodson asked. “Most can’t even afford a three percent drop.”

Services Office for Civil Rights (OCR), this has been the case since 2009. The OCR Wall of Shame highlighted that in the first week of 2018, there were four major breaches containing more than 500 patient records. This is the same number of breaches reported in the first week of 2017, but the momentum has increased from there. Through the first five months of 2018, there have been 149 breaches reported with over 2.8 million patients impacted, as compared to 134 breaches impacting 2.0 million patients during the same period in 2017. This represents an 11 percent increase in the number of entities impacted by a breach and a 35 percent increase in the number of individuals affected. While provider organizations appear to have been more heavily targeted so far in 2018, that doesn’t’ mean health plans have been left alone. Through May of 2018, health plans reported 24 breaches versus 15 in the same time period last year. Similarly, business associates reported 12 breaches in the first five months compared to seven breaches during the same time period in 2017. The report also addresses benefits and critiques of the FDA’s Medical Device Safety Plan, as well as the National Institute

of Standards and Technology’s Version 1.1 of its Cybersecurity Framework. Both plans were released in April. (A link to the downloadable Fortified Health Security mid-yeaer report is available online at NashvilleMedicalNews.com.) Dodson co-authored the mid-year report and noted email continues to be a key launching point for attacks. “The sophistication of attackers is unbelievable, because they can outsmart technology and rules to make themselves look like the organization,” he said. “For health systems, it’s a difficult challenge to keep up with it all, as you’re always working to educate employees as well as patients.”

A New Way of Thinking

Dodson regularly hears from frustrated chief information officers that administrators simply don’t understand cybersecurity risks … or why throwing high-dollar technology at the problem won’t solve it. He challenges administrators to consider how management of cybersecurity risks is interwoven into every hospital initiative. “They need to start managing cybersecurity risks no different than they would clinical risks,” he said. “It takes proactive measures, and administrators need to look at the issue holistically.”

RISK ASSURANCE & ADVISORY SERVICES Our goal is protecting yours

Network & Cyber Security Coding/Compliance Audit HIPAA, HITECH & HITRUST IT Audit Internal Audit SOX Compliance SOC Examination

Mid-Year Horizon Report

For hospitals, it’s not about if a breach will occur, but when. Fortified Health Security recently released their Mid-Year Horizon Report, which examines the state of cybersecurity in healthcare. According to their findings, “2018 has seen attack momentum increase and new hacking groups formalize with greater sophistication and focus than ever before.” A key finding was that provider organizations have been compromised more in 2018 than health plans. It also found that most healthcare organizations aren’t allocating enough capital to keep up with the attackers, given tight budgets, competing internal priorities and overall financial pressures. The report states that, “According to the U.S. Department of Health and Human

Healthcare Services

Lucy Carter

Scott Mertie

Gina Pruitt

ZZZNUDIWKHDOWKFDUHFRP‡ SEPTEMBER 2018

>

9


Change in Mindset Necessary for Stronger Information Security in Healthcare by

Mark Fulford, LBMC Shareholder

Compliance is king, but that’s not how it should be. Since the introduction of HIPAA in 1996, the healthcare field has centered data privacy and security efforts around compliance. If all the boxes were checked and organizations received a passing compliance report, everything was “all good.” The problem is, this led healthcare organizations to the false belief that as long as they’re compliant with the HIPAA rules, their systems are secure. Unfortunately, as we generally know today, that’s not true. This perspective can be problematic in any field, but it’s especially damaging in the healthcare industry. Here’s why: The HIPAA Security Rule became mandatory for use by providers, payers, and clearinghouses in 2005, and even with the additional features of the HITECH Act and the more recent HIPAA Omnibus Rule, the actual HIPAA requirements around security have not changed much. For perspective, the first iPhone wasn’t released until 2007. If companies are basing their security posture on a framework that’s 13 years old, it shouldn’t be a surprise that those organizations … while compliant … might not be secure. “It’s time now to really begin to pay more attention to our security programs holistically instead of being so compliancefocused,” said Mark Johnson, shareholder at LBMC and leader of the healthcare security practice. Johnson underscored the fact that companies shouldn’t Mark Johnson ignore compliance wholesale but should focus their efforts on the threats their organizations are truly facing — not the checkboxes that come with a HIPAA audit. But, as many are already aware, this is certainly easier said than done for many organizations. “Security is one of those things that you’re never done with. It’s not a project that you can say, ‘Okay, we’ve reviewed our security plans and procedures, and we’ve implemented this technology, and we’re good,” noted Johnson. Beyond that, it also can be difficult to get a board to see the importance of cybersecurity, because there’s no clear ROI. However, according to Johnson, boards are asking the wrong questions if they’re looking for the ROI on information security. Johnson said he believes organizations need to stop asking, “What’s the return on our investments in our cybersecurity efforts?” and start asking, “How much are we avoiding losing with our cybersecurity efforts?” This is especially true as healthcare reimbursement systems trend toward outcome-based reimbursement, meaning 10

