Nashville Medical News Nov 2013

FOCUS TOPICS DIABETES & COMORBIDITIES REIMBURSEMENT

Middle Tennessee’s Primary Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Preventing Type 1 Diabetes

By CINDy SANDERS

Craig Wierum, MD

Civil Rights Pioneer Andrew Young Headlines Event On Oct. 14, Meharry Medical College held its 138th Annual Convocation with civil rights leader Ambassador Andrew J. Young as keynote speaker and recipient of an honorary doctorate degree ... 4

Tennessee Hospital Association Reinventing Tomorrow’s Healthcare Every Day for 75 Years Established in 1938, the Tennessee Hospital Association has adopted the tagline “reinventing tomorrow’s healthcare every day for 75 years” as an ongoing theme for 2013 ... 18

PHOTO BY STEVE GREEN.

ON ROUNDS

Meharry Medical College Celebrates 138th Annual Convocation

November 2013 >> $5

Dr. William Russell talks with participant Ric Hudgins at the Vanderbilt Eskind Diabetes Clinic about a new study examining the ability of the drug abatacept to prevent type 1 diabetes. Hudgins, whose 13-yearold son has type 1 diabetes, noted, “Hopefully trials like these can help researchers find ways to prevent other children from receiving a type 1 diabetes diagnosis.”

What year did researchers discover the cure for polio?

Trick question … a cure wasn’t discovered, but Jonas Salk, MD, developed a highly effective vaccine to prevent polio that was first tested in 1952 and widely introduced in 1955. As a result, the devastating disease has been nearly eradicated worldwide.

Calling upon that same ‘ounce of prevention’ spirit, researchers participating in the international TrialNet studies hope to achieve a similar victory by preventing type 1 diabetes (T1D).

While only about 5 percent of diabetes cases in America are type 1, the Juvenile Diabetes Research Foundation estimates as many as 3 million Americans have T1D. The latest data from the National Institute of Diabetes and Digestive and Kidney Diseases finds more than 30,000 children and adults — approximately 80 people a day — are diagnosed with T1D each year in the United States. Furthermore, the Centers for Disease Control and Prevention identified a 23 percent jump in T1D prevalence rates among Americans under age (CONTINUED ON PAGE 6)

Tax Planning with Rates on the Rise

By JERRy MOSS, CPA & DAVID LISTER, CPA

Your 2013 tax bill might come as an unwelcomed surprise if you haven’t been paying attention to the tax changes that took effect for 2013.

Increased tax rates, brand new taxes and phase-outs of both itemized deductions and personal exemptions hit taxpayers this year. Depending on your income level, each of these changes could take its own bite out of your disposable income.

ATRA Increased Rates & Phase-Outs The good news is that the 2012 American Taxpayer Relief Act (ATRA) extended the Bush-era tax cuts for most Americans. For the past decade under these rules, the top individual income tax rate was 35 percent. The bad news is that, starting in 2013, there will be a new 39.6 percent top individual income tax rate applicable to individuals with adjusted gross income (AGI) over $400,000 and married couples whose AGI is over $450,000.

(CONTINUED ON PAGE 10)

ONLINE: NASHVILLE MEDICAL NEWS.COM

Saint Thomas Heart to Offer New Alternative to Open-Heart Surgery Learn more on page 5

PRINTED ON RECYCLED PAPER

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

REGION NS SM MALL BUSINESS Name e:

Com omp pan p any: y

PROMPT AND PERSONAL – IT’S HOW REGIONS KEEPS THE WHEELS OF PROGRESS TURNING FOR SMALL BUSINESS. Dr. Susana Leal-Khouri began her relationship with Regions in 1996 at the suggestion of her personal accountant. She was just starting her private practice, the Miami Dermatology Center, and needed to furnish the offices. “Regions has been very helpful in allowing us to be able to start and grow the practice. They’ve also helped make it possible for us to hire the right people,” says Dr. Leal-Khouri.

“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.

Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

Loans | Checking | Savings | Treasury Management | Wealth Management © 2013 Regions Bank. All loans and lines subject to credit approval.

2

>

NOVEMBER 2013

nashvillemedicalnews

.com

PhysicianSpotlight

On the Frontline of the Diabetes Epidemic Craig Wierum, MD: Director of Heritage Diabetes Center

By KELLY PRICE

hili.

Lala salama means “sleep well” in Swa-

This was just one of many things that Craig Wierum, MD, learned while living with a Maasai tribe during a junior year abroad program in which he participated as an undergraduate at Duke University.

The other semester of that year was spent in Great Britain studying literature and theater. Wierum even appeared on a London stage, sporting a British accent, in the lead role in a Tom Stoppard play produced by the college.

International relations have always been part of Wierum’s DNA. He grew up just outside New York City in Demarest, N.J. with a father who was an internal medicine physician and a mother who hailed from New Zealand. Wierum’s Kiwi heritage gives him dual citizenship.

Throughout his schooling, he excelled in science and math. Although initially pursuing a college path towards literature and theater, he ended up focused on medicine. After graduating magna cum laude from Duke, Wierum chose a career with specific interests in neuroscience at the University of North Carolina School of Medicine. In 1990, he came to Nashville for internship and residency at Vanderbilt University School of Medicine and served as chief resident for the University of Tennessee Residency Program at Baptist Hospital (now Saint Thomas Midtown).

Upon completion of his training in endocrinology, diabetes and metabolism, Wierum was appointed director of the Baptist Diabetes Center and hired as a full-time faculty member for the UT Residency program, where he taught and practiced for nine years.

In 2004, Wierum moved into private practice with Heritage Medical Associates and now serves as director of the Heritage Diabetes Center. His focus is on one of this nation’s most troubling health dilemmas — the epidemic proportions of the growth in the incidence of diabetes in this country.

Wierum noted the increase in the diagnosis of diabetes directly parallels the nation’s obesity epidemic. Currently, it is estimated that more than 26 million people in the U.S. have diabetes, and another 80 million are on the cusp of developing the disease.

Wierum observed, “The reasons are multifactorial but center mostly around three major factors: decreased physical activity, a high carb diet, and epigenetics.

This latter phenomenon is the most alarming. It means that an obese mother with nashvillemedicalnews

.com

Wierum with Maasai friends during his junior year abroad.

insulin resistance will actually program her unborn child to become insulin resistant, overweight and diabetic.”

