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FOCUS TOPICS ORTHOPAEDICS & SPORTS MEDICINE • PAIN MANAGEMENT & ADDICTION

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Patrice Harris, MD, MA

ON ROUNDS

Council Fellows: A Conversation with Hayley Hovious

Preparing to welcome the eighth class of Council Fellows, Nashville Health Care Council President Hayley Hovious recently shared insights with Nashville Medical News into what makes the intensive five-month program so special and so necessary ... 4

Fighting Fire with Fire The opioid epidemic crosses all demographic and geographic boundaries, but one common thread is intensity of use correlates to involvement in the criminal justice system. A Corizon Health MAT pilot in Philadelphia hopes to change the trajectory on relapse and recidivism ... 13

Grand Rounds

News from Middle Tennessee’s healthcare industry ... 17

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Head, Shoulders, Knees and Toes Orthopaedic Surgeons Shed Light on into Industry Changes, Improvements By MELANIE KILGORE-HILL

The catchy children’s song “Head, Shoulders, Knees and Toes” could also be an anthem for Middle Tennessee’s prolific orthopedic practice environment that offers specialized care from top to bottom. From providing cutting-edge care for professional athletes to watching out for weekend warriors, area orthopaedists utilize the latest techniques to get patients back in the game.

Innovation in Care

“The biggest innovation isn’t what’s being done in surgery but perioperatively around surgery, which is improving the continuum of

care,” said J. Craig Morrison, MD, orthopaedic surgeon at Southern Joint Replacement Institute (SJRI). That includes centralization of preparing patients medically and educationally long before surgery. “We want to make sure they’re aware of what they’re getting into and that they’re optimized for surgery in every way,” said Morrison, noting evolution of pain management options such as peripheral or spinal blocks rather than general anesthesia. In the face of a nationwide opioid epidemic, doctors also are adopting multi-modal pain regiments to attack post-surgical pain from a variety of angles while targeting different pain receptors. (CONTINUED ON PAGE 8)

The Faces of Opioid Addiction TDH Launches Campaign to Raise Awareness, Create Change By CINDY SANDERS

In mid-July, the Tennessee Department of Health launched a new awareness campaign that underscores the toll of the opioid crisis on every community throughout the state. The new “Tennessee Faces of the Opioid Crisis” tells personal stories and showcases the way addiction crosses all geographic, economic, racial, ethnic and religious boundaries. “We want to raise awareness about the impact of the opioid crisis on Tennesseans and demonstrate this issue affects people in every county and every community across our state. We wanted to literally put a ‘face’ on the crisis and show how it is impacting real people in Tennessee – our friends, families, (CONTINUED ON PAGE 15)

@NashMedNews

Cindy Reisz

ONLINE: NASHVILLE MEDICAL NEWS.COM

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The many faces of the TDH campaign include those who have struggled with addiction, family members, providers and community activists.

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PHYSICIAN SPOTLIGHT

Dr. Patrice Harris: First African American Woman to Lead Nation’s Oldest Medical Organization By SANDRA LONG WEAVER

When Patrice Harris, MD, MA, was growing up in rural West Virginia, she wanted to be a pediatrician. But there was no role model in her family who had been to medical school … no one to give advice on how to pursue a medical career … and women of color were not encouraged to pursue careers in the medical field. But she persisted. At first Harris looked at becoming a medical technician and then was steered by a counselor and her family toward a career in nursing. It was discouraging, she said. While nursing is a noble profession, it was not what she wanted. She earned her undergraduate in psychology and master’s degrees in counseling psychology from West Virginia University … and ultimately her medical degree in 1992. And in June, she was sworn in as the 174th president of the American Medical Association, the first African American woman to hold the position in the country’s oldest medical organization of physicians. “It’s a privilege to be the first,” Harris said during an interview at the 44th annual convention of the National Association of Black Journalists in Miami, Fla. “I consider the opportunity (to be president) to be evidence that women can aspire to leadership. You can be a physician, and you can be a leader. It is a big responsibility, and part of my job is to make sure I’m not the last.” Harris was also a panelist at the conference during a 90-minute session exploring health inequities. Access to healthcare is a major issue that the AMA is looking at, she said. “We want to get to equity, but you have to look at other issues as well to see how they are connected to the patient getting healthcare. We need to look at housing, transportation, and whether or not the neighborhood of the patient is a food desert.” She added, “We want people to have meaningful, affordable healthcare. We need to build on what we have. Ninety percent of people in this country are insured.” The AMA is also seeing an increasnashvillemedicalnews

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ing number of suicides in communities of color, Harris said. She works primarily with children up to ages 19, and bullying remains a huge issue. She said non-educational screen time needs to be limited for young people. In today’s world, when children make a mistake, everyone knows

about it, she pointed out, adding that can lead to major problems for children. Harris also discussed where the AMA stands on the opioid crisis and gun violence. “Mass shootings do not equate to mental illness,” she stated. “Hatred is not a mental illness.” And studies show people with mental health issues are more likely to be victims of violence rather than the perpetrators, she said. Harris also noted, science and data do not support that playing video games leads to mass shootings. The AMA recommends background checks and more research on gun violence and the effect on families and communities. Harris added, the Dickey amendment passed by Congress put a damper on funding research and said the CDC needs funding to learn more about what works regarding gun violence. The AMA also supports laws passed by several states allowing family members to temporarily remove guns from someone who may be at risk as a danger to themselves or others.

Harris is well known for her work on the opioid crisis. She chairs the AMA’s Opioid Task Force, which was established in 2014. During her year in office, she said she would like to amplify the work already occurring in that area. “Prescriptions have decreased, but deaths have increased. That is related to lethal doses of illicit fentanyl and heroin being in the marketplace,” she said. “We are laser-focused on treatment. We also need to increase treatment opportunities. The infrastructure needs funding, and we need to eliminate barriers to people getting treatment. “And insurers need to pay for on coverage,” she continued. “Treatment for opioid abuse should be on par with other diseases. In Pennsylvania, insurers have eliminated prior authorization for patients who need this therapy. Other states need to look at it, also.” Access to healthcare for those living in rural communities is also of great concern. “A larger segment of the population is uninsured for those living in rural areas. What helps now is having Medicaid. The hospital can be reimbursed,” she pointed out, although not every state expanded their Medicaid population under the Affordable Care Act. “Transportation can be an issue; telehealth can help but it has to be used appropriately.” In addition to spreading the word about the AMA’s work, Harris said she will be working to improve the health of the nation. She also wants to bring to

(CONTINUED ON PAGE 5)

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Council Fellows: A Conversation with Hayley Hovious By CINDY SANDERS

success. That’s not surprising, given the leadership involved, but it is very gratifying to see.

Preparing to welcome the eighth class of Council Fellows, Nashville Health Care Council President Hayley Hovious recently shared insights with Nashville Medical News into what makes the intensive five-month program so special and so necessary. A former director of Council Fellows, Hovious has a unique perspective on how the program has grown and evolved since the idea was first floated in 2012 to tackle some of the industry’s most complex issues.

NMN: Who is the ideal candidate to be a Council Fellow? Hayley: Council Fellows is a competitive program with well-defined criteria for consideration. Those criteria are: • Currently a C-suite or senior leader in their organization or poised The 28 newest Council Fellows from the Class of 2019 recently completed the six-month program. Who will be in the Class of 2020? to take on such a pivotal Applications open until Oct. 22, 2019. role. • Eager to define complex problems, identify solutions and ers from all of healthcare’s sectors to help unique collaborations and problem solving. effect change. develop solutions to the complex needs of Fellows have worked on projects together NMN: What was the impetus to • Open to learning more about and the U.S. healthcare system. and started new businesses based on their create Council Fellows? embracing innovation in healthcare. Since its inception, former U.S. Senate experiences in the program. Hayley Hovious: The Nashville • Part of a healthcare organization of Majority Leader Bill Frist, MD, and Larry Health Care Council any size in multiple sectors, including proVan Horn, healthcare management and NMN: What continues to surlaunched the Fellows viders, managed care, technology, public economics professor at the Owen Graduprise you about the program? program in 2012 in health, government, academia, nonprofit, ate School of Management at Vanderbilt Hayley: The fact that the program response to sweeppolicy or finance among others. University, have co-chaired the program. continues to improve each year is impresing changes that were • Endorsed by two industry leaders sive when you consider the quality of speakaffecting the health(through two letters of reference) and their NMN: Has there been a common ers we have attracted since its inception and care industry — and CEO. denominator among the various the caliber of candidates who apply year still are today. The • Able to commit to the 2020 Council classes? after year. It’s a testament to the vision of industry needed an Fellows class dates for class time. Hayley: Over time we have seen the the Council board and the hard work and intensive, advanced • Company based anywhere in the value of bringing together executives from dedication of the co-chairs, who reinvent Hayley Hovious leadership initiative United States. across healthcare sectors. Breaking down the experience every year. The program that brought together truly senior leadAdditionally, Council Fellows candithe silos that exist in the industry has led to simply continues to build on its impact and dates have common characteristics. They’re passionate. They have a huge heart for healthcare. And are dissatisfied with the LOCATIONS WHEN EXPERIENCE status quo and driven enough to lead the creation of value and effect change. This is MATTERS NASHVILLE what the Council Fellows program is about Hughston Clinic Orthopaedics www.hughston.com/tn and who the Council Fellows program is for. at TriStar Centennial 2400 Patterson Street, Suite 300

Malcom E. Baxter, MD

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NMN: What is the general procedure to apply to be a 2020 Council Fellow? Hayley: Applying to be a Fellow begins with connecting with your professional network for letters of reference and visiting the Council Fellows website to access the program application. The Council will accept applications for the 2020 Council Fellows class from September 9 through October 22, 2019. The application requests a bio, a statement of what a candidate hopes to gain from the program, and a description of the candidate’s perspective on a single challenge the candidate believes is critical to solve to transform the healthcare industry. The application for the 2020 Fellows Class can be accessed at healthcarecouncilfellows.com/apply. NMN: Any changes or new programming for the upcoming year? Hayley: Every year the Council and co-chairs work together to create (CONTINUED ON PAGE 12)

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Answering the Call: Preparing Veterans as Civilian Healthcare Leaders At the July meeting of the American College of Healthcare Executives of Middle Tennessee (ACHEMT), attendees gathered at the Cal Turner Center Ballroom at Meharry Medical College for an insightful program on putting the multifaceted skill sets of American veterans to work By DAVID A. WEIL as civilian healthcare leaders. Natasha Kurth, a captain in the U.S. Army transitioning from military to civilian life and availing herself of the Soldier for Life - Transition Assistance Program, spent at least eight hours a day sending hundreds of resumes and applying for positions online. At the first ACHEMT event she attended in November 2015, she met Andrew McDonald of LBMC. That meeting led to her being hired at LifePoint Health. Eighty percent of job candidates get their next job from connections, and Kurth’s experience is the classic example that networking is essential. The esteemed panel for the meeting included: • C. Bruce Green, MD: managing director Deloitte Consulting & chief medical officer for Deloitte’s Federal Health practice. The retired lieutenant general was the 20th Air Force Surgeon General; • Michael S. Huerter: vice president of operations for Ascension Technologies and retired colonel, U.S. Joint Special Operations; • Brian C. Lein, MD, FACS: division vice president, graduate medical education, at HCA’s TriStar Health and retired major general in the U.S. Army; and • Jameson Norton, MBA, FACHE: CEO of Vanderbilt Psychiatric Hospital