>

SEPTEMBER 2018

quality of care, patient satisfaction, readmission rates, and other metrics are playing a larger role into how providers are reimbursed. In these circumstances, with healthcare’s ever increasing reliance on technology to deliver, monitor, and document care, systems availability and data integrity are more important than ever to bottom lines in the healthcare ecosystem. Information security, in this context, goes well beyond the historical focus on maintaining confidentiality to protect patient privacy. So, what can be done? How should a healthcare company responsibly handle information security? It starts with a change in mindset. Compliance can no longer be king. Instead, healthcare companies must adopt information security as their new ruling principle. As a benefit, aiming for security will likely lead to compliance, whereas the opposite is not always true, as discussed above. Regardless of the level of sophistication, most (if not all) information security programs start at the same place – awareness. Organizations must know what their threats are. They must know where their assets are, and they must also know the vulnerabilities associated with those assets. After that, they should develop a plan to close those vulnerabilities and educate users on threats. The problem is that developing and maintaining a robust information security program requires vigilance, and, per Johnson, “Most small and medium-sized organizations just don’t have the resources to do that internally.” Because of this, Johnson added, “We’ve seen an increase in people thinking about outsourcing cybersecurity now.” If considering this avenue, it’s important to be aware that outsourcing IT is not the same as outsourcing cybersecurity. While an outsourced IT team (commonly referred to as an MSP – managed service provider) typically makes sure systems are running appropriately and that they’re patched regularly, they might not be con-

tracted … or have the expertise and experience … to monitor those systems or ensure their security in an ongoing manner. If looking for that level of service, consider an MSSP (managed security services provider). These types of vendors focus on security and can provide a higher level of assurance for information security programs. “Many organizations are doing better work around security now than they used to, but there’s still a lot of room for improvement,” said Johnson. When looking for a place to start improving company-wide awareness of the security program, a risk assessment is the perfect starting point. It will help identify some of the most important items mentioned above (i.e. threats, assets and vulnerabilities). Beyond that, it will help in the development of an action plan to address those risks and better secure all data. Effective risk assessments are based on strong methodologies, like NIST, FAIR, or OCTAVE. But, even with these methodologies, the process can be complicated. So, what answers should directors and owners of healthcare businesses be seeking related to their organization’s security? Here are few suggestions: • Who in the organization is actually tasked with making sure our systems are secure and that we are complying with the relevant regulatory requirements? If you can’t name the individual or organization with this responsibility, that should be remedied. If it’s not being actively managed, it’s probably not being done. • Do we know at all times where protected data “lives” in our organization? If there is any hesitation in answering this question, it probably points to a problem with asset management. The issue here is, if we don’t know which systems hold our crown jewels, there is a chance some of those systems are going unprotected — and, by the way, it also means you are not compliant with HIPAA. • Have we done a risk assessment in the last 12 months that considers the nature of our organization, the things that

can go wrong, and what we are doing about those things? If you are only checking the box on the HIPAA security rule requirements, you probably haven’t done a risk assessment that will be truly beneficial. For example, how are we prepared for something like ransomware? How are we protecting ourselves, and what will we do if we fall victim? • How are we doing with keeping our systems and the applications that run on them updated with the latest patches to keep them from being successfully attacked? This is a critical function that often goes undone if no one is minding the store. A vulnerability management program is absolutely key to protecting your systems. • How easy would it be for someone to break in to our systems from the outside or from the inside through social engineering activities like phishing? This is where it can pay to contract with an experienced company for a penetration test. It’s much better and less expensive for you to proactively discover those holes in your defenses than learn about them after a data breach that potentially leads to investigations or fines and penalties. • How are we monitoring our systems on a daily basis to ensure we catch bad actors before they can do serious damage? This is very hard for smaller organizations, as the bad guys never sleep. This is a perfect example of something many healthcare companies are choosing to outsource to firms who can provide aroundthe-clock vigilance. This is, by no means, an exhaustive description of everything healthcare companies and practices need to consider about their security program. Other topics include policies, disaster recovery, incident response, awareness and training, along with numerous other important facets. However, seeking answers to the questions above is a fantastic starting place. Then, the first step towards improvement must be a change in mindset. It’s time for healthcare companies to aim for security and accomplish compliance along the way, instead of the other way around. Mark Fulford, CISSP, CISA, CCSFP, HITRUST, is an LBMC shareholder in the Risk Services Division with nearly 25 years of experience in information technology, audit and security. LBMC Information Security’s team includes a diverse group of experienced professionals that help healthcare companies protect their systems and meet compliance obligations. LBMC is also the creator of the BALLAST automated risk management application, used by hundreds of organizations to identify, track, and remediate security risks. For more information, email mfulford@ lbmc.com or go online to lbmcinformationsecurity.com.