He continued, “If the same woman delivers a second child after 50-100 pounds of weight loss, she will deliver a child with normal glucose tolerance and a much lower risk of diabetes. In other words, this epidemic is actually feeding itself.”

Wierum added, “This is one of the reasons we are witnessing such an epidemic of ‘adult’ diabetes presenting in children.”

Since he began practicing, the armamentarium to fight diabetes has increased.

“When I started, we had only two classes of drugs, insulin and sulfonylureas. There are now 12 classes of drugs for the treatment of diabetes,” Wierum said.

He added. “The Heritage Diabetes Center uses state-of-the-art technology to help our patients trace and treat their diabetes.” Technology to assist patients includes the use of implantable glucose sensors, insulin pumps, disposable insulin pumps, insulin pens, and a large variety of glucose meter devices. Advances in drug therapy and device technology have dramatically enhanced the quality of life for diabetic patients by helping to minimize injection discomfort, minimize weight gain associated with older therapies, and prevent life-threatening low blood sugars, Wierum noted.

“For the Heritage Diabetes Center, the continuous glucose monitoring system (CGMS) has been one of the most helpful tools in our management of patients on insulin. It has allowed us to monitor glucose levels every few minutes, 24 hours a day.

This has taught us a tremendous amount of information about the effect on blood sugar that is caused by various meals, exercise routines, alcohol and sleep. We have discovered that some patients were having severe low blood sugars overnight that might have led to coma, seizures, or even death if left unrecognized and untreated,” he said.

“Changing human behavior is the hardest thing we attempt to do every day.

Fortunately recent advances in drugs, technology and laparoscopic obesity surgery have allowed us to help many patients who struggle to change their behavior.

Meanwhile, we have also learned that fear of complications is rarely the best motivation for many patients. On the contrary,

we have been able to motivate patients by taking the time to make sure they understand that we care about them … not just their labs or their numbers. It is repeated often and understood by all my staff that the greatest service we provide to our patients is to make them feel cared for,” he stressed.

Wierum observed, “Today’s residents, interns and students work shorter hours than they did during my training in the 1980s and 1990s. As a result, they are often unprepared for the reality of medical practice, which has no such restrictions.”

His advice to young doctors is to “always make the patient feel cared for … even if you are tired, frustrated, and irritated by non-compliance.” He added, “Always be kind and always be fair to your patients and your staff. Nobody wants to be sick, and not everyone deals with it gracefully.”

When he isn’t caring for patients, Wierum loves spending time with his wife and two busy, beautiful daughters, ages 12 and 14. He also heeds his own advice to patients about finding balance and good health. His personal prescription is to carve out time for reading, running, biking, and woodworking.

NOVEMBER 2013

>

3

Meharry Medical College Celebrates 138th Annual Convocation Civil Rights Pioneer Andrew Young Headlines Event On Oct. 14, Meharry Medical College held its 138th Annual Convocation with civil rights leader Ambassador Andrew J. Young as keynote speaker and recipient of an honorary doctorate degree.

“Andrew Young is one of the finest public servants this country has ever known,” said A. Cherrie Epps, PhD, president and CEO of Meharry Medical College. “We are honored to have him join us to formally launch our new school year and welcome students to this new academic year.”

Under President Jimmy Carter, Young became the 14th U.S. Ambassador to the United Nations and the first African-American to hold that post. He also served two terms as a U.S. Congressman from Georgia and eight years as mayor of Atlanta. Young, alongside Dr. Martin Luther King, Jr., played a major role in the Civil Rights Act of 1964 and in the passage of the Voting Rights Act of 1965.

Reminding Meharry students of their call to the medical profession and their ability to bring about change, he said, “You’re in one of the most exciting professions on the face of the planet. God has blessed you to be born at such a time as this.”

The son and brother of dentists, Young told Meharry’s dental students that the U.S. Congress should have addressed dentistry in the Affordable Care Act. “But it’s not too late,” he said. “The fun hasn’t started yet. Nobody ever thought that President Obama could get that (ACA) passed … and then when he got it passed, they never thought that he could get reelected, and he’s done that … and they can’t figure out what to do next.”

During the ceremony, a formal portrait was unveiled to honor the presidency

(Left): Andrew Young addresses the 138th Annual Meharry Convocation.

(Below left): Dr. Henry Wendell Foster admires his portrait.

(Below center): Dr. Byron Ford accepts his award for distinction in the biomedical sciences.

(Below right): Dr. Charles Mouton (L), dean of the School of Medicine, presents Dr. Arikana Chihombori with the award for distinguished physician.

of Henry Wendell Foster Jr., MD, whose career has been dedicated to fighting for healthcare equality for disadvantaged populations and to improving the quality of life for women and children. Foster is professor emeritus of the Department of Obstetrics and Gynecology and former dean of the Meharry School of Medicine. Additionally, five prominent leaders who have helped promote quality healthcare, especially for the underserved, were honored.

Rueben C. Warren, DDS, MPH,

omen W to WATCH

2014

Our annual

Women to Watch issue and event is coming in April 2014, and we want your input on women in Middle Tennessee that are impacting healthcare on a local, state or national level.

Clinicians, researchers, administrators, policy makers and allied industry suppliers who are changing the way we deliver care are all eligible.

4

>

NOVEMBER 2013

DrPH, MDiv, professor and director of the National Center for Bioethics in Research and Health Care at Tuskegee University and the former dean and associate professor of the Meharry School of Dentistry, received an honorary degree.

Dorothy Burton Berry, the first African-American female to hold the offices of assistant commissioner, deputy commissioner and commissioner of the Department of Personnel for the State of Tennessee, was awarded the Presidential

Presented by:

Call For Nominations!

To nominate, please go online to: nashvillemedicalnews.com and click the Women to Watch icon.

NOMINATION DEADLINE: FEBRUARY 10, 2014 For advertising and event sponsorship opportunities, please contact Tori Hughes, 615.844.9410 or thughes@southcomm.com

Distinguished Service Medal.

Arikana Chihombori, MD, FAFP, president and CEO of Bell Family Medical Centers, received the Axel C. Hansen, MD, ’44 Distinguished Physician Award.

William B. Butler, DDS, MS, FACP, former dean of the Meharry School of Dentistry received the Fred. C. Fielder, DDS, ’60 Distinguished Dentist Award.