& Clinics, and major in the U.S. Marine Corps Reserve. After sharing his experiences from command to command, building and managing hospitals and leading team-based care of patients through natural disasters, Green was frustrated during his transition to civilian life by the lack of teamwork and ability to find decision-makers until he began working on a project with Deloitte. His CMO role, which he’s held for over five years, puts his extraordinary skills to work. After decades of leading systems, he said he enjoys his role as a consultant who advises and educates and appreciates the variety of his projects. A third of veterans expect to double or triple their compensation after transitioning from military to civilian life, but that is often not the case. In fact, some make less. Veterans must consider how much of their compensation is deducted for income taxes and statutory benefits and not spend money until after the deductions are made. Veterans often have financial issues, as well as family issues, and need advice from fellow veterans during the transition process. Another major issue veterans face is that they are often undervalued. Employers lose veterans when leaders fail to take notice and address this. Lein shared his observations about the power of brotherhood, comradery and love. He said his personal experience at a Somalia hospital overrun with casualties changed his perspective. Despite excelling throughout his education and career, which included serving as U.S. Army Medicine CEO, Lein said his first interview in 38 years was terrifying. Although preparing for the civilian job interview was hard, he knew his experience, expertise and skills running a residency program were transferable. Lein told attendees location is important and needs to be a family decision. As soon as Lein and his family got off the

Dr. Patrice Harris, continued from page 3 the forefront the importance of mental health care into the overall health of an individual. She would also like to raise awareness of about the lifelong adverse impact childhood trauma can have on a person. To get the best outcomes for healthcare, Harris said it is important to have a relationship with your doctor and make sure your records follow you and they are up to date. On the professional side, Harris said she will continue to talk about health equity and also look at the diversity of the physician workforce. “We need more diversity in more specialties,” she added. “For example, black men do better when they have physicians that look like them.” She also wants to make sure all physician voices are heard. “Physicians have an nashvillemedicalnews

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important role in helping to shape policy,” she said pointing to the work of the AMA House of Delegates, which advocates on behalf of physicians and their patients at the federal and state levels. As for what advice Harris would offer to young people interested in pursuing a medical career, she noted: “Follow that dream, follow that goal, work hard where you are. Make sure you have a good science background but also a diverse background so you understand the broader context of healthcare. You need to have good grades in history, philosophy, the social sciences.” Harris added, “We older folks have to make sure we create an environment for young people to succeed. We have to make sure opportunities are available for them.”

plane, they agreed that they would not leave Nashville, whatever job he might get. It was not about money. He added a veteran might have been a two-star general but had to be willing to take two steps back when transitioning to a new career. While compromise might be important, one area that should be non-negotiable is that the organization’s values and the veteran’s personal values must be aligned. If the veteran has talent and communication skills, those will be recognized by the right organization. Third, he continued, the veteran needs to find a bigger purpose within the organization in order to continue being of service. Norton’s military experience included serving as a mobile assault platoon commander and being assigned to the 9/11 force without knowing whether he would be in a raid, rescue or conventional combat reinforcement. Transition and the unknown, he pointed out, can be stressful and traumatic for service members and their families. Norton, who serves as the executive sponsor of the Veteran Group at VUMC, said pursuing the mission in healthcare is complicated and that there are a lot of parallels that can be brought to bear, but he knew he could be enthusiastic about the mission at the VUMC Emergency Department. He also credited the leadership at Acadia, where he started, who told him that when he is ready they would find a place for him. He said Nashville supports its veterans and noted Google, which has plans to hire 5,000 people at its new location in Middle Tennessee, has a vision as to what veterans have to offer. Huerter had no affiliation with healthcare during his 28 years with the Army. Growing up playing football as a receiver in Texas, then at West Point, he was challenged every day and is comfortable serving on teams that strive for excellence. An infantryman, he served in Desert Storm before completing Ranger School. After a number of overseas engagements, he was selected to serve eight years in the Joint Special Operations Command and spent his last 17 years on combat deployments. Huerter then took a job at West Point and planned to be with the Army for 30 years. His civilian transition started with a call and then an interview for a position at Ascension Saint Thomas, Ascension Technologies, for which ACHEMT Board President Anna Pannier serves as senior director. Having a blended family with his wife, who grew up in historic Newburg, Tenn., made this a favorable location for the family and piqued his interest. Ascension’s mission-based and valuefocused foundation also aligned well for him. Recently, Huerter was called to lead Ascension’s participation in the Veteran Career Transition Assistance Program, created to help veterans not allowed to reenlist during the U.S. Army’s downsizing

to have a soft landing through a network of job sites starting in Alabama, Florida and Georgia. Additional organizations that help veterans with transition, according to Norton, include Reboot Recovery, Operation Stand Down and Veterans Corporate Council. Lein mentioned Vanderbilt helps veterans advance their education and that HCA is the largest employer of veterans. Green added Deloitte, which does much federal government contract work, sponsors programs that help veterans with mock interviews. Veterans should avail themselves of resources early and often during their transition to the civilian workforce and recognize the value they bring, particularly to mission-oriented, teambased industries like healthcare. Green also said having a veteran as a mentor makes a difference and emphasized the importance of networking and making connections through organizations like ACHEMT. David A. Weil is a healthcare attorney and adjunct professor at Belmont University. He serves as subcommittee chair of Membership Growth for ACHEMT. For more information, go online to achemt.org.

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

Don Baham, CISSP, CISA, MCSE, president of Kraft Technology Group, looks at ways to improve medical device cybersecurity, which are subject to a variety of cyber vulnerabilities. Lisa Nix, LBMC shareholder and practice leader for Transaction Advisory Services, discusses the healthcare private equity climate and the value of physician practices “Knowing your Numbers” Marc Tressler, DO, a surgeon with Hughston Clinic Orthopaedics with specialties including orthopaedic reconstruction and trauma of the foot and ankle, urges those with injuries to not ‘just do it’ but to truly ‘do it right’ when it comes to recovery.

SEPTEMBER 2019

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NMGMATen Minute Takeaway

MIPS: Past, Present & Future By CINDY SANDERS

The second Tuesday of the month, practice managers and industry service providers gather for an educational Nashville Medical Group Management Association (NMGMA) meeting at Saint Thomas West Hospital. In August, SVMIC Assistant Vice President of Medical Services Jackie Boswell, MBA, FACMPE, broke down MIPS implementation and reporting. Replacing the much-disliked sustainable growth rate (SGR) formula, Congress passed the Medicare Access and CHIP Reauthorization Act Jackie Boswell of 2015 (MACRA), which changed the way Medicare reimburses clinicians with a focus on value over volume. Under the Centers for Medicare & Medicaid Services (CMS), the new Quality Payment Program (QPP) created two ways to participate – Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). For those required to participate in either of the tracks, the Advanced APMs offer both greater risk and reward. The MIPS track, which is still based off the Medicare Part B Physician Fee Schedule, adjusts reimbursement up or down based on a final score calculation that considers quality, cost, improvement activities and promotion of interoperability. “Most practices are in MIPS right now,” Boswell stated, adding one reason is there have been limited practical Advanced APM options available. “There are more alternative payment models coming … we just haven’t had great ones in the past.” However, she continued, a new APM specifically targeting primary care providers is slated to roll out in January 2020. In the meantime, the majority of physicians and other providers required to participate have opted for the MIPS track. Boswell noted the new QPP went into effect in 2017, with the results of that reporting cycle impacting current reimbursement rates. “This year, 2019, is the first year any sort of payment adjustments are being made,” she explained. “Depending on how you did on MIPS in 2017, you may have gotten a slight increase or negative adjustment in 2019.” To avoid a payment penalty in 2019, providers participating in MIPS had several options to collect 2017 data or simply test the process through the ‘pick-you-pace’ program. In that first year of data collection, practices could literally report on one measure for one patient and still manage to avoid a 4 percent reduction on a per-claim basis for 2019 Medicare Part B payments. However, the “bare minimum” participation requirements have ramped up since then … as have potential penalties. “If you don’t participate, you’ll get a 7 percent penalty on your Medicare Part B,” Boswell noted of the impact of 2019 actions on 2021 reimbursements. By 2022, 6

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the maximum penalty or bonus will go up to 9 percent.

Boswell said it’s easy to see how much nonparticipation could impact the bottom line.

Participation

Choosing a Strategy

Not all providers are required to participate. Boswell said eligible clinicians are exempted in their first year of Part B participation, if they are participating in an Advanced APM, or if they are under the low volume threshold. The low volume exception is for those who billed $90 thousand or less in Medicare Part B or who treated 200 or fewer Medicare beneficiaries. “New for 2019, if you have less than 200 billed codes to CMS, you don’t have to participate,” Boswell added of the new covered professional services exemption. The list of eligible clinicians required to participate has grown in 2019. Last year, the clinician list included physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. This year, physical therapists, occupational therapists, clinical social workers, qualified speech-language pathologists, audiologists, registered dieticians and nutritional professionals, and clinical psychologists are all expected to participate unless they meet the exemption criteria. Boswell noted CMS will review two 12-month time periods to determine whether or not a provider meets the low volume threshold. Additionally, there are some exceptions for hospital-based physicians and for those with 100 or fewer patient-facing encounters. To check participation status, log on to http://qpp. cms.gov, select ‘MIPS’ from the menu at the top right, then select ‘Check Participation Status’ and enter each provider’s NPI number.

The Cost of Non-Participation

“You might have a physician who says, ‘I don’t think I’ll participate,” Boswell noted. However, she continued, “You’re in it whether you like it or not unless you meet an exception.” And, she added, the cost of non-participation is going up. Boswell illustrated the financial impact of a required provider not reporting. In the example, the provider bills $167,000 annually in Part B services. If the provider opted not to report in 2017, then in 2019 a 4 percent penalty of $6,680 would be deducted from that provider’s reimbursements. However, that provider would also forego incentive and bonus opportunities that could have been worth as much as $3,972.93, so the maximum variation on 2019 reimbursement could actually exceed $10,500. Each year, the penalty increases until it maxes out at 9 percent. Similarly, the bonus and incentive opportunities also increase. If that same provider still isn’t reporting in 2020, then the 2022 max penalty on that Part B $167,000 billing is $15,030. Additionally, the lost opportunity for incentives and bonus dollars could cost the provider an additional $23,380 for a total maximum variation on 2022 reimbursement revenue in excess of $38,000. Multiply that lost revenue opportunity across a practice with 10 providers, and

In 2017, a provider only had to have three points to avoid a penalty and 70 points to qualify for the exceptional performance bonus. In the 2019 reporting year, it takes 30 points to avoid a 7 percent penalty and 75 points to qualify for the exceptional bonus. While non-participation could be unquestionably costly, Boswell said there are strategies about the best ways to participate. “Do you want to go for a bonus or just avoid a penalty for 2019?” she asked. “Either may be the right strategy,” she continued. Another consideration is whether to report for each individual provider or aggregate the data across the group and report under one tax identification number. “It’s really a case-by-case basis,” Boswell said. “It’s hard to make a determination without really going through the practice.” She said it’s less burdensome to report as a group instead of individually at the NPI level, but it also might be less fair to providers who do the lion’s share of the work to hit the reporting parameters. Currently, the entire group could get credit based on the work of one physician. However, Boswell noted, “That’s subject to change next year.”

Reporting Data

Under MIPS, Boswell said everyone gets a single score off of which their penalty or bonus is figured. That overarching score is calculated from reporting in four categories and must hit 30 to avoid a penalty this year. While the categories have remained the same, the weight of the reporting requirements has changed over the last few years. In 2017, quality measures represented 60 percent of a provider’s score and cost wasn’t yet weighted. In 2019, quality accounts for 45 percent of the total score, improvement activities (IA) account for 15 percent, promoting interoperability (PI) for 25 percent and cost for 15 percent. Although it’s already September, it is still possible to collect the necessary data for 2019. “I promise it’s not too late,” said Boswell. “With an electronic health record, you can still pull the data needed.” She added that quality and cost (which is calculated by CMS from claims data) performance is figured for 12 months, but IA and PI only require a continuous 90-day period for reporting. In 2018 and 2019, most providers or practices have to report on six quality measures on 60 percent of all patients (not just Medicare patients). “That shouldn’t be hard if you have a qualified EHR,” Boswell said of being able to extrapolate the needed info. Each reported measure is worth 10 points for a total of 60 points possible. “You can almost meet the threshold of 30 points (to avoid penalty) just by reporting something in quality,” she said. IA didn’t exist as a measurable category prior to MIPS, but now there are

118 different activities that qualify for a maximum of 40 points of the overall score. Boswell said medium-weighted activities are worth 10 points and high-weighted ones are worth 20 points. “You may already be doing things you could get credit for under improvement activities,” she added. As for promoting interoperability, Boswell noted PI is the new MU. To start with, the EHR has to meet the 2015 Edition Certified EHR Technology (CEHRT) for reporting. Practices or individual providers must report across several required measures including e-prescribing and electronic access for patients to their health records and must also attest ‘yes’ to three informational statements including having completed a security risk analyses. “And you have to be able to back it up,” Boswell added of the security risk analyses, which caused quite a few practices to fail under MU. Of note, a significant number of MIP participants do not have to report in the PI category. The long list of exceptions ranges from hospital-based clinicians to physical, occupational and speech therapists. There are also hardship exemptions for small practices, those with spotty internet connection and several other exceptions. In those cases, there is an automatic reweighting to the quality category.