nashvillemedicalnews

.com


BYOK: Bring Your Own Key

Change Healthcare Rolls Out Kill Switch Technology Despite all the training, despite the warnings, breaches of security still happen, and data can be quickly compromised. Change Healthcare hopes to put the power in clients’ hands when every minute matters. The Nashville-based company announced a big breakthrough in the health security landscape this summer, bringing “kill switch” and “Bring Your Own Key” (BYOK) technology to users to quickly respond to internal and external data compromise. Using the Microsoft Azure cloud, the technology gives payers, physicians, hospitals and health systems full security control and allows them to rapidly respond to active threats. Considering the number of healthcare hacks reported each year, having the equivalent of a ‘panic button’ to lock systems down in the face of a cyberattack is an appealing option. “Hospitals, payers, and providers are under constant attack from a global network of cybercriminals using advanced and evasive techniques to penetrate networks, steal data, extort healthcare organizations, and capitalize on the personal health information of patients,” said Haddon Bennett, chief information security officer at Change Healthcare. “It is of paramount importance that sensitive data be protected by proper encryption that is fully controlled by the payer or provider, so they can mitigate both insider and external threats on their own terms. This is a significant advancement that reduces the risk profile for all healthcare stakeholders, including health plan members and patients.” Change Healthcare Security Management, now part of the HealthQx® analytics suite, includes BYOK service to provide this added security level. While the HealthQx suite’s main function is to collect, analyze, and report claims data and other information to help healthcare stakeholders with their value-based care programs, the security feature gives payers and providers granular control over their cybersecurity profile. Customers using HealthQx can make security changes without having to involve Change Healthcare staff and have their cloud-based systems re-encrypted and operational without service interruption. Prior to this rollout, cloud encryption keys in healthcare have traditionally been the responsibility of solution vendors to manage. Providers and payers had to contact their vendors to respond to requirements large and small, including routine key updates, revocation of employee clearances, perceived threats, or actual attacks and breaches. This approach could take valuable time, which in turn

NASHVILLEMEDICALNEWS

.COM

could have a major impact in keeping data secure in the face of a threat. The new BYOK capability lets payers and providers create, update, or revoke encryption keys on demand, enabling rapid responses when potential or active threats to sensitive data in the cloud are anticipated or encountered. Payers and providers can invoke a virtual “kill switch” that instantly stops access to protected data and services and can then re-enable access within minutes using a new encryption key — effectively stonewalling active threats. To deploy the virtual kill switch, two authorized operators within the healthcare entity must issue a revocation order, which then locks the system down. “Transparent data encryption with Bring Your Own Key capabilities helps organizations better protect sensitive data and meet regulatory and industry-specific compliance obligations which require specific key management controls,” said Lindsey Allen, partner group program manager for Azure SQL Database R&D at Microsoft. “We integrated this technology in Azure SQL Database so that we could help ensure that the sensitive data of users was protected in a compliant manner.”

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website.

NEW IN SEPTEMBER: George Buck, president emeritus, and Judd Peak, chief compliance officer and general counsel, with Frost-Arnett Company, take a vendor’s perspective to drill down on “Laws and Regulations Continue to Affect Patient Pay: The Fair Debt Collection Practices Act.” In part two of this sixpart series, the authors look at the tangled network of federal and state interpretations of the 1977 federal FDCPA, which leaves the accounts receivable management industry in a continual posture of navigating, monitoring and updating compliance programs. Larry McClain, healthcare writer and Nashville Medical News contributor, provides a wrap-up of the recent Health:Further conference. He shares insights from a number of presenters at this year’s event, which brought together healthcare innovators and thought leaders from across the country. Brian Tolbert, practice leader for Bernard Health Benefits, shares highlights from the company’s recent 8th Annual Health Reform Luncheon, which looked at ways to get more transparency and better control over healthcare costs. Lawrence Weinstein, MD, ABHM, chief medical officer for American Addiction Centers, looks at “The Stages of Relapse” during National Recovery Month. Even when treatment is effective, relapse is often a part of the recovery process. Weinstein discusses the stages of mental and emotional relapse individuals often go through before physically relapsing and shares warning signs and preventative tactics to help those in recovery.

Join over 4,000 Ascension healthcare providers now practicing with Certitude.

Certitude coverage delivers: • Risk resources to help you manage your practice, enhance patient safety, and save money • Flexible payment options to fit your needs • Certitude peer input for difficult claims and underwriting issues • Unified claims approach that helps you protect your important identity • Enhanced coverage for today’s ever-changing medical environment

For more information on Certitude, call ProAssurance at 800.282.6242 or visit CertitudebyAscension.org.