Byron Ford, PhD, professor in the Department of Neurobiology and the director of the Neuroprotection, Neurorepair and Stroke Program at the Morehouse School of Medicine, received the Harold D. West, PhD, Distinguished Biomedical Scientist Award.

Following the convocation, Meharry marked the rededication ribbon-cutting ceremony and open house of Hulda Margaret Lyttle Hall, which served as a home to Meharry’s School of Nursing until its closing in 1962. One of the oldest buildings on Meharry’s campus, Lyttle Hall was built in 1930. In 1998, the structure was listed on the National Register of Historic Places. The building, which now houses office space, has been recently renovated.

“Meharry is an institution growing to better serve the city of Nashville and communities across our nation,” concluded Epps. “Our students, faculty and alumni share a dedication to serving and treating those whom no one else will. Convocation is a time for us to recognize their dedication and accomplishments and demonstrate our appreciation for their service to their communities.” nashvillemedicalnews

.com

Saint Thomas Heart to Offer New Alternative to Open-Heart Surgery Saint Thomas Heart has become the first center in TN to have the MitraClip available, as part of a national clinical trial, for patients with congestive heart failure (CHF) and mitral regurgitation (MR).

MR is the most common type of heartvalve insufficiency in the United States, affecting approximately 4 million people.

The MitraClip is a small metal clip that helps patients with mitral regurgitation (MR), a condition in which the heart’s mitral valve leaflets do not close tightly, causing blood to leak into the heart’s left atrium. The condition can lead to advanced heart failure.

This new treatment expands the options for selected patients with MR, especially those who are not candidates for invasive open-heart surgery. The procedure allows doctors to use catheter-based technology to repair the mitral valve via a groin puncture without requiring patients to undergo cardiopulmonary bypass or the need for traditional chest incisions.

The MitraClip procedure shortens recovery time and ultimately improves quality of life for those experiencing life-altering symptoms like fatigue and shortness of breath.

With MitraClip and the recently introduced transcatheter aortic valve replacement (TAVR) procedure, Saint Thomas Heart’s Cardiac Team is now able to treat a number of serious heart conditions using the least invasive techniques available.

“This is the first time that we’ve had the ability to manage these very complex patients who are too ill to undergo open heart surgery,” said Dr. Evelio

Rodriguez, Director of Minimally Invasive and Robotic Cardiac Surgery at Saint Thomas Heart. “In the past, the only option to help patients with congestive heart failure was to band-aid the symptoms with medication. This is a huge opportunity to increase the health and quality of life for many patients.”

During the MitraClip procedure, our interventional cardiologists use traditional catheter methods to guide the clip into the left atrium. The clip is lowered and attached to the valve to repair or reduce MR. Before final placement, the clip can be moved and rotated to ensure optimal fit.

The new MitraClip trial is a great complement to Saint Thomas Heart’s ongoing transcatheter aortic valve replacement (TAVR) program, which helps patients with severe aortic stenosis, narrowing of the opening of the aortic valve in the heart. During this procedure, a replacement valve is inserted through a catheter and implanted within a diseased aortic valve, allowing for valve replacement without traditional open-heart surgery and while the heart is beating, therefore also avoiding cardiopulmonary bypass.

It is the only valve replacement option for patients with severe aortic stenosis who are not well enough to undergo traditional open-heart surgery. Without surgery, 50 percent of symptomatic patients with severe aortic stenosis will die within an average of two years if untreated.

For more information about transcatheter aortic valve replacement (TAVR) or the MitraClip national clinical trial at Saint Thomas Heart, call the Saint Thomas Heart Valve Center at 855.789.2593.

Saint Thomas MitraClip Clinical Trial - YouTube

http://www.youtube.com/watch?v=mC-hSxksR3k&feat...

To learn more about MitraClip, use a free QR code reader on your smartphone. http://kaywa.me/nvrh5

Download the Kaywa QR Code Reader (App Store &Android Market) and scan your code!

nashvillemedicalnews

.com

NOVEMBER 2013

>

5

Preventing Type 1 Diabetes, continued from page 1 20 between 2001 and 2009.

Whereas type 2 diabetes can often be prevented, delayed or even reversed through behavioral modifications in diet and exercise, T1D is an autoimmune disorder that doesn’t fundamentally respond to the same types of external interventions (although nutrition and exercise still play a critical role in disease management). In type 1 diabetes, the body’s immune system destroys the insulin-making beta cells in the pancreatic islets.

William E. Russell, MD, director of Pediatric Endocrinology & Diabetes for the Monroe Carell Jr. Children’s Hospital, directs they Type 1 Diabetes TrialNet program at Vanderbilt Eskind Diabetes Clinic, which is one of 14 North American clinical center sites. He also is protocol chair for the latest international TrialNet T1D prevention study on abatacept, which will soon include sites in Australia, England, Finland and Italy. In addition to the 18 clinical centers worldwide, more than 150 physician offices and medical centers are part of the larger screening effort and TrialNet consortium.

“The mission of TrialNet is to find ways to prevent type 1 diabetes,” stated Russell. “It starts as an immune system problem. The endocrine system is one of its targets,” he continued. “We’re looking at how to turn off the immune attack on the beta cells in the pancreas.”

Russell noted, “People often think that screening for type 1 diabetes risk factors is unimportant because there is

currently nothing that can be done to mitigate their risk level for type 1 diabetes.” However, he continued, TrialNet provides hope that researchers might one day find the right mechanism to prevent, or at least significantly delay, T1D in high risk populations.

Pathway to Prevention

There are three major T1D prevention studies that are part of TrialNet. The entry point to all three begins with a T1D autoantibody screening panel in the Pathway to Prevention study. Qualified participants must be between the ages of one and 45 and have a blood relative with T1D. From ages one to 20, it can be any blood relative with the disorder. From 2145, participants must have a first degree relative with T1D. After meeting the initial inclusion criteria, Russell said clinicians draw blood from potential participants and screen for five different antibodies, which can be present in the blood up to a decade before diabetes is diagnosed. A positive result for any one of the five antibodies significantly increases the chance of developing T1D, and Russell said the more positive responses, the quicker the progression to the autoimmune disorder.