SOS

While the QPP might still seem daunting three years in, Boswell said the good news is there are plenty of resources to help providers and practice managers navigate the new system from start to finish. In addition to organizations like SVMIC, most EHR vendors and professional associations, as well as CMS, have subject matter experts and toolkits available to answer questions.

Upcoming Events September There won’t be a September NMGMA meeting so area practice managers can participate in the TMGMA Fall Conference – “Path to the Future” – Sept. 12-13 at the DreamMore Resort in Pigeon Forge. For more information, go to tmgma.com.

October The NMGMA fall social and update from Tennessee’s Medicare Administrative Contractor Palmetto GBA is set for Tuesday, October 29 from 4-7 pm at the Burr Forman offices on Second Avenue North. More information on the event and how to make reservations will be included in the October issue of Nashville Medical News and online at NashvilleMGMA.org.

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Getting America Moving

Physical Activity Guidelines Focus on New Findings, Prevention & Health Promotion By CINDY SANDERS

Calling all weekend warriors, runners, walkers, armchair athletes and especially couch potatoes – the updated Physical Activity Guidelines for Americans offer new findings that rethink some aspects of ‘conventional wisdom’ and focus on the preventive benefits of movement, noting even small changes can make a real difference in health. The guidelines were released at the end of last year from the Office of Disease Prevention and Health Promotion (ODPHP), the department of Health and Human Services that acts as the gatekeeper for consumer health information (healthfinder.gov). ODPHP also serves as thought leader in health prevention and promotion through the publication of national guidelines and goals including Healthy People 2020 (healthypeople.gov). Throughout this summer, the American College of Sports Medicine has published a collection of papers – ACSM Scientific Pronouncements: Physical Activity Guidelines for Americans, 2nd Ed. – in their scientific journal, along with informative blog posts on the ACSM site offering additional insights into recommendations outlined by the Physical Activity Guidelines Advisory Committee. Kenneth Powell, MD, MPH, cochair of the 2018 Physical Activity Guidelines Advisory Committee, sat down with Medical News to share some of the key highlights from the updated standards. Now retired, Powell Dr. Kenneth Powell was an epidemiologist with the CDC for 25 years in Atlanta and has focused on the intersection of physical activity and health throughout his career. He served on the 2008 advisory committee for the first edition of the national guidelines and discussed a number of advancements over the past decade that helped inform the 2018 advisory report.

New Findings

“The benefits of physical activity haven’t changed,” Powell pointed out. “What has changed is our knowledge and awareness.” One of the biggest areas of discovery, he said, has been realizing the impact of physical activity on brain health. “Regular moderate to vigorous physical activity has an almost immediate demonstrable improvement in cognition,” stated Powell. He added improvements over the past decade in diagnostic tools analyzing brain activity helped show how regular physical activity reduces the risk of dementias, including Alzheimer’s, and improves cognitive skills. “I think this is one of the biggest and most important areas for us to uncover,” he added. Another discovery was the riskNASHVILLEMEDICALNEWS

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reducing benefits of moderate-intensity to vigorous-intensity physical activity (MVPA) on multiple cancers. In 2008, the science recognized MVPA reduced the risk of developing breast and colon cancers. In the updated guidelines, Powell said, “We now add six more sites – bladder cancer, endometrial cancer, esophageal cancer, lung, cancer, kidney cancer, and stomach cancer – that also exhibit reduced incidence among people who are physically active.” In 2008, the guidelines looked at physical activity from the standpoint of weight loss. The updated report focused on the preventive benefit of movement. “The 2018 report demonstrates very clearly that people who are more physically active … who engage in moderate to vigorous physical activity … have a reduced risk for becoming obese or gaining excess body weight.” While the newer guidelines shifted emphasis to prevention in many cases, Powell said there was also a focused effort to bring the immediate value of MPVA to the forefront. “This time, there’s a much great emphasis on how physical activity makes people feel every day. They think better; they feel better; they sleep better; and they have more energy to conduct their daily activities,” he noted.

ease among diabetics, improving cognition for stroke patients, decreasing the risk of atherosclerosis among those with hypertension, and improving function and reducing pain for those with osteoarthritis. Ultimately, Powell said the committee looked at about 15 common chronic conditions and found evidence of the preventive benefits of MPVA on all but one of the conditions … where there simply wasn’t enough evidence to make a determination one way or the other. “Our evidence strongly suggests that regular moderate to vigorous physical activity can be beneficial to practically everybody,” Powell concluded.

of activity and in total time spent moving in a week. The preferred target of 150-300 minutes of MVPA remained the same. However, Powell noted, “What happens too often when people hear this range of 150-300 moderate to vigorous physical activity minutes, they think they have to get there to get any benefit. You don’t have to get to 150 minutes in order to get some very important health benefits.” To hit the preferred target range, people engage in 10-15 MET – or metabolic equivalent of task – hours per week. Sitting perfectly still has no benefit in lowering all-cause mortality, but even getting 2.5 MET hours of activity in a week reduces mortality risk by about 20 percent. “You get a substantial reduction in your risk of dying by just adding five minutes a day of walking when you haven’t been doing anything,” Powell pointed out. That isn’t to say people shouldn’t strive to hit the 150-300 minutes of MVPA. “We think for the whole population this target range is a good one to think about in general, but for individuals, there may be a different target,” he continued. “For someone who has been doing nothing, adding anything really helps. That behavior should be reinforced.” Similarly, while most all of the

Rethinking Target Zones

Two of the biggest changes in the updated guidelines are how much and how long people have to move to realize any benefit from physical activity. Powell said the new guidelines underscore an increased flexibility both in bouts

(CONTINUED ON PAGE 8)

New Populations

“Back in 2008, there was not enough evidence for us to look at the health benefits for children three to five years,” Powell said, adding the earlier guidelines did include information for those 6-18 years of age and adults. Now, however, Powell said there is enough available data to say children in this younger age group benefit from regular physical activity, too. While movement is often natural to younger children, Powell noted adults need to be cognizant of the health benefits of actually putting children in situations that encourage active play over sedentary pastimes. “Also new in 2018 is evidence of the underlying benefits of regular physical activity for those who already have some type of chronic health condition,” Powell continued. Again, he noted, the focus in 2008 was more on physical activity as one part of a treatment plan for many chronic conditions, including type 2 diabetes, whereas the new guidelines were focused on what movement meant to the prevention of comorbid conditions and complications. For example, he said, the evidence points to MVPA lessening the risk of heart dis-

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Head, Shoulders, Knees and Toes, continued from page 1

Blood loss concerns have also been mitigated thanks to widespread use of tranexamic acid – a drug that stabilizes formed blood clots and reduces active bleeding, greatly Dr. Craig Morrison diminishing the need for transfusion. Robotic-assisted and computer-navigated procedures have also inundated the market in the past decade.

Head

Concussion treatment has come a long way in recent years. Andrew J. Gregory, MD, FAAP, co-director of the Vanderbilt Sports Concussion Center, said the “zero stimulation” theory still practiced by many doctors and parents has fallen by the wayside in favor of newer findings. “People used to advocate complete Dr. Andrew Gregory rest and putting someone in a cold dark room with no stimulation, but we’ve learned that no stimulation is bad for people and can actually make symptoms worst,” said Gregory, who serves as team physician for Nashville Christian School, Vanderbilt University, the Nashville Soccer Club and USA Volleyball National Teams. “Getting people back to physical activity after a few days of rest is good for recovery and actually speeds it up.” Gregory said concussions should be followed by a day or two of rest before starting light physical activity as recommended by a physician. Gregory recommends providers put patients on a treadmill after one or two days to gauge exertion levels before symptoms develop. The test provides a starting point as to how much exertion is acceptable, and exertion levels can be increased. Concussion symptoms range from

sleep problems to headaches, cognitive difficulty, balance or eye trouble or emotional problems. Balance, ocular or cognitive therapy are beneficial for those whose symptoms persist for more than a month. According to Gregory, 90 percent are better within the first three weeks. “We want patients to return to activity quickly, even if it’s just walking or using an elliptical,” he said. “Research in the last year has proven that recovery is faster when you become active sooner.”

Shoulders

Robert Landsberg, MD, FRCS, of Landsberg Orthopaedics in Hendersonville, said the shoulder’s unique balland-dish design puts the joint at higher risk for injury and dislocation. When exercises, splinting and injections no longer control pain, patients often opt for arthroscopy, recon- Dr. Robert Landsberg struction of the rotator cuff or total shoulder replacement. “Total shoulder replacement has been around since the 1970s, but the main improvements over the years have been in design and technique,” Landsberg said, noting popularity of the reverse total shoulder in recent years. “Total shoulder replacements aren’t just for arthritis now but for older adults who have no rotator cuff and need a reverse total shoulder.” Considered an end stage procedure, reverse total shoulders entail putting the ball on the socket side and the socket on the humeral side to create more constraint. That’s because the reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. Partial shoulder replacement (involving only the ball or humeral head) provides a faster recovery and is often an effective solution for younger patients with arthritic shoulders. Computer navigation for shoulder replacement is currently dominated by

ExactechGPS, whose 3D planning software allows surgeons to better position the socket by mapping the perfect position ahead of time. “The biggest difference is that we’re able to better handle larger bone deformities with more confidence and efficiency, which leads to more accurate placement and better survivorship,” he said.

Knees

SJRI’s David DeBoer, MD, performs nearly 400 knee replacements each year. He said one of his most valuable tools is a database of the group’s 8,000-plus joint replacement patients that allows him to track which procedures have yielded the best outcomes. “We collect Dr. David DeBoer so many details about patient characteristics and each surgical procedure, from pain scores to functional results, so that we don’t make changes without knowing for certain that we’re improving quality of care, whether that’s choosing a different implant or technique,” he said. Compared to traditional knee implants, today’s medial pivot knee implants more closely match normal knee kinematics – natural movement of the joint. And better material means implants are now lasting 15 to 20 years. “Implants have gotten better, and today’s knees help patients regain normal stability for higher demand activities like tennis, golf or skiing,” said DeBoer, noting the increasingly younger demographic of today’s joint replacement patients. “Patients today are living longer and are extremely active,” he said. “Those combinations and improvements in joint replacement have led to more innovation and medical attention for treatment of arthritis at younger ages.” Nationally, the average age of joint replacement patients is around 65 – a testament to an active baby boomer population refusing to grow old in a rocking

Getting America Moving, continued from page 7 focus is on MVPA, the committee found that even light intensity physical activity could be helpful. Those who sit the most and do the least have the highest risk for all-cause mortality. For those in the most sedentary group overall who sit at desks at work all day, Powell said risk decreases at least a little by simply standing up and moving around for just a few minutes during the day. Bout length of exercise was another area that garnered a lot of attention. Powell noted conventional wisdom called for MVPA to be accumulated in bouts of at least 10 minutes. In that scenario, a fiveminute walk didn’t count. “We decided to revisit that for a couple of reasons,” said Powell. First, he explained, health recommendations were at odds. The 2008 guidelines 8

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called for 10-minute bouts but the Community Guide for Preventive Services recommended shorter actions like taking the stairs instead of an elevator or parking a little further away from the door. “It’s not good to have public health recommendations that aren’t consistent,” he pointed out. The second issue, Powell continued, was an absence of information that proved bouts of less than 10 minutes weren’t helpful. While it’s hard for people to remember a two-minute activity here and a five-minute one there, the use of accelerometers moved the science from selfreporting to data collection and showed people who accumulated 150-300 minutes of MVPA in shorter bursts did just as well as people who hit the target range with activities lasting 10 minutes or longer.