SEPTEMBER 2018

>

11


NMGMATen Minute Takeaway

Insights from an OIG Agent By CINDY SANDERS

The second Tuesday of each month, practice managers and healthcare industry service providers gather for the monthly Nashville Medical Group Management Association (NMGMA) meeting at Saint Thomas West Hospital. During the August luncheon, Tony Maffei, a special agent for the Office of the Inspector General (OIG) with the Department of Health and Human Services (HHS), offered insights into the types of healthcare investigations undertaken, case origination, and recent trends in OIG enforcement efforts. Although Maffei is based in Middle Tennessee, he pursues cases throughout the state and across the nation. He started his talk by noting the OIG, a statutorily created independent entity within the Department of Justice (DOJ), is the watchdog for various federal agencies and divisions. The OIG’s job is to detect and deter waste, fraud, abuse and misconduct. Assigned to HHS, which has a $1.2 trillion budget with upwards of 85 percent assigned to Medicare and Medicaid, Maffei said the majority of his job was to protect those dollars from being misused. Before continuing, he noted his comments were based on his 16 years of field experience, rather than being an official OIG statement or policy. With the disclaimer out of the way, Maffei embarked on ‘Current Trends in Healthcare Fraud’ … or, as he continued with a laugh, “The alternative title is ‘Ways to See Me and My Friends Again,’ and you know y’all don’t want to see us.” Maffei added there is a big difference in making mistakes in billing and coding and actually committing fraud. “You don’t just accidentally commit fraud,” he pointed out. “Fraud is a matter of criminal intent.” While mistakes are often resolved with civil monetary penalties, fraud can result in both criminal and civil actions.

Types of Cases

Maffei said most cases fall into two categories – billing fraud and relationship fraud. The former includes billing for services not provided or upcoding to unlawfully enhance reimbursement. Relationship fraud ties into abuses of the federal AntiKickback Statute and Stark Law. “A common podiatry scheme is to bill for nail avulsions but only provide routine foot care,” he said of an example of upcoding. A nail avulsion is the excision of the body of the nail plate from its primary attachment. “A nail avulsion doesn’t take a lot of time, but there’s going to be a local (anesthetic) and probably wound orders,” he explained. A slew of avulsion claims is a red flag for agents. Ascertaining whether or not a provider has been fraudulently billing for the service is often as simple as speaking to patients. “If you get a nail avulsion, you 12

>

SEPTEMBER 2018

know it,” Maffei pointed out wryly. By its nature, relationship fraud involves multiple parties. This past spring, for example, two Tennessee healthcare executives were charged in an indictment for their alleged participation in a $4.6 million Medicare kickback scheme involving durable medical equipment (see Medicare Fraud Strike Force – oig.hhs.gov/fraud/ strike-force). Since those original charges in April, the DME company owner also has been indicted in another alleged kickback scheme involving four healthcare executives in East Tennessee.

Case Origination

Fraud cases originate from both within the OIG and from outside sources. “We have a 1-800-Medicare/Medicaid hotline that rings all the time in D.C.,” Maffei said. He added that whistleblowers (qui tam cases) account for a lot of the large settlements often covered by news outlets. However, he continued, the OIG also engages in proactive data analysis, which can raise red flags. Pointing to a recent settlement, the integrity auditors identified an aberrant biller of physical therapy services in East Tennessee who used a KX modifier 100 percent of the time. The modifier, which identifies a beneficiary as qualifying for medically necessary services in excess of the cap, has legitimate uses, but it’s unlikely that it would apply to every single patient walking through the doors. In fact, the national average of physical therapy services with the KX modifier is about 10 percent. When agents met with the therapist attached to the National Provider Identifier (NPI) on the claims, it turned out she hadn’t even worked for the company submitting those bills for two years. The company owner wound up paying in excess of $65,000 to settle the fraudulent claims and could have been charged with identity theft for using the NPI number of a former employee. Maffei said the OIG sees a lot of ambulance fraud settlements as a result of data mining and common sense. “If you’re an ambulance company, and you bill for a

lot of advanced life support (ALS) or basic life support (BLS) services, you better wind up at a hospital,” he said. “How can you go to a house, have the run end at the house, and bill for ALS?” he questioned.