“People with two or more (autoantibodies) have close to 100 percent lifetime risk of developing type 1 diabetes,” he said. ”And if you have three or four, it’s going to be a more rapid progression to diabetes.”

Are you stIll AskIng…

Why am I working harder,

but my practice is earning less?

Oral Insulin Trial

Answers.

When It Counts.

And it always does.

• Practice & billing office assessments • Reimbursement consulting • Tax consultation & preparation • Financial audit & assurance services • Budget assistance & profit planning 1114 17th Avenue South Nashville, TN 37212

615.320.0225 www.clcpas.com

Lucy R. Carter, CPA

6

Sara S. Lankford, CPA

CL ad_4.875x6.375_2011_v3.indd 1

>

NOVEMBER 2013

For those who test positive, the next step is a confirmatory lab test where the autoantibody screening panel is repeated.

Clinicians also run a number of other tests including hemoglobin A1C, oral glucose tolerance and HLA (human leukocyte antigen) typing.

“At that point, we’ve identified multiple people who had type 1 diabetes and didn’t know they had it,” Russell said, noting those patients were then immediately referred to a physician for active disease management. “Several have been the parent of a child with T1D and were well outside the traditional age range thought to be vulnerable to developing type 1 diabetes. This study is helping redefine the profile of the ‘typical’ T1D patient,” he continued.

Those with only one autoantibody are monitored annually or semi-annually, depending on the results of the additional screening tests. For those who tested positive for two or more antibodies but did not yet have T1D, the potential participants have several options: opt not to participate in a trial but be followed and monitored every six months, drop out of the study completely, or enter one of the three trials based on which entrance criteria was met.

“Two of the three trials are aimed at antibody-positive individuals with normal glucose tolerance, indicating there has been no significant pancreatic damage yet,” said Russell. “The third one is for people who have two or more antibodies and abnormal glucose tolerance but are not yet in the diabetic diagnostic range.

This is a particularly high-risk group. The glucose tolerance abnormalities reflect significant beta cell loss, and these individuals have an 85 percent likelihood of developing T1D in the next five years.”

All three studies are placebo-controlled and double blinded, and all of the trials are still recruiting participants.

The longest-running trial, which launched in 2002, is the oral insulin trial.

“We’re testing the hypothesis that if you deliver insulin by mouth you might make the body more tolerant of insulin and turn down the attack on the beta cells,” Russell explained. He added the idea of taking insulin in a capsule form, which is broken down in the stomach, is that the body will view it more like food rather than as a foreign substance to defend against.

“To qualify, one of the five antibodies tested positive for must be the antibody against insulin,” he noted. Russell added this trial is for those who still have normal glucose tolerance.

Half the patients receive the insulin capsule and half a placebo powder. Patients are then followed until they develop diabetes. Russell said the trial’s endpoint will be when the statisticians, who are the only ones who know which patients are in the active arm, determine the oral insulin demonstrates a statistical difference in developing or delaying T1D … or not.

However, he added, pilot human studies and mouse model studies have suggested oral insulin might make a difference in

delaying onset.

Abatacept Trial

Inclusion criteria for this trial include the presence of at least two autoantibodies and a normal glucose tolerance. However, the potential participant cannot be positive for the insulin autoantibody. In that case, the individual would be referred to the oral insulin trial.

The abatacept (brand name Orencia®) trial is the newest one for TrialNet and rolled out this summer. Also known as CTLA-4 Ig, abatacept was first approved by the Food and Drug Administration in 2005 for treatment of other autoimmune disorders, chiefly rheumatoid arthritis.

“It’s a molecule that has been engineered and blocks the activation of T lymphocytes … the T cells are the ones that do the dirty work,” Russell said of CTLA-4 Ig. Because T cells are critical to those fighting certain viral diseases including HIV, hepatitis and Epstein-Barr, potential participants are carefully screened for the presence of such conditions before being approved for the study. Safety labs and continual monitoring for diseases that compromise the immune system occur throughout the active portion of the trial.

Participants are given abatacept or placebo intravenously for 14 treatments over a year’s time. Those who pass the safety screens are given an infusion on the first day of their regimen, a second infusion two weeks later, a third one two weeks after that, and then monthly infusions for the balance of the year. After the active treatment phase is completed, participants are followed every six months with safety labs and an oral glucose test.

Russell said the trial design is a bit different for this arm of TrialNet. “In the abatacept study, we said, ‘Let’s not make diabetes our endpoint. Let’s make abnormal glucose tolerance our endpoint,’” he noted. “Once you have abnormal glucose tolerance, you have an 85 percent chance of progressing to type 1 diabetes within five years. This will shorten the duration of the study considerably,” Russell continued of the surrogate marker.

Anti-CD3 mAB Trial

The third trial is for those who have two autoantibodies of any kind and an abnormal glucose tolerance. In July 2011, Vanderbilt became the first to enroll a patient in the teplizumab TrialNet prevention study. However, Russell noted, the drug has been studied in conjunction with diabetes in other trials since the early 2000’s.

He added both abatacept and teplizumab have been used in active intervention trials for those newly diagnosed with T1D. “Both of these drugs have been shown to be effective at slowing down the further loss of beta cells even when the damage has been great enough to cause diabetes.”

Teplizumab, which is not currently on the market for any other medical disorder, is a monoclonal antibody that at(CONTINUED ON PAGE 7)

11/21/11 3:53:56 PM nashvillemedicalnews

.com

Early Warning System: Researchers Identify Diabetes Risk Biomarker

By CINDY SANDERS

What if a simple blood test could provide information that your patient had a significantly elevated risk of developing diabetes within the next decade? What might that mean from the standpoint of early intervention and prevention? While it’s much too soon for this type of clinical application, researchers at the Vanderbilt Heart and Vascular Institute (VHVI) and Massachusetts General Hospital have identified a novel biomarker that lends itself to such intriguing questions.

Led by Thomas J. Wang, MD, director of the Division of Cardiovascular Medicine at Vanderbilt and physician-in-chief for VHVI, the team recently published results of their discovery of elevated 2-aminoadipic acid (2-AAA) as a precursor to diabetes in The Journal of Clinical Investigation. Tapping into the rich data source of the Framingham Heart Dr. Thomas J. Wang Study, which is now following its third generation of participants, the Wang research team studied blood samples gathered more than a decade ago from 188 individuals who ultimately developed type 2 diabetes and 188 who did not develop diabetes.