Physical Activity Promotion

From the built environment and public policy to cognitive behavioral change and tracking technology, Powell said, “The evidence indicates there are many types of interventions that help people become more physically active.” However, he continued, “To make big population changes, we’re going to have to make many changes. They all help … and they all help a little … but none of them are going to be the single solution.” Still, Powell said the evidence has shown any physical activity confers some benefit. He added the healthcare community plays a key role in reinforcing that message and encouraging patients to take the first step toward becoming more active even if it’s just a few minutes a day.

chair. William Shell, Jr., MD, orthopaedic surgeon at Tennessee Orthopaedic Alliance, said patients not only expect pain relief but also want to regain a high level of function. “Implant design continues to evolve,” Shell said. “Total knees historically do not replicate normal Dr. William Shell knee mechanics, but we now have patient-specific implants manufactured to fit each individual patient. This technology may be the best marriage of navigation/robotics and implant design. We have gait lab studies demonstrating knee kinematics with these knees similar to a normal knee.” Considering the younger and more demanding patient population, coupled with a rising incidence of heavier patients, Shell believes there will be a renewed interest in cementless implants. “We know bone cement will fatigue over time leading to implant loosening,” he explained. “Ingrowth of the implant to bone eliminates that concern and may result in greater longevity of the replacement.” When treating younger patients, surgeons like Landsberg also restore articular cartilage in the knees by performing a graft transplant. “A 25-year-old is too young to receive a total knee, so we replace the joint surface using a fresh allograt (donated cartilage transplant),” he said. Landsberg also biopsies and cultures the patient’s own cells, allowing them to and receive their own articular cartilage.

Toes

Geoff Watson, MD, orthopaedic surgeon at the Bone and Joint Institute of Tennessee, said surgical foot and ankle innovation is on the rise. Watson is now performing cartiva implants to resolve joint pain in the big toe – a welcome alternative to fusion. “The implant is a spacer shaped like a gum drop, and it’s synDr. Geoff Watson thetic cartilage to hold the joint open,” he explained. The implant is proving effective at preserving motion while reducing pain. Achilles tendon repairs have also received an upgrade: Watson said 1-inch percutaneous incisions have replaced the four-to-five-inch incisions used in the past. Patients also are benefitting from advances in ankle replacements, first attempted more than 30 years ago. “The original ankle replacements didn’t do well, but the new ones have a 95 percent track record, providing a lot of pain relief and allowing for better motion,” Watson said. “Ankle replacement is challenging because it’s a smaller joint under a lot of stress, but innovation in surgery means we can help get patients back on their feet.” nashvillemedicalnews

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TOS Addressing Practice Concerns, Opioid Legislation Surgeons Search for Middle Ground to Help Chronic Pain Patients By MELANIE KILGORE-HILL

The Tennessee Orthopaedic Society (TOS) held its annual meeting Aug. 24, marking the 68th yearly gathering of the state’s board-certified bone and joint surgeons. TOS President John “Jay” Crawford, MD, said the meeting focused on seven major areas: balanced billing, scopeof-practice issues, telemedicine implementation, crossborder payer billing issues, hospital merger issues, neglected rural influence in TOS, and opioids. “These issues aren’t just relevant to Dr. Jay Crawford Tennesseans,” said Crawford. “They’re nationally consistent with concerns in orthopaedic care of patients around the country.”

The Opioid Epidemic

When it comes to addressing the best ways to care for patients in pain, TOS has unique insight into industry challenges, and solutions, thanks to leadership from orthopaedic surgeon John McGraw, MD, one of 28 health experts nationwide selected to join the U.S. Department of Health and Human Dr. John McGraw Services Pain Man-

agement Best Practices Inter-Agency Task Force in 2018. The appointment has given the Knoxville physician a national platform to speak about opioid use in orthopaedics. It’s a topic the TOS has taken a strong stance on with state legislatures, as providers strive to balance their responsibility to population health with their commitment to patients. “Here in East Tennessee, opioids were almost the exclusive problem with crime, with 95 percent of prisoners using drugs,” said McGraw, who also served as Jefferson County commissioner. “While some orthopaedic surgeons did overprescribe, the outcry from leaders seven years ago actually led to legislation that harmed patients.”

TN Together

Passed in 2018, the TN Together law was intended to attack the statewide opioid epidemic: Tennessee remains in the top 15 of all states in drug overdose deaths. The law received pushback from the Tennessee Medical Association and TOS, concerned with their ability to appropriately treat patients with acute and chronic pain. “This past legislative season, significant changes were made under Gov. Lee, and that didn’t just come from the medical community,” McGraw said. “It came from citizens: patients who relied on narcotics for relief from chronic pain, and you can’t just yank them off low dose prescriptions they’ve been on for years. Those laws were more beneficial to the legislative side than the medical side, because you can’t always

TOA to Launch Sports Performance Center By MELANIE KILGORE-HILL

Tennessee Orthopaedic Alliance is growing again. Slated for an early 2020 opening, the TOA Sports Performance Center in Franklin will house physicians and services currently found at the TOA Franklin location in Williamson Medical Center. Located at 215 Gothic Court (formerly A-Game Sportsplex), the Sports Performance Center will include an 8,500-square-foot facility that will serve as TOA’s Williamson County hub for urgent care, physical therapy and performance training. “We plan to engage with the community in a number of ways by combining our orthopedic expertise with a more holistic approach to an active lifestyle,” said TOA Chief Executive Officer Rob Simmons. That approach, he noted, nashvillemedicalnews

.com

includes yoga and fitness classes, as well as group and one-on-one strength and conditioning programs, nutrition services and after-hours orthopedic urgent care. Expanded services will include specialized physical therapy, preventative and post injury performance and condiRob Simmons tioning training. “Our strength and conditioning coaches will be aligned with our PT specialist to provide contiguous care, so that once physical therapy is complete and patients need that extra push to confidently go back to the activities they enjoy, it is seamless, safe, and mitigates the chances for re-injury,” Simmons said.

manage major pain with ibuprofen.” TOS leaders support the idea of multi-modal pain relief but say national and local payers have been slow to approve alternative pain management techniques. “It’s easier to pay for oxycodone than nerve injections, which work equally well and would cut down on opioid use,” McGraw noted.

Striking a Balance

Crawford remains hopeful that feedback from the state’s medical community will help steer Tennessee’s opioid laws back toward the center line to minimize harm while still looking out for patients. “Our leaders meant well, but in the process of refining legislation, they just didn’t take into account true patient need and they over-corrected a bit,” he said. “We’re now trying to help get everyone back on track.” The TOS is now supporting state recommendations based on McGraw’s national Task Force findings: • To manage pain by medical expertise rather than hard legislative rules; • To use the fewest pills, lowest dosage and shortest duration of treatment

Scott Arthur, M.D.

Ian Byram, M.D.

possible; and • To leave judgment to educated physicians and patients. “We think this will significantly improve patient and state outcomes, as well as the ability to practice medicine and surgery in the state,” Crawford said. “I want the medical community to be reassured we’re actively engaged in trying to maximize musculoskeletal health,” he continued. “We have a responsibility to do everything in our power to maximize Tennessee citizens’ quality of life and their ability to gain access to healthcare, and we’re working hard to maximize our contribution to the state so we can all achieve optimal productivity.”

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Cory Calendine, M.D.

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HEALTHCARE ENTERPRISE

Leading with TENNACITY

Nashville Non-Profit Funding Therapy, Training for Trauma Survivors By MELANIE KILGORE-HILL

TENNACITY founder Thomas Stephenson never envisioned running a foundation for trauma patients. The Nashville non-profit launched in 2018 to facilitate access to hands-on physical therapy and strength training for survivors who lack financial resources or access to pay for services outof-pocket.

“Our intention has always been to take it slow in terms of bringing patients on, because we want to iron out the process patient by patient,” he said.

Eligibility

further therapy and training after their initial hospital stay, along with physical therapists and health and fitness specialists. Partners typically offer TENNACITY 30 to 50 percent off regular treatment rates and funds are paid directly to the provider rather than the patient. The foundation covers 15 physical therapy visits and 24 training sessions.

TENNACITY recipients are located in Middle Tennessee and must have Strength after Trauma access to a partner training “Our goal with all our training partfacility. To qualify, recipiners is not just helping patients with pain ents must have experienced but helping them understand how to conSurviving Trauma a single accident or incident tinue improving,” Stephenson said. “We Stephenson’s life changed that has resulted in a lifewant trauma patients to know what to do December 2014 when the altering state physically. when they walk into the gym once they 21-year-old was involved in Recipients also must leave therapy.” a fatal car accident just south be motivated to do the TENNACITY Advisory Board of Nashville. In minutes, the work. “We make it clear Member Richard Storie II, EdD, director Franklin, Tenn., native went in the application (available of the Human Performance Lab at Cumfrom an ambitious triathlete online) that we want to know berland University, said the role of exerpreparing to graduate from their goals, because it can cise physiologists is strongly under utilized Western Kentucky Univerbe surprisingly difficult to in trauma rehab. “The typical physical sity to a LifeFlight patient at find motivated patients in a therapy model is designed to allow a perVanderbilt University Medirehab setting,” he said. son to function to the best of their ability cal Center, where he underStephenson stressed within their limitations, but our goal is to TENNACITY Founder Thomas Stephenson went from triathlete to trauma went surgery to fuse his spinal that the group isn’t only eliminate the limitations,” Storie said of patient in a matter of minutes. Working his way back to triathlete took a lot column, surgery to put a titalooking for indigent patients, exercise physiologists. longer and a lot of support. Now he’s paying it forward. nium rod through his femur as they’ve also helped coor“There comes a point after PT where and subsequent reconstructive dinate care for those with patients still need specialized strengthensurgeries on his feet and ankles. the ability to pay TENNACITY’s dising and conditioning and to adopt a syslevel of guilt for being able to have the He was told his triathlon days were counted rate out-of-pocket. “We’ve got tems approach to get to the next level,” type of recovery I’d had, and it all came over, and he likely would never play sports the resources to guide patients and help Storie continued. “Patients often don’t down to the fact that my parents had the again. Stephenson spent the next three them know where to get help, even if they realize they can do so much more than ability to help,” Stephenson continued. weeks at VUMC followed by a month of have the ability to pay their own way,” he what they were led to believe. When we “There was this massive community of inpatient rehabilitation. With one semesnoted. get involved, we start pushing people trauma patients facing the same chalter remaining, the political science major beyond limits they thought were possible, lenges I did but without the extra help, returned to WKU wheelchair-bound to Partnerships because the human body is amazing.” so when they hit that wall at the end of graduate with his classmates. Core partners include Elite Physical As TENNACITY continues to build, therapy they might get worse, become Therapy, Personal Best Fitness and ChadStephenson is focused on educating the unemployed or get hooked on opioids. I Discovering a Need wick’s Fitness and Performance Training, state’s healthcare community on their missaw the downstream effect of trauma and Stephenson went to physical therapy with others in the pipeline. “Right now, sion. “We want to have name recognition looked at what made my own recovery so as ordered but soon learned insurance we’re working on negotiating rates with as the go-to people for trauma recovery effective, and it was ultimately my ability only covered a pre-determined number of new partners, as we’re essentially acting and to be out in the community so peoto continue PT and intensive training after visits – not enough for debilitating trauma as a payer,” he noted. ple know what we’re doing,” he said. “If I hit that wall.” injuries. “At that point, I was living the life TENNACITY is also partnering with you’re a doctor or healthcare organizathey told me I’d be living – I was in pain acute-care, long-term care, and rehabilitation, we want you to know you have someStepping Out all the time,” he said. tion facilities to identify patients who need where to send trauma patients.” The Stephensons’ first order of Fortunately, Stephenson’s family was business was to find out exactly how big able to pay for therapy out-of-pocket, and a problem this was. Turns out, it was he was soon connected with an athletic huge. “We talked to a lot of people, from Running with a Purpose trainer who took his rehabilitation to the physical therapists to athletic trainers next level. Months later, Stephenson was and surgeons, and the answer was overThe Inaugural TENNACITY Trail Run 5k is back running and biking, and now considwhelmingly, ‘This is an epidemic,’” said scheduled for Saturday, Oct. 26 on a private ers himself to be in better shape than ever. Stephenson. farm in Fly, Tenn., which is located on He then set to work establishing an Leipers Creek Road in the Santa Fe area. Paying it Forward executive board equipped with the knowlRunners and walkers will enjoy In 2018 Stephenson and his wife edge to build a successful enterprise from wooded areas, open fields and Abby attended a 5K in honor of a friend’s the ground up. Next, he formed an advicreekside boardwalks along the child who’d been born with a heart abnorsory board of healthcare professionals who Natchez Trace Parkway. All proceeds mality. Funds raised benefited others knew what patients needed and could help from entries and sponsorships benefit fighting the same battle. “We walked away select recipients. the TENNACITY Foundation to provide and said, that’s such a cool thing, to take The year-long process paid off, and rehabilitation services to trauma your own experience and show empathy the TENNACITY board officially charsurvivors in Middle Tennessee. for others,” said Stephenson, who’d been tered July 1, 2018. Patients have started struggling with ideas of how to help other The last day to register is Oct. 12. Go online to tennacityfoundation.org trickling in, and Stephenson hopes to fund trauma survivors. for details and to sign up for the run. therapy services for 10 this year … and “In the back of my mind, I’d felt some 25 next. 10