Enforcement Trends

This summer, the OIG and enforcement partners at a federal and state level participated in the largest healthcare fraud takedown in history. In June, more than 600 defendants in 58 federal districts were charged with participating in fraud schemes totaling about $2 billion in losses to Medicare and Medicaid. Maffei noted they have seen an uptick in urine drug testing and toxicology cases, which he said is partly a byproduct of the opioid epidemic and increase in pain management physicians. In addition to ordering unnecessary tests, agents have seen kickbacks in the form of IT equipment, medical directorships, leases, processing fees, golf clubs and other personal items. “Kickbacks don’t have to be an envelope of cash under the table,” he noted. The opioid crisis has given rise to a new DOJ Opioid Fraud and Abuse Detection Unit. “The OIG response has been to identify and hold accountable those engaged in fraud … those prescribing opioids outside the scope of medical practice and without medical purpose. You are a drug dealer,” Maffei said unequivocally about those who profit from improper prescribing. A series of high profile, high dollar settlements over the past few years has highlighted the broad temptation to overbill or collude to cheat the federal government. “When you are treating the beneficiary not as a patient but as a revenue means, you can lose focus, I think,” said Maffei. When that happens, special agents come knocking. Although many cases never rise to the level of criminal activity, those that do typically wind up with the OIG and DOJ on the winning end. “Our batting average is pretty good … 95 percent,” Maffei said. “If we’re going to indict you and press charges, then we’ve got you.”

Don’t Miss This Month’s Meeting September Features National MGMA Chair Mark the calendar for Tuesday, Sept. 11 when Yvette Doran, MBA, FACMPE, board chair for the national MGMA organization, is the featured speaker. Doran, who is president & CEO of Saint Thomas Medical Partners, will discuss updates and issues impacting medical practices from the national perspective. The event is scheduled for 11:30 am-1 pm at Saint Thomas West in the hospital conference center. Free parking is available in the Seton Garage. Members should register Yvette Doran online at nashvillemgma.org. Non-member practice managers and professionals interested in attending should email NMGMA President Joy Testa at website@nashvillemgma.org.

Mark Your Calendars Third Annual ACHEMT Golf Outing • Sept. 21 • Two Rivers Golf Club The American College of Healthcare Executives of Middle Tennessee is hosting its annual golf event featuring an 18-hold scramble and ‘closest to the pin’ challenge. This year’s event benefits The Trap Garden. For questions or to ask about sponsorship opportunities, call Cissy Mangrum at 615.397.5042, Caroline Burris at 615.238.1379, or email info@achemt.org. To register, go online to achemt.org and click on the events tab.

Matthew Walker EPIC Gala • Sept. 22 • The Mansion at Fontanel Entertainment • Philanthropy • Involvement • Community – Enjoy an EPIC gala featuring three live music genres with complementary menus in support of Matthew Walker Comprehensive Health Center. Tickets are $150 and available online at bit.ly/ mwchcEPIC.

Neighborhood Café 2018 • Sept. 27 • Janet Ayers Academic Center at Belmont University Marking its 42nd year of service in Middle Tennessee, Neighborhood Health is hosting the organization’s annual fundraising breakfast event featuring Meharry Medical College President and CEO James E.K. Hildreth, MD, as the featured speaker. The event runs from 7-8:30 am. To register, go online to NeighborhoodHealthTN.org.

Faith Family 10th Annual Birthday Breakfast • Oct. 3 • Woodmont Christian Church Join staff and nearly 500 guests for a 7:00 a.m. fundraising breakfast to celebrate Faith Family Medical Center’s birthday and to support the nonprofit clinic’s mission to serve the uninsured and under-insured in our community. RSVP deadline is Sept. 19. Go online to FaithMedical.org/Support-Faith-Family/Events.

TSU Scholarship Gala • Oct. 19 • Music City Center Tennessee State University is hosting a gala dinner event to support the TSU Foundation, which awards scholarships to students across the university’s programming, including the large College of Health Sciences. Tickets are $150 per person with a reception a 6 pm followed by dinner and programming. For details or to purchase tickets, go online to tnstate.edu/gala.

nashvillemedicalnews

.com


Serving Those Who Serve Centerstone Opens New Clinic, Names Military Director Governor Bill Haslam was on hand along with other officials last month for the official grand opening of the new Steven A. Cohen Military Family Clinic at Centerstone. Located in Clarksville, the center seeks to be a resource for veterans and families in a post-9/11 world. “Clarksville is home to one of the largest populations of retired military in the country,” said Lisa Eggebeen, MSSW, LCSW, clinic director for the Cohen Clinic at Centerstone. “The need for mental healthcare services in this region and among this population is great, and this clinic will be an incredible resource for the community. We are pleased that we can provide timely and compassionate care that changes people’s lives for the better.” The new 10,000-square-foot facility offers outpatient treatment for post-traumatic stress, depression, anxiety, adjustment and transition issues, relationship issues, children’s behavioral issues, anger, grief and loss. The clinic provides behavioral health and case management services for veterans, regardless of their discharge status or role. Additionally, services are available to veterans’ families and to the families of active duty military including spouses, children, parents, siblings or caregivers without regard to ability to pay. The staff of the Cohen Clinic at Centerstone has been trained in military competencies to meet the unique challenges of the armed services community and their families. Currently, the clinic has four full-time therapists but has pledged to add staff as needed to meet demand and see patients in a timely manner. While the ribbon cutting ceremony