Using these blood samples, the in-

vestigators were able to compare levels of metabolites to see if there were any differences between the group that went on to develop diabetes and the group who did not. Wang noted newer technology now makes it possible to profile hundreds of metabolites at one time.

“One of the things that really lit up when we looked at the people who developed diabetes was 2-aminoadipic acid,” he said. “Having elevated levels of 2-AAA predicted risk above and beyond their blood sugar at baseline, their body weight, or other characteristics that put them at risk.” Wang added there doesn’t appear to be a specific threshold of risk at this point … the higher the levels of 2-AAA, the higher the risk of developing diabetes.

In fact, those in the top quartile of 2-AAA concentrations had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared to those in the lowest quartile.

Interestingly, the researchers found 2-AAA might not be just a passive marker.

As part of the same study, the team conducted mouse model testing and discovered giving 2-AAA to the mice actually altered the way the animals metabolized glucose.

“It suggests the molecules might be playing a direct role in how the body processes glucose rather than being an innocent bystander in the process,” Wang said.

He added that elevated levels of 2-AAA don’t necessarily mean the molecule is bad for the body. Instead, it could be a defense mechanism where the body is producing higher levels to fight risk from another, as yet unknown, source.

Figuring out the metabolite’s exact role in the functioning of pancreatic cells is one area for future research. If, indeed, 2-AAA turns out to be a defense mechanism to stave off diabetes, the good news is that the metabolite could be given to humans in the form of nutritional supplements. On the other hand, if 2-AAA turns out to be harmful to the body’s glucose regulation system, further research could reveal methods to lower the metabolite’s presence.

Wang was quick to say the next step is to conduct additional research to measure 2-AAA in other human populations outside of the Framingham study through both retrospective and prospective studies. More in depth animal model studies are also in the pipeline. “A lot of the effort will be focused on trying to understand the biologic effect of 2-AAA in developing diabetes,” he said of the work going forward.

However, Wang said the current research results at least raise the possibility

that somewhere in the future knowing how high a person’s circulating 2-AAA levels are could impact clinical practice by allowing providers to adopt a more aggressive intervention posture among those at highest risk, whether that be through exercise, weight loss or pharmacologic measures. It is conceivable that 2-AAA might be the type of red flag for diabetes that high cholesterol is for heart disease.

“Understanding why diabetes occurs and how it might be prevented is a very intense area of investigation because of the serious consequences of having the disease,” Wang said. “Down the road, this might be one part of the armamentarium of tests that could be considered. If this were proven useful in further studies and could be used clinically, it would be an easy test to administer.”

As for the impact of the findings right now, Wang added, “In 2013, it highlights a specific pathway that might be related to diabetes risk that we previously didn’t know about.”

Considering the prevalence of type 2 diabetes and growing obesity epidemic in the United States, that is an important lead for researchers working to develop strategies to interrupt the disease progression and stop risk from becoming a reality.

Preventing Type 1, continued from page 6 taches to the CD3-epsilon chain that is expressed in mature T lymphocytes. The T lymphocytes monitor the destruction of the insulin-producing beta cells. The hypothesis is that teplizumab might modulate the immune response by inhibiting unwanted beta cell destruction.

“This drug transiently depletes the recipient of T lymphocytes,” explained Russell, who added that potential participants are closely screened for conditions that would make it dangerous for the participant to receive teplizumab.

For those who meet the screening criteria, half receive the anti-CD3 drug and half placebo in the form of 14 IV infusions

TrialNet at Vanderbilt Type 1 Diabetes TrialNet is funded by the National Institutes of Health. For more information about TrialNet and the international consortium, contact the Vanderbilt team or visit the website.

By Phone: (888) 884-8638

By Email: diabetesresearch@ vanderbilt.edu

By Website: www. vanderbiltdiabetesresearch.com

nashvillemedicalnews

.com

on 14 successive days. Because of the need to perform safety labs before each infusion and the time required for the treatment protocol, it isn’t unusual for these participants to stay overnight in the clinical research center for two weeks.

The End Game

“I explain to families that their participation in a study may not prevent their family member from developing diabetes … but that they have an opportunity to be part of the solution so when their children become parents of the next generation, T1D may be eliminated,” Russell said.

“That, to me, is the homerun … no more type 1.”

He continued, “I’ve been treating patients for many years. My goal is to help put an end to type 1 diabetes in my lifetime.” However, Russell added, he isn’t planning on slowing down any time soon.

“I’ve got plenty of energy left for this.”

While he and TrialNet colleagues continue striving for the ‘homerun,’ Russell is quick to admit that significantly delaying the onset of T1D would be a big win, too.

“It would be a really, really good first step,” he concluded.

The cytogenetic laboratory and information resource of choice for physicians who demand accurate, timely, and state of the art cytogenetic diagnostic services for their patients.

• Chromosome Analysis • Polymerase Chain Reaction (PCR) • Fluorescence In Situ Hybridization (Fish) • Array Comparative Genomic Hybridization (Microarray) Genetics Associates Inc. is CAP accredited, CLIA and State of Tennessee Licensed.

Our professional staff includes four American Board of Medical Genetics (ABMG) certified directors.

1916 Patterson Street, Suite 400 • Nashville, TN 37203 (615) 327-4532 • 1-800-331-GENE (4363)

Where advanced cytogenetic technology meets old-fashioned service www.geneticsassociates.com NOVEMBER 2013

>

7

Controlling Diabetic Comorbidities who first showed clinical evidence of neuropathy, then diabetic retinitis and finally, nephropathy.

Carlson said there are some new treatments for the various conditions. For example, intraocular injections of Avastin® (bevacizumab) are a relatively new option for the treatment of diabetic retinopathy.

“Ophthalmologists can now inject medicine into the eye to control the formation of fragile blood vessels that can leak or bleed and lead to a detached retina or blindness,” Carlson said of the anti-angiogenic therapy first used in certain cancers to control blood vessels in tumors by blocking the VEGF (vascular endothelial growth factor) protein.

With nephropathy, he continued, “High glucose damages the part of the kidney that filters the waste products.”