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Enablr: Connecting Therapists, Patients By MELANIE KILGORE-HILL Nashville recently welcomed the first mobile therapy platform designed to connect patients and therapists in Middle Tennessee. Launched by Kyle and Sarah Keene, founders of Nashville-based Project Play Therapy, Enablr Therapy serves both children and adults in need of speech, physical and occupational therapy.

Meeting a Need

“When we started Project Play three years ago, we immediately noticed a rift in the market as far as traditional brick and Kyle Keene mortar set-ups, which were often difficult for families to get to,” said Kyle Keene. “I found myself constantly having conversations with families who couldn’t get off work in time to get to a clinic across town by 4 p.m. There was this community of people who weren’t getting the therapy they needed because they didn’t have realistic access to it.” The Keenes also saw a market where therapists only wanted to work a few days a week, work in their section of town or work with a specific type of client. They did their research and soon learned the benefits of natural setting therapy – services provided in a patient’s home – and spent the next year working through what therapists and clients alike would want in an app.

Benefits to Patients

The platform allows users to browse local therapists available to meet when and where families need them most – saving time and allowing clients to meet with their providers in a natural environment. Profiles on the site allow users to view therapist pricing, education, experience and certifications. Users can also read and provide reviews in real time, adding a level of transparency that doesn’t exist in traditional practices. If the therapist is the right fit, appointments can be booked with just a few clicks. “One of the groups we’ve found that enjoy our services the most are working professionals or a retired adult who wants physical therapy at their home,” Keene said.

Benefits to Therapists

Enablr provides therapists with more options too. The platform allows professionals to set their own schedule, prices and coverage area. “We had a lot of interest from therapists right off bat,” Keene said. “Many really want to be CEO of their own practice, but we’re there to help with marketing, scheduling and billing.” Enablr therapists go through a rigorous qualification and application process including interview and reference, licensure and resume checks. “It’s a very controlled process to keep our therapists high-quality,” Keene said. “We want to make sure we’re proud of who we’re putting on the platform.”

Membership is free to both patients and therapists. Enablr bills patients for services and takes a small percentage of overhead from the price set by the therapist. While the platform is private pay, Enablr does offer clients a “super bill” for those who want to submit to their insurance for reimbursement. Keene said lack of a physical office space and staff means the company is able to offer competitive

private pay rates. “Study after study shows families and kids aren’t getting enough therapy, and we know that early intervention makes a big difference,” Keene said. “Even when kids receive free services through their school, they often need a lot of supplemental services. Therapy really does make a difference, and we’re trying to advocate those services from all fronts.”

Saint Thomas, Kindred Get CON Nod In late August, the Health Services and Development Agency of the State of Tennessee granted Certificate of Need approval for construction of the Saint Thomas Rehabilitation Hospital, a 40-bed freestanding inpatient rehab facility on the health system’s midtown campus. The project is a joint venture between Ascension Saint Thomas and Louisville-based Kindred Healthcare. The new facility will serve nine counties and a population of 1.9 million, including more than 298,000 senior citizens. According to the CON application, filed in late June, the proposed 98,000-square-foot facility and parking garage is anticipated to cost an estimated $48 million and will replace the current 24-bed acute rehabilitation facility located at Saint Thomas Midtown Hospital. Plans call for a two-story facility built above a two-story parking garage that includes all private rooms and bathrooms and a designated wing specifically for traumatic brain injury patients. The main therapy suite is expected to include a therapy gym, cooking therapy area, an activities of daily living (ADL) therapy suite, private therapy rooms and a courtyard. “Ascension Saint Thomas has always been committed to providing high-quality inpatient rehabilitation services designed to help patients with acute physical limitations progress toward independent living,” said Fahad Tahir, president and CEO, Saint Thomas Midtown and West Hospitals. “This specialized collaboration with Kindred Healthcare will improve the lives of Middle Tennesseans and enhance clinical integration across the acute care and rehabilitation treatment settings.”

Council Fellows: A Conversation with Hayley Hovious, continued from page 4 PHOTOS COURTESY OF THE NASHVILLE HEALTH CARE COUNCIL

curriculum for the class that directly addresses the topics and trends healthcare leaders need to be prepared for. This year, we’re devoting classes to innovation and problem solving, state and federal policy reform, population health management, integrated delivery networks, applications for data and analytics, consumerism and more. — they extend beyond Fellows classes Fellows class years, Experiential learning helps participants from different industry sectors gain a deeper continue to be highly beyond state lines and understanding of the larger healthcare ecosystem. interactive and deeply through the many subengaging. One of our sectors of the country’s biggest learnings has been the value of healthcare industry. was that important? immersions — everything from a day spent Any professional who becomes a Hayley: The Fellows program has in the hospital to a poverty simulation that Council Fellow is immediately connected grown over the course of seven classes put Fellows into the shoes of the populato a distinguished network of leading into a national program it is today. More tions they serve. healthcare innovators, entrepreneurs, than 20 percent of participants come from and thought leaders. The Council Fellows healthcare organizations outside of Middle NMN: An alumni component Alumni Association builds on the momenTennessee. What pleases me most is seeing was added several years ago. Why tum created in the classroom by providing the relationships the program has created opportunities to continue conversations and collaborations beyond graduation. In addition to the organic connections alumni make, the Council facilitates alumni activity with regular network Go to HealthCareCouncilFellows.com for more detailed information and to apply. news updates to and annual networking

Council Fellows 2020

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A fun outing hones problemsolving and teamwork skills.

events for the Alumni Association. NMN: Any final reflections on what makes Council Fellows unique? Hayley: Having been the Fellows director and now the president of the Nashville Health Care Council, I have continued to be impressed by the Fellows themselves. Each year we bring in a group of disparate executives with varied backgrounds and experiences. By the end of six months, they’re collaborating and working to make healthcare better in new and exciting ways. At the end of the day, we are very fortunate that healthcare, which is so important to Nashville and to each of us personally, is run by such intelligent, compassionate people. nashvillemedicalnews

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Fighting Fire with Fire Corizon MAT Pilot in Philadelphia Takes on Opioid Addiction By CINDY SANDERS

The opioid epidemic crosses all demographic and geographic boundaries, but one common thread is intensity of use correlates to involvement in the criminal justice system (JAMA Network Open, July 6, 2018, Tyler Winkelman, MD, MSc, et. al.). Similarly, a 2010 report – Behind Bars II: Substance Abuse and America’s Prison Population – found 65 percent on inmates in U.S. prisons met the DSM-IV medical criteria for alcohol or other drug abuse and addiction. Adding to the risk profile, those who had an opioid addiction prior to being sentenced are at a much higher risk of overdose-related deaths than those who have never been incarcerated. According to the National Reentry Resource Center, which is administered by the U.S. Department of Justice, one study in the state of North Carolina found “risk of overdose death from opioids was 40 times higher for people released from incarceration in state facilities than it was for the general population in the state.” Recognizing an opportunity to address these inequities and potentially impact recidivism, Brentwood-based Corizon Health, which provides physical and behavioral healthcare for more than 220 correctional facilities across 17 states, decided to tackle opioid addiction in a new manner with an eye toward longterm recovery. In 2018, Corizon launched a year-long medication-assisted treatment (MAT) pilot in conjunction with the Philadelphia Department of Prisons. Corizon medical providers who helped develop and deliver the protocol presented their observational findings earlier this year at the spring conference of the National Commission on Correctional Healthcare held in Nashville. The success of the MAT protocol to date has led Corizon to begin the process of rolling out the program to other facilities under their umbrella.

A Community in Need

The year before the pilot launched, Philadelphia County had the highest overdose rate of any of the country’s 10 most populous counties, and opioids were linked to 88 percent of drug overdose deaths. “The opioid addiction we’re seeing is nationwide, but within the city of Philadelphia itself, there was a big drive to do something about overdose deaths … particularly with opioids,” said Jacqueline S. Martin, MD, site medical director for Riverside Correctional Facility and acting director of addiction medicine with Corizon for the Philadelphia Department of Prisons. Dr. Jacqueline Martin “If you were using drugs when you came in, we put you on a withdrawal protocol to help you through withdrawal, but it was basically comfort meds,” Martin explained of the procedure prior to the MAT pilot at the women’s prison. nashvillemedicalnews

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Noting the average length of stay in the Philadelphia Department of Prisons is just over 100 days for men and about two months for women, inmates had time to detox but often didn’t change their underlying addiction or adjust the amount of drug taken when they returned to using. “If you’ve had no opiates, no heroine and then are released, you have a higher chance of overdosing on the same amount that was comfortable for you before incarceration,” Martin noted.

A Window of Opportunity

Martin said the data showed that if someone incarcerated within the Philadelphia system wasn’t released in a 14-day period, then they would most likely be held for 30-90 days. “We did have a captive audience,” she said quite literally, “where we could initiate treatment.” Inmates with substance abuse issues were identified during the intake process that screened for mental and physical health concerns. Martin stressed those identified as being eligible for the MAT program were absolutely allowed to opt in or out. She added some said ‘no’ simply because they didn’t think they needed the program or because they preferred another option, such as methadone treatment. However, she continued, “The majority of patients that come in with substance use disorder do participate in medicationassisted treatment.”

dence supported expanding the program to the men’s prison population within six months of launching the women’s pilot program. Additionally, Corizon and Riverside have moved out of ‘pilot’ phase and now offer the MAT program on an ongoing basis. Martin said what they have seen so far in Philadelphia is promising. She also pointed to a recent study in Rhode Island that compared post-incarceration fatal overdoses before and after implementing a MAT protocol for inmates. Although a relatively small sample size, there was a 60.5 percent reduction in mortality after statewide implementation of a MAT prison program. Similarly, she said the success of Rikers Island methadone program has been well documented for years. Despite successes being seen at Riverside by Corizon and in the Rhode Island and New York City programs, Martin knows there are those who are skeptical of the approach. Particularly among officers and non-medical personnel, there is a lingering feeling that one drug is just being replaced by another. “There has been a challenge to show this is treatment of a disease,” she said. However, Martin likens it to any other chronic condition. A patient with hypertension can maintain their health by taking any of a variety of evidence-based medications

to keep blood pressure in check. Getting off those medications, however, can have a devastating impact and potentially lead to fatal stroke or heart attack. Similarly, she pointed out, “You can take a dose of Suboxone in the morning and go to work and take care of your family. By not taking a maintenance amount of medication, they run a risk of overdosing.”