GRAND ROUNDS OVME Launches Local Medical Aesthetics Studio, Names Lead Provider

Atlanta-based retail medical aesthetics boutique OVME (pronounced “of me”) has announced the company plans to launch its first minimally invasive cosmetic services studio in Nashville this November at the Hill Center. Founded by S. Mark McKenna, MD, MBA, and backed by Equity38, OVME offers services including neurotoxins, dermal fillers, microneedling, hydration therapy, weight management, body services, and men’s services including testosterone replacement therapy and PRP for hair loss. Additionally, OVME has announced Advanced Aesthetics Nurse Amber Cruth, RN, as lead aesthetic provider for the new Nashville location. Cruth has over 13 years experience with injectables, fillers, lasers and aesthetic medicine. Amber Cruth “Amber brings a nashvillemedicalnews

.com

JOSH VAUGHN PHOTOGRAPHY

By CINDY SANDERS

Gov. Bill Haslam (center) joined a number of other dignitaries to mark the grand opening of the Steven A. Cohen Military Family Clinic at Centerstone. The Clarksville clinic will serve as a new behavioral health resource for veterans and loved ones.

was in August, the clinic began seeing patients earlier this spring and has already worked with more than 200 service members and their families. New clients are given an intake screen when they initially contact the clinic and should expect their first appointment within a week. The clinic is a partnership between national behavioral healthcare provider Centerstone and the Cohen Veterans Network (CVN), a not-for-profit organization serving veterans and their families through a nationwide system of mental health clinics. CVN, which was established in 2016 with a $275 million commitment from philanthropist Steven A. Cohen, has now funded 10 clinics across the nation with this being the first in Tennessee. “We’re honored Cohen Veterans

Network selected Centerstone for this partnership,” said Bob Vero, EdD, CEO of Centerstone. “Our organizations share a commitment to providing specialized care to veterans, service members and their loved ones. This clinic expands the ways Centerstone serves military families, and we look forward to working with the Cohen team to continue to explore how we can leverage our resources and expertise to reach more people in need.” Centerstone also announced a new executive director for Military Services in August. Jodie Robison, PhD, LPC-MHSP, NCC was tapped to fill the position previously held by Col. (Ret) Kent Crossley, who is retiring this month. Robison has more than 18 years of behavioral health and management experience. She will

wealth of experience and leadership, along with a passion for what she does. We’re confident that she is not only the best fit for Nashville but also a valuable resources as we grow nationally,” said McKenna, who also noted expansion to Nashville is the beginning of a national rollout for the company.

served as senior vice president of medical affairs for Catasys, Inc. in California, The announcement of Weinstein’s new role coincided with the news that AAC’s previous national medical director, Mark Calarco, DO, had been promoted to national medical director for clinical diagnostics. In this role, Calarco will work closely with Addiction Labs to conduct medical and laboratory research, as well as develop innovative products and services that will improve patient outcomes.

AAC Names CMO

Brentwood-headquartered American Addiction Centers (AAC), a national provider of inpatient and outpatient substance abuse treatment services, recently announced the appointed of Lawrence M. Weinstein, MD, ABHM, as its new chief medical officer. Weinstein began his new role in midAugust overseeing Dr. Lawrence M. Weinstein medical operations and supervising medical staff for all AAC facilities. He brings more than 20 years’ experience in psychiatry, addiction and managed care to his new role. Weinstein most recently served as CMO at Humana Behavioral Health, a position he held since 2011. Prior to that, he

TriStar Skyline Names New CNO

TriStar Skyline Medical Center has appointed Chris Staigl, MSN, RN, as its chief nursing officer. In her new role, Staigl is responsible for leading the nursing team at both TriStar Skyline and TriStar Skyline Madison.  Staigl, who has more than 16 years of Chris Staigl healthcare nursing leadership experience within HCA hospitals, holds a master’s in Nursing Leadership/ Management and an undergraduate

oversee Centerstone’s military-related services, programming, operations, business development and fundraising activities from the behavioral health organization’s Nashville headquarDr. Jodie Robison ters. Before her new appointment, Robison served as the lead clinician for the Cohen Family Clinic at Centerstone and prior to that as director of clinical services for Centerstone’s Military Services. Robison first joined Centerstone in 2007 as a behavioral health worker in Pediatric Integrated Care before establishing her own private behavioral health practice in 2012. Active in the military community, she is both a military spouse and parent. Professionally, she has collaborated with numerous military-related organizations throughout her career. “My entire life has been around the military, and I’ve made it my mission to serve those who’ve been willing to sacrifice so much for me and my family,” said Robison. “I’m committed to helping provide our service members and their loved ones with the support and services they need to lead the most fulfilling lives possible.” Robison received her master’s in counseling and personnel services from the University of Maryland and her doctoral degree in human services, social and community services from Capella University. She is a member of the American Counseling Association, American Mental Health Counseling Association and Tennessee Licensed Professional Counselors Association. degree in Nursing from Western Governors University, Utah. She is also a graduate of the HCA CNO Development Program.