Two classes of medications used to control blood pressure — angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) — have both been shown in clinical studies to prevent or slow progression in those with early renal disease. Carlson said it is important for primary care providers and endocrinologists to be aware of even slight elevations in a diabetic patient’s blood pressure and to routinely check for albumin in the urine. In addition to kidney disease, those with diabetes have a significantly elevated risk for hypertension and cardiovascular disease.

By CINDy SANDERS

As if trying to manage diabetes isn’t difficult enough, patients and physicians must also be alert to the comorbid conditions that, if left unchecked, can be as dangerous and deadly as the primary diagnosis.

Michael G. Carlson, MD, FACE, a board-certified endocrinologist with the Frist Clinic, said physicians … both primary care providers and specialists … must be aware of the numerous complications associated with diabetes and look for red flags that can signal a looming issue.

Retinopathy, ne- Dr. Michael phropathy and neuropa- G. Carlson thy are three of the key comorbidities that plague patients who have a difficult time with glucose control.

“High blood sugar, over time, damages the eyes, the kidneys and the nerve endings,” said Carlson.

The vascular damage to the venules, capillaries and arterioles in patients with diabetes has long been documented. In a 1954 presentation during the American Medical Association annual meeting, Howard F. Root, MD, of Boston; William H. Pote, Jr., MD, of Los Angeles; and Hans Frehner, MD, of Switzerland used the term “triopathy” to describe diabetic patients

Carlson said with diabetic neuropathy, “The typical early symptoms would be numbness or tingling in the feet. It typically starts in the feet and moves up the legs. Less commonly it affects the hands. He added patients might feel the occasional sharp pain and are at increased risk of developing ulcers that can be difficult to heal.

He continued, “Diabetic neuropathy is the most common complication of diabetes. About half of all diabetics will go on to develop diabetic neuropathy.”

However, Carlson continued, only a small portion of those patients progress to painful diabetic neuropathy. For those who do, a number of medicines are used to control the pain including antidepressants and anti-seizure medications such as Lyrica® (pregabalin) and Neurotin® (gabapentin).

Carlson noted a high potency B-complex vitamin preparation, Metanx, is another possible therapy. “It can heal some of the nerve damage and improve sensation in the feet,” he explained.

However, Carlson stressed, at every turn the best option is glucose control.

Unfortunately, he said, too many patients don’t truly understand how diet impacts their diabetes.

“Many people think that if they just avoid sugar, that’s what they need to do.

We stress to them it’s carbohydrates that need to be looked at in general,” Carlson said.

“The main issue that we see that is overlooked by primary care providers is referring them (newly-diagnosed diabetic patients) for nutrition counseling,” he continued. “Following a healthier diet plan is half the battle in controlling diabetes.”

Carlson added it is also extremely beneficial for patients to see a certified diabetes educator to learn as much as possible about the disease.

Of course the first step in controlling diabetes is to be aware that you have it.

“We can certainly do a better job of screening people at risk to allow early intervention to prevent complications,” Carlson concluded.

Online Event Calendar To submit or view local events visit the Nashville Medical News website.

A user name and password are required to submit an event.

Under Member Options, go to “free sign up” to register.

nashvillemedical news.com

Your

Announcing Avenue Bank Private Client Banking Medical and Professional Services

Primar Y

Source

for

ProfeS Sional

H e a lt H care

newS

na shvil le

Steve Jaynes Senior Vice President Director of Private Client Banking, Medical & Professional Services

InCharge Healthcare 2014

N

ashville is a city where thought leaders are always willing to make strategic moves, groom the next generation of leaders, and help ensure our city’s e a llines healthcare industry stays on theHfront research, t H Cof ar e 2 0 13 policy making and best clinical and business practices.

Mike Blanchard

©2013 AvEnuE BAnk

Senior Vice President Private Client Banker, Medical & Professional Services

Bob Lawhon

MEMBEr FdiC

Senior Vice President Private Client Banker, Medical & Professional Services

Offering financial services with industry expertise to physicians, physician practice groups and professional service firms in Middle Tennessee.

8

>

NOVEMBER 2013

PROOF APPROVAL REQUIRED Version

____

Ads due: Friday, November 15 Materials due: Wednesday, November 20

MECH __RB___

NASHVILLE

CD ____________

Avenue Bank Corporate Office 111 10th Avenue South, Suite 400 Nashville, TN 37203 615-252-2265

13avenue10888 M1rb Medical Vertical Announcement ad.indd 1

In December 2013, the 2014 edition of InCharge Healthcare will showcase the leaders who have risen to the top of one of Nashville’s most lucrative industries.

This is Nashville’s resource guide for who’s who in the healthcare sector and provides a strategic opportunity for your brand to align itself among the healthcare elite who subscribe to Nashville Medical News.

AD ____________ EquAl HouSing lEndEr

avenuenashville.com

InCharge

8/22/13 11:49 AM

PROOF _________ AE_____________Your Primary Source for Professional Healthcare News CLIENT ________

Please contact Tori Hughes at thughes@southcomm.com or 615.844.9410 or your Nashville Medical News account executive.

nashvillemedicalnews

.com

DIABETES AND CLINICAL PRACTICE: YESTERDAY, TODAY, TOMORROW Andrea Hayes MD November, deemed “National Diabetes Month,” is a perfect time to examine diabetes as both a national and local healthcare crisis. It is also apropos to review advances in treatment options and our understanding of this complex disease state.

In 2010 The Institute for Alternative Futures was commissioned to model the spread of diabetes over the next 15 years.

Current and future trends were examined nationally and on a state-by-state basis. This model estimates that by the year 2025, the number of people in the United States living with diabetes will increase 64 percent from a total of 32.3 million today to 53.1 million. These are staggering statistics to say the least. Tennessee boasted a 15 percent prevalence of diabetes in 2010 affecting nearly 1 million lives and costing our local economy $8.2 billion. Estimates of currents trends predict a 40 percent increase by 2025 leading to a total of 1.3 million affected Tennesseans.

For those of us involved in diabetes care, the above statistics certainly bode well for job security. Although this spiraling epidemic appears quite dismal, we now have a vast armamentarium of treatment options for this common disease state. We have certainly come a long way from the days of Banting and Best who so eloquently discovered insulin thanks to the isolation of insulin-producing beta cells from a dog named Marjorie. I have witnessed the explosion of new pharmaceutical agents and technology over the last 20 years (I can’t believe I am that old!). As I started my fellowship at Vanderbilt, our “tools” for the treatment of diabetes included cumbersome insulins and sulfonylureas. Metformin represented the new “blockbuster” drug introduced to market after having been available in Europe for many years. When I developed Type 1 diabetes at the tender age of 15, blood glucose monitoring was not even available thus necessitating the use of such crude technology as urine glucose dipsticks!