Lessons Learned

“The opioid addiction numbers are staggering and not going away,” pointed out Martin. “When you look at reasons for incarceration, you do see a high number of those are related to drug use and crimes committed to support an addiction. The more people we can help break that cycle of addiction, the more those things should definitely improve.” Martin said they have gotten a lot of interest in their program not only from other correctional facilities but also from community programs searching for the best means to address the epidemic. As Corizon has refined the Philadelphia MAT program, the biggest lesson learned has been the need to link inmates to resources upon release. “We’re not just throwing you out there and leaving you to figure it out yourself,” concluded Martin. “We’re putting all the pieces in play.”

The Protocol

“We use buprenorphine in our program,” said Martin. She added patients are given an initial 4mg dose of Subutex. “After that initial dose, the next day and daily after that, the patients take 8mg of buprenorphine and 2 mg of naloxone (Suboxone),” she explained. Additionally, behavioral counseling is available for those who want to access the service but is not a mandatory component of the MAT program. While the protocol hasn’t varied much during incarceration, Martin said the program has been refined as individuals transition back into the community. “When we first started the program, we sent them out with a prescription for a five-day supply. Unfortunately, we found many had a hard time getting the prescription filled for various reasons,” Martin noted. Now, program participants are released with a 15-day supply of medication. “They use it to hold them over until they get to one of the outpatient centers we refer them to,” she said, adding Corizon already had links to community health providers through the ‘Release with Care’ program. While the initiative was originally created to help those with chronic health conditions, Martin said it was adapted to identify centers of excellence in dealing with substance use disorders in partnership with the MAT pilot.

A Strong Start & a Few Skeptics

While the program is still too new to have long-term data on continued sobriety and recidivism rates, the anecdotal evi-

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Addressing Addiction Oklahoma Judge Orders J&J to Pay

As we were going to layout on the September issue, an Oklahoma judge issued a landmark ruling in one of many cases across the country brought against opioid manufacturers and marketers. Judge Thad Balkman ordered Johnson & Johnson to pay $572 million for the company’s role in stoking Oklahoma’s opioid epidemic. State Attorney General Mike Hunter successfully argued J&J pushed doctors to prescribe opioids while downplaying the addictive risk of the drugs, thereby creating a ‘public nuisance.’ While a number of other pharmaceutical companies have settled, J&J opted to go to court in a case that has been seen as a litmus test for thousands of other pending lawsuits by states and cities dealing with the wreckage of the opioid crisis. Although the monetary verdict was hefty, it was significantly less than the $17 billion Hunter requested. J&J’s attorney is expected to immediately appeal.

Mark Your Calendar: Celebration of Courage

A Breakfast to Benefit Park Center Tuesday, Sept. 17 • 7:30-9 am The Westin Nashville This annual breakfast event raises awareness and funds for Park Center to support programming for people with chronic mental illness, homelessness and addiction. Although there is no cost to attend, reservations are required and donations are greatly appreciated. Go to ParkCenterNashville.org to make reservations.

Spero Opens Dickson Facility

Brentwood-based Spero Health, a CARF-accredited organization specializing in outpatient addiction treatment, opened their new Dickson Spero Health Clinic in late July. This latest addition marks the organization’s 27th clinic and aligns with the company’s plan to further expand in Tennessee to address the opioid epidemic. “Our approach is designed to provide rapid access to care in order to treat this chronic disease, making it possible to see patients the very same day they seek treatment. Individuals need a local option so they can remain in their communities developing life skills in order to continue working and caring for their families,” said Spero CEO Steve Priest. The Dickson clinic has named Dean Harless, MD, clinic medical direcSteve Priest tor and lead physician. Harless is board certified in internal medicine and board eligible in addiction medicine. Spero Health is enrolled with TennCare, as well as select commercial plans.

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JourneyPure Names National Medical Director

Nashville-based JourneyPure, a national provider of addiction treatment and mental health services, has named Stephen Loyd, MD as national medical director, effective immediately. Loyd joined JourneyPure in May 2018 to serve as medical director for services in Middle Tennessee Dr. Stephen Loyd including four outpatient clinics and the flagship residential facility JourneyPure At The River in Murfreesboro. As he transitions to this new role, he will focus his efforts on the immediate implementation of universal medical protocols in all JourneyPure markets, in addition to providing consultation regarding medical service delivery, quality assurance, medication assistance, and other duties. He will also continue his Middle Tennessee duties on a part-time basis. A widely recognized thought leader and clinician, Loyd has decades of experience in internal medicine, mental health, and substance abuse services. His background includes service as medical director and assistance commissioner for Substance Abuse Services with the Tennessee Department of Mental Health and Substance Abuse Services and an appointment to Governor Bill Haslam’s Opioid Workgroup and Public Safety Subcabinet. An ardent activist for those living with addiction and co-occurring mental health disorders, Loyd brings firsthand knowledge to his role in helping those struggling with addiction as he has been in recovery from opioids and benzodiazepines since 2004. JourneyPure has rapidly expanded its footprint in regional markets throughout the southeastern United States, currently serving patients through six residential treatment facilities and a dozen outpatient clinics throughout Tennessee, Kentucky, and Florida. All JourneyPure facilities offer Medication-Assisted Treatment (MAT) in combination with counseling and behavioral therapy to provide an effective, holistic approach to treatment.

Highest Judicial Honor Bestowed on Tennessee Judge for Work on Opioid Crisis

Tennessee Judge Duane Slone is the 2019 recipient of the National Center for State Courts’ (NCSC) William H. Rehnquist Award for Judicial Excellence, one of the highest judicial honors in the country. Judge Slone, of the Circuit Court in the Fourth Judicial District, is being recognized for Judge Duane Slone his ground-breaking

work helping people with opioid use disorder. The award will be presented to Judge Slone by the Chief Justice of the United States John G. Roberts, Jr. during a ceremony at the U.S. Supreme Court November 21. He is the first Tennessee judge to win the prestigious award. Combatting the opioid epidemic is not just a professional commitment for Judge Slone. It’s personal. In 2011, he and his wife, Gretchen, adopted an infant son who was born suffering from withdrawals as a result of his birth mother’s opioid use. “That’s when I did a deep dive into this problem. I was motivated by Joseph.”  Although he had presided over drug court for years, once Joseph came into his life, Judge Slone gained a much different perspective about addiction. He sought information from medical professionals who explained substance use disorder as a chronic brain disorder. “Simply put, my child’s mother experienced cravings for opioids that were 10 times more powerful than my cravings for food … for Joseph’s mother, her opioid use was a matter of survival,” he said.   This knowledge and understanding has shaped Judge Slone’s approach to helping those who come into his court. “We must understand that addiction is a preventable, treatable condition and people recover. We must go as far upstream as possible, meet people where they are, and provide hope and healing. I believe it is our duty as judges to find a way to help them.” His approach has transformed not only a number of Tennessee courts but other courts around the country. He has created or helped found a number of innovative programs and has partnered with the Tennessee Department of Health to implement a NAS prevention initiative, which has been credited with reducing the incidence of newborns suffering from NAS by as much as 60 percent in the pilot counties. Elected to the bench in 1998, Judge Slone co-founded the Fourth Judicial District Drug Recovery Court in 2009, co-founded a Veterans’ Treatment Track in 2015, and chairs the eight-state Appalachian-Midwestern Regional Opioid Initiative, as well as the Tennessee Judicial Opioid Initiative. He is also a member of the National Judicial Opioid Task Force.

CaredFor, ILC Partner to Support Ongoing Recovery

Nashville-based CaredFor, a mobile app company that helps treatment centers build long-lasting relationships with clients and alumni, has signed Integrative Life Center (ILC) as one of its newest clients. ILC is the eighth treatment center in Middle Tennessee to partner with CaredFor. Offering a full continuum of care for individuals suffering from mental health disorders, substance use disorders, eating disorders, co-occurring disorders, and other addictions, ILC has made client communication and alumni relations

a priority. CEO Ryan Chapman noted, “Reintegration into real life and the real world after treatment improves greatly when alumni are part of a community that welcomes and supports them. We live in a digital world driven by technology, and we knew an ILC app was the best way to further support our clients, their families and our alumni community.” The new ILC app powered by CaredFor includes: • A peer support network where users can post content and engage with other users’ posts, • A recovery counter for tracking anniversaries, • A gratitude journal to record positive life moments, • Quizzes, challenges and other content that encourage user engagement, and • Private messaging among clients and their treatment team. ILC enrolls clients in their app as soon as they begin treatment. Clients use the app to schedule appointments and contact their treatment team between sessions, then transition to alumni status once they complete treatment. Family members are also invited to join so they have a place to ask questions, get support and receive updates about treatment (with client approval). “For someone finding their footing after treatment, there is nothing more important than access to a community that knows them and understands them” said Chapman. “With the ILC app, their peer support network and ILC family is just a click away.” CaredFor CEO Parker Polidor said the platform allows important relationships built during treatment to continue. “CaredFor helps the treatment center extend that shared experience beyond the physical walls and build a community that wants to help one another succeed,” he said. Additionally, he noted, “Every treatment center wants to tout long-term success to prospective patients and payers. CaredFor provides the engagement data and assessments that help measure the outcomes and success of treatment programs.” Currently, CaredFor is being used by 12,000 users at 75 treatment centers in 20 states and Canada.

ReVIDA, 180 Health Partners Work Together to Address NAS

Lee Dillworth, CEO of Nashvillebased ReVIDA Recovery Centers, recently announced a new partnership with Franklin-based 180 Health Partners to address Neonatal Abstinence Syndrome (NAS). ReVIDA and 180 Health Partners, a hybrid care provider using a relationship-based model to help opioid-exposed expecting mothers deliver healthy babies, will coordinate care for expectant moms at all seven ReVIDA locations in East Tennessee and Southwest Virginia. (CONTINUED ON PAGE 15)

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The Faces of Opioid, continued from page 1 coworkers, neighbors – and also show what people are doing in their communities to combat the problem,” said TDH Commissioner Lisa Piercey, MD, MBA, FAAP. “We are so grateful to those sharing their stories as a way to give hope to others who may be struggling with substance abuse and Dr. Lisa Piercey connect people with resources in their communities.” While no state in the country is immune to the devastating effects of the opioid epidemic, Tennessee has been particularly hard hit. The state routinely ranks among the highest for opioid prescribing and overdose deaths. The National Institute on Drug Abuse tallied 1,268 overdose deaths involving opioids in Tennessee in 2017 compared to less than 200 in 2002. The most recent figures put the rate of overdose deaths at 19.3 per 100,000 people in Tennessee, which is above the national rate of 14.6 deaths per 100,000. “We want to reduce stigma against

those struggling with substance with patients,” she noted. “The abuse and help people undersite also provides information stand the disease of addiction on community-based resources can happen to anyone,” Piercey including safe drop-off sites for continued. “We are reaching unwanted or expired medication tens of thousands of Tennessethat are available in every county ans by sharing these stories on across the state.” our website and social media Piercey said the feedback platforms, and the reactions thus far has been positive as include an outpouring of supthe stories seem to really resoport for those who are in recovnate with those who have seen ery from substance abuse,” she the campaign. The “Tennessaid. see Faces of the Opioid Cri“We also want to empower sis,” which is scheduled to Tennesseans to be part of the run through the end of this solutions by helping connect month, includes public service them with resources in their announcements, posters, and communities,” she continued. digital videos sharing personal “Everyone can be part of the perspectives from a variety of solution to this problem.” viewpoints including those batOf course, Piercey added, tling addiction, family members, providers play a large role in providers and community advocombating the problem and cates. connecting patients to available Vanderbilt Emergency Medicine Physician Dr. Tyler Barrett knew the dangers To read the stories supports. “We invite provid- of opioids at work. As a parent and president of the Nashville Youth Hockey and learn more about the ers to visit our campaign web- League, he was surprised to learn of the increased usage risk for young athletes. campaign and communitysite TNFacesofOpioids.com. based resources, go online to public service announcement videos to share They can request materials including our TNFacesofOpioids.com.