TriStar Centennial Welcomes Gilmore

Last month, TriStar Centennial Medical Center welcomed thoracic surgeon, Denis M. Gilmore, MD, to its medical staff. Gilmore specializes in the treatment of lung cancer, lung disease, lung nodules, esophageal disease, mediastinal adenopaDr. Denis M. Gilmore thy and pleural effusion. He attended medical school at Royal College of Surgeons in Dublin, Ireland and completed his general surgery residency at Beth Israel Deaconess Medical Center in Boston. While in Boston, Gilmore completed a clinical fellowship in thoracic surgery at Brigham and Women’s Hospital and research fellowship at Harvard Medical School. He continued his training by completing a cardiothoracic surgery fellowship at Vanderbilt University Medical Center. SEPTEMBER 2018

>

13


GRAND ROUNDS HCA TriStar Division Welcome New CFO

HCA’s TriStar Division recently announced Wes Fountain as the healthcare division’s new chief financial officer (CFO). A 25-year HCA Healthcare veteran, Fountain joins HCA’s TriStar Division after many years serving as CFO with healthcare facilities in both Texas Wes Fountain and Florida, most recently with Methodist Healthcare System in San Antonio, Texas. He earned his undergraduate degree in accounting from the University of West Florida and an MBA from Auburn University.  

Nashville Lung Surgery Debuts Latest Robotic System

Nashville Lung Surgery, part of AdvancedHEALTH, Middle Tennessee’s largest, independent, multi-specialty practice, recently announced the practice is continuing to build its Thoracic Robotics program and is now using the latest da Vinci Xi Robotic system at Saint Thomas West Hospital. “This minimally-invasive technology allows us to perform complex procedures with less recovery time, pain and surgical trauma for our patients,” said Nashville Lung Surgery’s Mathew Ninan, MD. With the da Vinci Xi Robot, Nashville Lung Surgery is able to perform advanced thoracic robotic procedures, including: lung resections for lung cancer; mediastinal and chest wall lesion removal; foregut surgery, such as robotic laparoscopic hiatal hernia repairs and

anti-reflux procedures, like the Linx magnet procedure. With continued growth of the robotics program, the practice will be performing esophagectomy with a total port access approach.

Centerstone Adds Norton, Reid to Key Positions

National not-for-profit behavioral health provider Centerstone has recently made two significant additions to its staff. Kevin Norton has been tapped to take on the role of chief operating officer, effective Sept. 1, as long-time COO Barry Hale retires. Norton has 25 years of experience in behavioral health, having begun his career as a therapist. Most recently, he served as CEO for Kevin Norton Lahey Health Behavioral Services and in the same role for Northeast Behavioral Health, Inc. where he

led the integration of the organization into Lahey. He earned an undergraduate degree from SUNY at Fredonia, a Master of Science in Counseling Psychology from Salem State University in Massachusetts and his MBA from Suffolk University in Boston. He has served on a number of national boards. Johnel Reid joined the organization over the summer as vice president of public affairs and will oversee Centerstone’s marketing and communications efforts, along with strategic brand management. She has 15 years experience in healthcare communicaJohnel Reid tions and strategic planning with prior executive roles including stints with Franklin-based Community Health Systems and Nashville-based HCA. Reid earned her undergraduate degree from Longwood University in Virginia.

Image Surgical Arts to Launch Surgery Center

Image Surgical Arts (ISA) is set to open a cosmetic surgery center in Nashville. Founded and helmed by triple board-certified surgeon Brady Harris, MD, the center will exclusively offer high-definition liposuction. Other services will include laser skin rejuvenation with HALO, Forever Young BBL and Fractionated Erbium treatments, along with standard procedures such as breast augmentations and facelifts. The 6,000-square-foot- ISA office will be located on 21st Avenue South. Harris earned his medical degree from the University of Louisville School of Medicine before completing his cosmetic surgery fellowship at Southern Surgical Arts in Chattanooga. He is currently serving on the credentialing committee of the American Board of Facial Cosmetic Surgery and gives lectures internationally.

COMING IN DECEMBER

InCharge Healthcare 2019 Don’t miss your opportunity to advertise in this annual publication highlighting the decision-makers and leaders shaping Middle Tennessee’s healthcare industry. With a 12-month shelf life, advertising in InCharge is an important vehicle to share your message with Nashville Medical News’ highly targeted healthcare readership.