Dr. Hayes welcomes new patients with diabetes, thyroid disease and other endocrine disorders.

Well, today, we have available pharmaceutical agents aimed at treating many of the underlying metabolic defects that occur in diabetes including insulin resistance, insulin deficiency, unrestrained hepatic glucose output, the intestinal incretin system, fat metabolism, glucose absorption, gastric emptying, satiety, and urine glucose excretion … just to name a few. Some of these newer drugs have distinct advantages with regards to weight control, hypoglycemia, beta cell preservation and durability. Available insulin analogs have been engineered to more closely mimic normal physiologic insulin secretion so that we now have insulins that treat both prandial and basal needs thus mitigating the risk of dangerous hypoglycemia. Each patient must, of course, be treated individually taking into account many factors such as age, BMI, co-morbidities, acceptance, and A1C, not to mention COST and formulary availability.

Further emphasizing the technology front, we now have vastly improved insulin pump technology as well as “continuous glucose monitoring” devices (CGMS). CGMS allows for a small cannula to be placed in subcutaneous tissue thus measuring levels of glucose in the interstitial fluid. The data is transmitted to a hand held receiver, and a new glucose measurement occurs every 5 minutes. Imagine how many finger sticks it would take to measure this many values! High and low blood sugar settings will provoke the device to alarm, allowing the patient to respond quickly to blood glucose trends. This information is downloaded and the data presented in most any fashion one could possibly imagine. Of course, the utility of this information is dependent upon accurate patient data entry including carbohydrate intake, exercise, and medication administration.

Now, turning to the challenge of outpatient medicine, I find myself frequently fraternizing with other clinicians regarding their unique experiences in both the clinical and administrative aspects of running a practice. A common challenge that many physicians face is the implementation of electronic medical record (EMR) technology. I keenly remember the painful six months that ensued after purchasing and implementing our EMR in 2004. It was hard to imagine at the time that this technology would ever be my friend. But I am now happy to report that this tool allows much greater ease in charting, coding, billing, documentation and data analysis. As our patient outcome data lies shyly in the future as our link between a grade of a job well done and our financial remuneration, we must all get comfortable quickly with the idea of reporting our numbers. I am pleased to report that I have not laid eyes on a paper chart in years, and our days of dictation, searching for lost charts and crinkled sticky notes are a distant memory.

I have long believed in the idea of “physician extenders” as a vital component to the treatment of patients with chronic disease states such as diabetes. A physician can quickly grow weary in trying to treat a large number of patients single handedly.

Lack of job satisfaction and waning personal reward are natural consequences of Hayes Endocrine and Diabetes Center this physician-centric approach. So the days of a patient seeing “the doctor” every 501 28th Avenue North, Nashville, TN 37209 • 615-320-1620 time he or she visits a medical facility are over. Maybe the traditionalists do not agree with this concept, but in the field of diabetes, where the number of practicing endocrinologists is rapidly dwindling, I find that having well trained, energetic nurse practitioners allows me to treat a much larger population of patients than I could ever see alone. Embracing the realities of cultural diversity, I am thrilled that one of my NPs speaks fluent Spanish, as this alleviates my need to speak very loudly and perform sign language. As I represent an example of a nearly extinct species, that of a solo practitioner, I am comforted by the fact that I am not really “solo” at all.

Attesting to another lesson learned, after having experienced the devastation of employee embezzlement, I have transformed my previous persona of indifference to the financial aspects of running a practice to one who meticulously analyzes excel spreadsheets and bank accounts on a daily basis. I have made it my goal to becoming a diligent bookkeeper/financial analyst/accountant/detective in my spare time! I fully believe that we, as physicians, should be as familiar with QuickBooks as we are with our patient’s A1Cs. The most successful practices will be those whose physicians embrace technology and take a “hands-on” approach to the administrative aspects of office management. We must dismiss the days when all any of us ever wanted to do was “practice medicine!”

________________________________________________ SPONSORED CONTENT _______________________________________________ nashvillemedicalnews

.com

NOVEMBER 2013

>

9

Tax Planning with Rates on the Rise, continued from page 1 These same AGI thresholds of ATRA also trigger a 20 percent top capital gain rate applicable to qualified dividend income and gain on the sale of capital assets for individuals. This rate had been 15 percent for the past decade. It should be noted that this 20 percent top rate does not include the new 3.8 percent Medicare tax on unearned income, as explained below.

In recent years phase-outs of itemized deductions and personal exemptions haven’t been a concern. For 2013 and beyond, these rules have resurfaced for individuals with AGI over $250,000 and married couples with AGI over $300,000.

These limitations can reduce otherwise allowable itemized deductions by up to 80 percent of their face amount.

ACA New Taxes In addition to the new rates outlined above, individuals with AGI over $200,000 and married couples with AGI over $250,000 should also expect a new 3.8 percent Medicare tax on unearned income and an additional 0.9 percent tax on earned income.

The new 3.8 percent Medicare tax on unearned income will apply to the lesser of your “net investment income” (NII) or your AGI over the appropriate threshold amount. Generally, interest, dividends, annuities, royalties, rents and capital gains are all considered NII and are subject to this tax. Income from a passive, flowthrough entity is also subject to the new NII tax. Thankfully, there are exceptions for tax-exempt bond interest and distributions from qualified retirement plans.

But, taxable distributions from retirement plans do serve to drive up your AGI that could cause you to be subject to this tax.

The additional 0.9 percent Medicare tax on earned income applies to wages and self-employment income of taxpayers in excess of the $200,000/$250,000 thresholds noted above.

Year-end Tax Planning Strategies As you can see from the various threshold amounts noted above, the days of tax planners being able to “roughly estimate” clients’ tax liabilities are over. With calculations for regular tax, alternative minimum tax, net investment income tax and the additional Medicare tax, there are at least four separate but interdependent calculations to be made to determine a taxpayer’s tax liability.

In order to minimize current year tax liability, most tax planning revolves around opportunities to defer income and accelerate deductions.