New Data Shows Continued Decline in Opioid Prescribing The 2017 Tennessee Opioid Summary by the National Institute on Drug Abuse found the state had the third highest prescribing rate for opioids in the nation in 2017 with 94.4 opioid prescriptions written per 100 people. While still 1.5 times higher than the national average, the report noted the 2017 prescribing rate represented a 25 percent decline since 2013, according to statistics from the Centers for Disease Control and Prevention. A more recent report released this summer by IQVIA tracked a 13.3 percent decrease in opioid prescriptions in Tennessee between 2017 and 2018, and a 32.3 percent drop in the five-year period since 2013. Additional state-by-state data from the American Medical Association Opioid Task Force also showed a dramatic increase in the number of queries to Tennessee’s Controlled Substance Monitoring

Database (CSMD), rising from 8.6 million in 2017 to 11.4 million in 2018. The CSMD is used to identify and address overprescribing and prevent patients from “doctor shopping” for prescriptions. According to the AMA report, CSMD queries in Tennessee have increased every year since 2014, when state officials reported 5 million queries. Nearly 51,000 physicians and other healthcare providers are now registered to use the Tennessee CSMD, up from about 39,000 in 2014. “Our focus in the Tennessee medical community for the past several years has been – and continues to be – controlling what we can control with opioid prescribing and getting better at non-opioid pain management,” said Elise C. Denneny, MD, a Knoxville otolaryngologist and president of the Tennessee Medical Association. “We continue to focus on appro-

Addressing Addiction, continued from page 14

ReVIDA physicians and counselors will work with patients at their facilities while 180 Health Partners uses its StrongWell approach to care for substance-exposed mothers and build relationships with them. StrongWell delivers structured prenatal care as it supports pregnant women on their path to recovery by reducing the risk or decreasing the severity of NAS. “180 Health Partners is reducing the number of babies who suffer with NAS through its integrated care model that builds supportive care communities, nashvillemedicalnews

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stabilizes social determinants of health, and fills the gaps in care that substanceexposed mothers often face” said Justin Lanning, 180 Health Partners president and CEO.  “It’s often said that it takes a village to raise a child, and through our partnership with 180 Health Partners, ReVIDA is dedicated to helping expecting mothers reclaim their lives from opioid use disorder and protect their child at the same time,” added Dilworth.

priate opioid reduction while creating best team-led practices to address pain. This data affirms that we are moving the needle in the right direction and progressing in areas where physicians can make a real difference fighting the epidemic.” TMA, which helped lead the way Dr. Elise. Denneny in changing the prescribing educational requirements for Tennessee physicians, offers a number of proprietary opioid and pain management resources for doctors and other prescribers at tnmed.org/opioids.   While working to decrease excess

prescribing practices, the physician organization has also advocated for balance in laws and corporate regulations that might limit access to opioids for patients in need. Most recently, TMA has challenged the controlled substance policy at Walmart and Sam’s Club, sending a letter to the company’s compliance department and lodging a complaint with the Tennessee Board of Pharmacy after hearing from several physician members that opioid prescriptions were being denied. TMA maintains Walmart’s policy to restrict initial acute opioid prescriptions shouldn’t be applied to certified pain management specialists treating chronic pain with controlled drug prescriptions, as long as those specialists remain in compliance with applicable state and federal laws.

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Tivity Health Conference Promotes Innovation in Healthy Aging By CINDY SANDERS

areas and technology replaces face-to-face On Aug. 14, interaction. Donato Tramuto, Couric noted she CEO of Tivity is currently exploring Health and cothe idea of a documenfounder of Health tary on social isolation eVillages, welcomed and the lack of comnearly 250 attendees munity that crosses age to the Omni Nashand geographic boundville Hotel for the aries. Asked if she’d Third Annual Conever felt lonely, Counectivity Summit on ric quickly responded, Rural Aging. The “Of course I’ve been 2019 programming Tivity Health CEO Donato Tramuto leads a conversation with broadcast icon and author Katie Couric lonely!” She said she focused on demyslost her husband at the tifying the social age of 41 and experideterminants of health through two days said Tramuto. “Our annual summit serves enced both profound sadness and loneliof panel discussions, fireside conversations, as a driver for change and a forum for key ness in the aftermath, but she added lonely interactive roundtables and shared stories. stakeholders to engage to spark innovation experiences also happen in personal and Launched in 2016, attendance at and strengthen existing solutions to supprofessional moments throughout life. the conference has grown three-fold as port those aging in rural areas.” In the wake of her husband’s death diverse stakeholders gather to address the On day one, award-winning broadfrom colon cancer, Couric famously formidable barriers impacting an aging cast journalist and author Katie Couric helped break down taboos and start a conpopulation. The MIT AgeLab and Jefferjoined Tramuto for a fireside conversaversation by undergoing a colonoscopy as son College of Population Health joined tion on pressing issues facing seniors and part of her national morning show. Just Tivity and Health eVillages in hosting the the larger community. Calling loneliness by telling people’s stories, she said it’s pos2019 summit. a national crisis and the new “chronic sible to spark change. “I think people want “Tivity Health is uniquely posicondition of the 21st century,” Tramuto to have an emotional connection, and tioned to address critical health factors for said technology and human mobility they’re craving it,” Couric said. “I think seniors, including inactivity, food insecuhave exacerbated the issue for many rural step one is talking about it, and step two is rity and social isolation and loneliness,” seniors as children move away to urban giving people hope.”

Readily admitting to being a ‘Pollyanna’ even in a historically divisive time, Couric said she thinks hope is happening on a grassroots level, particularly as people are losing faith in big institutions. “People are instead going into their communities and saying, “Where can we change things in our own backyards? We can’t wait for the government to fix all our problems. We need to actually step up and create solutions ourselves.’ I find that to be an incredibly important development, and it fills me with hope,” she stated.

A Deeper Dive in October More information on the conference and insights from panelists and participants are coming in the October issue of Nashville Medical News as part of our senior health focus. While the conference concentrated on rural health settings, so many of the lessons shared are applicable in urban settings, as well – from addressing social isolation and other barriers to optimal health to innovative programming that helps seniors age well in place.

State on Lookout for Hep A, VapingAssociated Respiratory Illness The Tennessee Department of Health (TDH) is on the lookout for additional hepatitis A cases and also asking healthcare providers to be alert to serious respiratory illness that might be tied to vaping devices.

Hep A

TDH and numerous state and local partners, including the Metro Department of Public Health, continue to investigate and respond to a large, multi-state hepatitis A outbreak. More than 2,300 cases of hepatitis A have been confirmed in Tennessee, including 13 resulting in patient deaths. As of late August, there have been 223 confirmed cases in Davidson County. “The Tennessee Department of Health, metro health departments, jails and many other community partners are working every day to ensure people at high risk of infection with the hep A virus are vaccinated to prevent more illness and save lives,” said TDH Commissioner Lisa Piercey, MD, MBA, FAAP. The liver infection caused by virus can be transmitted through contact with feces or consumption of contaminated food or water. However, the groups most at risk for hepatitis A in the current outbreak include people who use recreational drugs, men who have sex with men 16

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and people experiencing homelessness. “It’s critical for people in these high-risk groups to receive the hepatitis A vaccine to protect themselves and others around them,” said Tennessee Immunization Program Medical Director Michelle Fiscus, MD, FAAP. “We know this vaccine is safe and effective.”  Local health departments are offering free hepatitis A vaccine for people in highrisk groups. For more information about Tennessee’s response to this outbreak, go online to tn.gov/health/cedep/tennesseehepatitis-a-outbreak.html. 

Vaping-Associated Respiratory Illness

TDH is asking healthcare providers to be on the lookout for any cases of suspected serious respiratory illness they treat among patients who use electronic cigarettes or other vaping devices and to report that information to the state. The Centers for Disease Control and Prevention is investigating a cluster of severe pulmonary disease among people who use e-cigarette delivery systems. By late August, the CDC noted more than 300 severe respiratory cases across 29 states were suspected of being linked to vaping. On Aug. 23, Illinois health officials linked vaping to a patient death from severe lung disease, potentially

making it the first known death tied to the popular smoking alternative according to the Associated Press. Locally, the Monroe Carell Jr. Children’s Hospital at Vanderbilt has begun to see cases with a suspected link to vaping. “In the last six months, we have had four cases here,” said Jacob Kaslow, MD, a secondyear pediatric pulmonary fellow at Children’s Hospital. “We are seeing patients with symptoms that seem out of the ordinary and appear more severe than a respiratory infection.” Kaslow reported seeing patients with shortness of breath, severe pneumonia, lung collapse, coughing up blood and complete respiratory failure, often placing them in the Pediatric Intensive Care Unit. Some patients have recovered while others will have irreversible lung disease. “As a pulmonary department, we are beginning to develop more awareness of the impact that e-cigarettes are having,” Kaslow continued. “Users are inhaling chemicals that are not meant to be inhaled. With cigarettes, it took 40-50 years to see the negative impact. It appears that some of the effects we are seeing with use of e-cigarettes can occur within hours after inhalation while others are developing over months.” With the rapid increase in cases reported across the country, the state anticipates addi-

tional cases of severe respiratory disease will occur here, as well. “We are alerting Tennessee healthcare providers to be on the lookout for patients with severe respiratory symptoms who report vaping in the weeks before they got sick,‘’ said TDH State Epidemiologist Tim Jones, MD. ‘’We expect to find cases of this illness in Tennessee,‘’ Jones continued. ‘’We’ll investigate any cases reported here to look for common factors and collect information on specific components or brands of vaping products that may be the source of the illness.‘’ Across the country, patients have had symptoms including cough, shortness of breath and fatigue, with symptoms growing worse over a period of days or weeks before admission to the hospital. Other symptoms could include fever, chest pain, nausea, abdominal pain and diarrhea. Most of the cases are among adolescents and young adults. TDH issued a public health advisory on the risks posed by vaping, juuling and use of other electronic nicotine delivery products in December 2018 and continues to urge caution to Tennesseans of all ages who use or are considering the use of electronic nicotine delivery systems. For questions about reporting, call TDH’s Communicable and Environmental Disease line at (615) 741-7247. nashvillemedicalnews

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GRAND ROUNDS

Save the Date

Neighborhood Health Annual Breakfast Sept. 26, 2019 City Winery Nashville The annual fundraising breakfast helps Neighborhood Health continue to provide medical, dental, and behavioral health care for over 30,000 patients each year. For more information, go to neighborhoodhealthtn.org. 5th Annual Joint Replacement Symposium September 27, 2019 Omni Nashville Hotel Earn CME credit and gain additional insights into comprehensive care for joint replacement patients at the Fifth Annual ‘A Joint Effort’ symposium on Friday, September 27. Dr. Michael Bolognesi of Duke is the event’s keynote speaker. For more information or to register, go online to TriStarHealth.com/JointEffort. Tea & Conversations Oct. 12, 2019 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. Power of Prevention: Diabetes Awareness Health Expo  Nov. 16, 2019 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.

Long Tapped to Lead THA In late August, the Tennessee Hospital Association (THA) announced Wendy Long, MD, MPH, has been selected as the association’s next president and CEO and will succeed long-time leader Craig Becker, who is retiring after 26 years of service. Long, Dr. Wendy Long who will step into her new role in mid-October, was selected after a seven-month national search. Long most recently served as the director of Craig Becker the Metro Public Health Department for Nashville/Davidson County. She previously held the position of deputy commissioner of the Tennessee Department of Finance and Administration, serving as director for the TennCare program. “I look forward to working with Dr. Long to make the transition period as smooth as possible,” said Becker. “I have had a great working relationship with her over the years, and I know our staff looks forward to supporting her through the onboarding process. Dr.