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 Gregg Knorn, Sales Director gknorn@nashvillemedicalnews.com Cindy Sanders Maggie Bond Pam Harris Jennifer Trsinar MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Mark Fulford, Melanie Kilgore-Hill Cindy Sanders CIRCULATION subscribe@nashvillemedicalnews.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— 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: subscribe@nashvillemedicalnews.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

For deadlines and pricing, contact Gregg Knorn at gknorn@ nashvillemedicalnews.com Cindy Sanders at csanders@ nashvillemedicalnews.com or call 615.397.2836

14

>

SEPTEMBER 2018

Expanded Grand Rounds Online NashvilleMedicalNews.com

nashvillemedicalnews

.com


GRAND ROUNDS Health Care Council Update

Nashville Health Care Council Fellows has published its first white paper – 2018 Year in Review, which shares key insights from the initiative’s most recent discussions. “The 2018 Year in Review advances the Council Fellows’ commitment to facilitating conversations about the challenges and the opportunities facing healthcare leaders throughout this country,” said former U.S. Senate Majority Leader Bill Frist, MD, co-chair of the Fellows program. “We’re proud to share these takeaways from our most recent class, in hopes of continuing the important discussions relevant to our field during this time of transformation and innovation.” The paper, is available at HealthCareCouncilFellows.com/2018-Review. In other news, two Council staff members have been recently promoted. David Greider has been named vice president of member services after previously serving as director of membership, and Maureen Iselin has been promoted to communications manager from communications coordinator.

New Senior Leadership at Saint Thomas Midtown & West

Last month, Saint Thomas Health announced key leadership positions for their two flagship Nashville hospitals. At Saint Thomas Midtown, Jeremy Gray has been named as chief operating officer. Most recently, Gray was COO at Chippenham Medical Center, a HCA affiliate in Richmond, Va. Prior to joining HCA, Gray held operational roles at CHS affiliate hospitals Jeremy Gray in Shelbyville and Jackson, Tenn. He earned his degree in physical therapy from the University of South Alabama and his master’s from the University of Alabama at Birmingham. Marco Marco Fernandez Fernandez has been named chief nursing officer. Fernandez has been with Saint Thomas since 1995, serving in a variety of leadership roles. He earned his master’s in nursing from Vanderbilt. At Saint Thomas Harrison Kiser West, Harrison Kiser has been named chief operating officer. Kiser previously served as COO for several hospitals within Northwest Health System in Arkansas, part of CHS. He Sam Straton earned his bachelor’s degree from the University of Memphis and his MBA in healthcare administration from Lipscomb University. Sam Straton has been named chief nursing officer. Straton joined Saint Thomas as the director of Cardiac Services in November 2016. Previously, the registered nurse served in various leadership roles at Jewish Hospital and the University of Louisville Hospital in Kentucky. nashvillemedicalnews

.com

With over $215 Million in dividends returned since inception, our record speaks for itself. At MagMutual, one of the leading providers of medical professional liability insurance, you are more than a policyholder – you’re a PolicyOwner . As an owner, SM

we believe you should benefit from your company’s success, which is why we strive to return as much as we can back to our PolicyOwners. Over 22,000 physicians and healthcare organizations are benefitting from MagMutual ownership, are you? Dividends

Owners Circle® Loyalty Rewards

UpToDate® Access

*Dividends and Owners Circle allocations are declared at the discretion of the MagMutual Board of Directors.

MagMutual.com

|

800-282-4882

SEPTEMBER 2018

>

15


YOUR

NEW DESTINATION FOR ADVAN C ED J O IN T R E P L AC EM ENT SURG ERY Patient Benefits:

Building upon a longstanding history of providing our patients with high-quality, outcome-driven orthopedic care, TriStar Centennial Medical Center is excited to introduce a new era in joint replacement surgery. Our new, state-of-theart TriStar Centennial Advanced Joint Replacement Institute is a “hospital within a hospital” and is uniquely designed to offer each individual patient a highly personalized treatment plan supported by the region’s top surgeons who specialize in the most advanced procedures and treatment options. The TriStar Centennial Advanced Joint Replacement Institute will greatly enhance the patient and provider experience, ensuring our specialists are further positioned to meet the growing joint replacement needs of patients throughout the region and beyond.

Learn more at TriStarCentennial.com

• Specialty-trained orthopedic physicians, nurses and therapists who are dedicated solely to the unique needs of the joint replacement patient • Hotel-like setting with a patient concierge, a large family waiting room with fireplace, private seating booths and a full-service coffee bar • Complimentary valet parking for patients and families

September 2018 NMN  

Nashville Medical News September 2018

September 2018 NMN  

Nashville Medical News September 2018