Groundbreaking News Nashville’s building boom isn’t limited to downtown as new healthcare facilities are in the works to help meet the needs of a growing suburban population. On Aug. 13, Ascension Saint Thomas and Acadia Healthcare broke ground on the construction of Saint Thomas Behavioral Health Hospital at 300 Great Circle Rd. in Nashville’s Metro Center. The 76bed inpatient behavioral health treatment facility is expected to create more than 200 jobs and will have dedicated adult and geriatric units, offering a wide range of programs to better serve these populations. In addition to inpatient acute care, the new facility will feature partial hospiJeffrey Woods, Division President of Acadia. talization programs, intensive outpatient services, traditional clinic services, residential care, and opioid treatment programs.

The project is anticipated to be complete fall 2020.

Rendering of TriStar Brentwood Development nashvillemedicalnews

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Also last month, officials celebrated the groundbreaking ceremony for TriStar Health Park in Brentwood. The new development will offer 120,000 square feet of clinic space and feature primary and specialty care, urgent care, imaging services and outpatient surgery. Located at 1001 Health Park Drive in Brentwood, the project is slated for completion in the fall of 2020.

Long is the best possible candidate given her knowledge and experience in Tennessee. THA has grown significantly in the last 26 years, and I know Dr. Long will take THA to the next level of service for our members and the communities and patients our hospitals serve.In addition to her senior executive role at TennCare, Long held the positions of deputy director and chief medical officer with the agency. She previously was an assistant commissioner for the Tennessee Department of Health, where she oversaw core public health programs administered by the department, as well as the operation of regional and county health departments. Long earned her undergraduate and medical degrees at The Ohio State University and completed a preventive medicine residency and Master of Public Health program at the University of South Carolina. Long is a 2015 Council Fellow, a past president of the Tennessee Public Health Association and a previous Nashville Medical News Women to Watch honoree.

Lamastus Named CFO of TriStar Horizon

Harrison Named Lead of First Tennessee Medical Private Banking in Nashville

Clarksville physician Thomas Ely, DO, FACOFP, FAAFP, has been named president-elect of the American Osteopathic Association. He will lead the national organization as 2020-21 president. Ely has been on the AOA Board of Trustees for the past 13 years and is a past president of the Tennessee Dr. Thomas Ely Osteopathic Medical Association and also served on Tennessee’s osteopathic medical licensing board for nine years. Ely graduated from what is now the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine in Missouri. A commissioned officer in the U.S. Army Medical Corps., he completed a family medicine internship and residency at DeWitt Army Community Hospital in Fort Belvoir, Va. After retiring from the Army in 1988 as a lieutenant colonel, Ely went into private practice in Clarksville and spent a 13-year stint as chief medical officer for Gateway Medical Center.

First Tennessee Bank recently announced the promotion of Matthew Harrison to senior vice president, team lead, private client relationship manager for the company’s Medical Private Banking office in Nashville. Harrison will continue reporting to Andrew Kintz, executive vice president of First Tennessee’s Music Industry Group and Private Client Services division in Middle Tennessee. Harrison, who has 15 years of experience in the banking industry, joined First Tennessee 11 years ago as vice president of Medical Private Banking in Nashville. Harrison earned both his bachelor’s degree and MBA from Mississippi State University. He currently serves as president for the Tennessee chapter of the ALS Association and as an ambassador for the Vanderbilt Ingram Cancer Center.

Last month, TriStar Horizon Medical Center announced the promotion of Marti Lamastus as the new chief financial officer for the 157-bed hospital. With more than 16 years of financial management experience, Lamastus previously served as TriStar Horizon’s controller Marti Lamastus for the past 10 years. She began her career as a staff accountant for TriStar Centennial Medical Center where she quickly advanced to the role of senior accountant. Lamastus then served as assistant controller for TriStar Skyline Medical Center before returning to her hometown of Dickson in 2009 as controller at TriStar Horizon. Lamastus earned her bachelor’s degree in accounting from Lipscomb University and is completing her MBA from the University of North Alabama.

Ely Named AOA PresidentElect

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GRAND ROUNDS

Wishes Granted

Belmont University has been awarded a $1.5 million 2Gen Family Wellbeing Program grant from the Tennes-

PHOTO: JOHN RUSSELL/VANDERBILT PHOTOGRAPHY

see Department of Human Services. Funds from the grant will support the work of the Belmont Ministry Center and the adjacent nonprofit, The Store, in providing local, low income families support through food Pictured (L-R): Kimberly Williams Paisley, Tennessee Department of Human Services Commissioner Danielle W. Barnes, Brad provision, nutritional and pharPaisley and Belmont President Dr. Bob Fisher. macy education, health screenings, legal aid clinics, mental health counseling and music therapy. The Belmont Ministry Center  opened on 12 South last year to offer services to the community while a groundbreaking was recently held for The Store, a free grocery store founded by Belmont alumnus Brad Paisley and his wife Kimberly Williams Paisley. Saint Thomas Medical Partners (STMP) has received a $69,972 grant from Susan G. Komen Central Tennessee. The funding will be used for Our Mission in Motion (OMIM), STMP’s mobile mammography program that has screened 21,111 women at 1,420 events since 2011. In addition, the physician-led medical group was awarded $10,000 from the National Breast Cancer Foundation, Inc. This award will fund biopsies and diagnostic mammograms and ultrasounds for low-income Middle Tennessee women. Vanderbilt University School of Nursing  has received two awards totaling more than $5 million from the U.S. Health Resources and Services Administration (HRSA) to increase the number of nurse practitioners working in rural and underserved communities where there aren’t enough primary care providers. In response to the growing need for mental health services, both awarded programs will have a psychiatric/mental health component (L-R) Vanderbilt School of Nursing faculty Christian Ketel, Courtney Pitts, Leah Branam and Pam Jones will use HRSA that integrates behavioral health grants to increase the number of nurse practitioners in rural and into the primary care setting. The medically underserved areas.

Let’s Give Them Something to Talk About! Awards, Honors, Achievements

Middle Tennessee companies were well represented on this year’s Inc. 5000 list with several of the fastest-growing companies in America being healthcare companies or allied service providers for the industry. Companies included on the list that intersect with the region’s robust healthcare industry were MDSave (#888), Advent Health Partners (#1713), Senior Solutions Home Care (#1827), ProviderTrust (#2073), REN Dermatology (#2441), EnableComp (#2631), Cumberland Consulting Group (#4070), Crosslin Technologies (#4324), Bernard Health (#4503), InfoWorks (#4666), Reliable Pharmaceutical Returns (#4703), and Jones Therapy Services (#4752). Life Credit Union, a notLife Credit Union CEO Pam Tenpenny presenting scholarship to for-profit financial institution Matthew Smith. serving the healthcare industry, recently announced the recipient of the second annual Debbie Jones Memorial Scholarship. Congratulations to Matthew Smith, a graduating senior from Martin Luther King, Jr. Magnet School. He will be attending the University of Tennessee this fall, majoring in Aerospace Engineering. Officials with Fisk University and HCA Healthcare recently announced the creation of HCA Healthcare Scholars at Fisk University. The program will create scholarships and internship opportunities for high-achieving Fisk students. In addition, HCA Healthcare will provide guest lecturers to inform and prepare students who may be considering a career in healthcare. To fund the scholars’ program, HCA Healthcare has committed $1 million over the next four years.

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school received a $2.7 million award to support the development of a learning track within VUSN’s family nurse practitioner  (FNP) program that will focus specific education on serving rural and underserved populations and building collaborations with health agencies. Funded under HRSA’s Advanced Nursing Education Workforce (ANEW) initiative, the Collaborative AcademicPractice (CAP) Program will recruit and graduate a minimum of 60 FNPs over the course of the grant. VUSN’s second HRSA grant will create a primary care nurse practitioner residency program to prepare and increase the number of new nurse practitioners practicing in rural and underserved communities.

Hubmann to Lead Fourroux Communications Jennifer Hubmann has been named corporate marketing and communications director for Fourroux Prosthetics. Previously, she served as marketing director for Hughston Clinic Orthopaedics and prior to that worked in business Jennifer development for a large Hubmann hospital system in East Tennessee. She earned her degree from Tusculum College in Greenville, Tenn. Fourroux, which was founded in 1956 and provides prosthetic services to amputees, is headquartered in Huntsville, Ala., with additional locations in Birmingham, Atlanta, Memphis and the newest location in Nashville. Hubmann will continue to be based in Middle Tennessee.

Alive Appoints Goessele as President & CEO Alive, one of the oldest hospices in the nation and the only nonprofit provider of hospice care and end-of-life services in Middle Tennessee, announced the appointment of Kimberly Goessele as president and chief executive officer effective September 23. Kimberly Goessele In her new role, she will lead two residential and three satellite locations, along with a team of 328 clinical and administrative staff and nearly 450 volunteers. A recognized strategist and innovator in the Nashville healthcare community, Goessele joins Alive from 180 Health Partners, where she served as chief operating officer and led business development and strategy for the nonprofit. She also served as executive director of the 180 Impact Fund, the 501(c) arm of the organization. Previous experience includes leadership positions with Premise Health, W Squared, and Healthways. Following a nationwide search, Goessele succeeds Anna-Gene O’Neal, who led the organization from 2012 to 2019.

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 csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Melanie Kilgore-Hill Cindy Sanders Sandra Long Weaver David A. Weil 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

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Business Briefs

Nashville-based Cumberland Pharmaceuticals Inc. recently announced second quarter results. In addition to year-to-date net revenues being up 25 percent from the prior year period, other highlights included continuation of a company-wide strategic review; expansion of sales team and national territories in support of key brands; finalization of the Vibativ agreements with Hikma Pharmaceuticals LLC for the Middle East, R. Pharma LLC for Russia and the CIS, and Dr. Reddy’s Laboratories Ltd. for India; provision of additional data to the FDA in support of approval submission for a new line of methotrexate products designed for the treatment of patients with arthritis and psoriasis; and completed submission to the FDA in support of an update to the Caldolor approval that included new geriatric, shortened infusion, pediatric, and safety data. Nashville-based Council Capital, a healthcare-focused private equity firm, recently announced it has sold its stake in Atlanta-based EspriGas to an entity affiliated with Kaltroco, a private investment company with operations in both the United States and Europe. EspriGas is a technology and data-driven medical and industrial gas company that utilizes a network business model to manage the gas supply chain. Since Council Capital’s investment in 2013, EspriGas has more than doubled revenue and EBITDA and gained significant traction with customers in the healthcare vertical. Terms of the transaction were not disclosed. LBMC has acquired Think Data Insights, a data analytics firm specializing in business intelligence for healthcare and several other industries. A2H, Inc. has expanded to Middle Tennessee. Earlier this year, the Memphis-based collaborative planning and design firm merged with Brentwoodbased M2 Design Services. The new A2H office, located in Franklin, is led by architect Rick McAllister, who previously founded M2 Design.

Griffith Joins Loven Dermatology

James Griffith, MD, a board-certified dermatologist and Mohs surgeon, has joined the Hendersonville location of Loven Dermatology, which is part of AdvancedHEALTH. Griffith earned his undergraduate degree from the University of Colorado, followed by Dr. james Griffith a master’s in Biology at Mississippi College. After serving as an adjunct professor at Mississippi College, he earned his medical degree from the University of Mississippi School of Medicine and then completed a residency in dermatology and a fellowship in clinical research, lasers and photomedicine at Henry Ford Hospital in Detroit. Griffith also completed a second fellowship in Mohs micrographic surgery and dermatologic oncology, specializing in facial and aesthetic reconstructive surgery. nashvillemedicalnews

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

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