One of the simplest ways for individuals to defer income is through contributions to qualified retirement accounts.

Workers are allowed to defer up to $17,500 through a 401(k) for 2013. Those over 50 can contribute an additional $5,500 catchup amount.

If you’re a healthy individual, consider a high deductible health plan that allows for tax deductible contributions to a related health savings account (HSA). Individuals can contribute up to $3,250 annually and up to $6,450 for family coverage.

Individuals age 55 or older can contribute an additional $1,000. Unused amounts left in an HSA account can accumulate and grow on a tax-free basis if ultimately used for qualified medical expenses.

While itemized deductions of highincome taxpayers may be phased out, opportunity exists for others to “bunch” multi-year deductions within the same tax year. This strategy can be used for: • Two years of property tax.

• an extra payment on home mortgage to get additional mortgage interest, and • grouping of charitable contributions.

Also, don’t miss the opportunity to use expiring tax breaks. While Congress could extend these options, it is uncertain whether or not they will do so.

Kraft Healthcare Consulting, LLC presents:

ICD-10 Boot Camp This fast-paced boot camp is designed for coders and others in health information management and compliance who are already ICD-9 proficient and need to maintain their professional credentials.

Two course options available for participants:

For individual taxpayers, the option to deduct state and local sales and use taxes (instead of state and local income taxes) is set to expire at the end of 2013. If you know you’re going to make a major purchase in the next few months — a boat or new car for example — it would be wise to do so before year-end to lock in this expiring deduction.

Likewise, individuals age 70-½ or older have the option to make tax-free distributions from their IRAs for charitable purposes. This option is also set to expire at the end of 2013. Individuals who buy qualified small business stock before Jan. 1, 2014 will be able to exclude 100 percent of the gain on the sale if they hold the stock for more than five years. This exclusion is also set to expire unless Congress acts.

Business owners should: • Look for opportunities to maximize accelerated depreciation allowances for tax purposes. The Section 179 expensing election allows for current deduction of up to $500,000 of fixed asset additions. Bonus depreciation remains allowable at 50 percent for newly manufactured business property.

• Review their accounting methods to make sure income recognition is timed as late as possible and deductions are recognized as early as possible • Consider whether a pension or profit-sharing plan may benefit both the business owner and employees.

We encourage taxpayers to make some estimation of their 2013 income and resulting tax before year-end so they are not surprised to see their liability next spring. While tax rates are going up and deductions are being limited, there is still time before year-end to take action and manage your 2013 tax liability.

Jerry Moss is a member and David Lister is a tax manager with Nashvillebased KraftCPAs PLLC. You may contact them via email: jmoss@kraftcpas.com or dlister@kraftcpas.com

SAVE THE DATE

November 6, 7, 8

Materials will be provided, and CEUs will be available.

Location: KraftCPAs PLLC 555 Great Circle Road Nashville, TN 37228 MetroCenter

Speaker Heather Greene, MBA, RHIA, CPC, CPMA, is an AHIMA-approved ICD-10 CM/PCS trainer and a senior compliance consultant with Kraft Healthcare Consulting, LLC.

Learn more and register at www.kraftcpas.com/ events.php.

Course 1: ICD-10 CM Boot Camp (12 CEUs) Course 2: ICD-10 PCS Boot Camp (12 CEUs)

MGMA Reports Costs, Revenues Higher with PCMH According to the Medical Group Management Association’s Cost Survey for Primary Care Practices: 2013 Report Based on 2012 Data, practices adopting the patientcentered medical home (PCMH) model incurred higher costs but also enjoyed higher revenues.

In comparison to practices that that were not operating as a PCMH, those that embraced the delivery care model saw an increase in operating costs per patient but also reported higher total medical revenue per patient. The median total operating cost per patient in a PCMH practice was $245.79. In the non-PCMH practice, the cost came in at $177.11 per patient.

The national survey, which included data on 969 groups, found increased per-patient cost were due, in part, to the greater number of staff and providers required to optimize the delivery model.

PCMH’s reported a median of 29 total full-time-equivalent (FTE) support staff per 10,000 patients compared to 18.5 FTE support staff per 10,000 patients in non-PCMH practices. Similarly, PCMH practices also reported a higher number of FTE providers. Increased costs of medical equipment and supplies also added to costs in the PCMH practice.

“It’s possible to be truly patientcentered in any model of delivering care,” said Susan L. Turney, MD, MS, FACMPE, FACP, president and CEO of MGMA-ACMPE. “Regardless of model, it requires a proper structure Dr. Susan L. and foundation — the Turney right providers and staff — to truly provide quality and cost-effective care to patients.”

She continued, “It’s encouraging that physician practices are working to care and support their patients in new and innovative ways, even if it means a greater investment up front.”

Turney added it’s heartening that doing what is best for the patient remains a top priority even in an environment of fiscal uncertainty.

This program has been approved for continuing education units (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

10

>

NOVEMBER 2013

nashvillemedicalnews

.com

Corporate Owners & Operators Help Rural Facilities, Small Hospitals Find Financial Security

By CINDY SANDERS

With shrinking margins, growing demand for technology investment, mounting fines for regulatory missteps, and increasing expectations of pay-forperformance and coordinated care, it has become difficult for many hospitals to operate independently. For small community hospitals, ‘going it alone’ and ‘surviving’ are often mutually exclusive concepts.

Certainly the economies-of-scale mindset has been good for the multiple investor-owned hospital operations companies based in Middle Tennessee including HCA, Community Health Systems, RegionalCare Hospital Partners, IASIS, Ardent Health, Capella Healthcare, and LifePoint Hospitals. In fact, rumors began earlier this fall that the M&A trend might make Capella ripe for purchase by a larger hospital owner/operator … perhaps a nearby neighbor.

What’s good for the hospital companies is often good for the community hospitals, as well, depending on how agreements are laid out and whether or not the new partner is sensitive to the community’s needs, character and expectations. In the best scenarios, a struggling hospital doesn’t simply find a way to sur-

vive but actually to grow and flourish.

Jeff Seraphine, president of LifePoint Hospitals Eastern Group, said his company knows a thing or two about turning around struggling hospitals. After all, the company was founded on that concept in 1999.

With 23 underperforming hospitals in nonJeff Seraphine urban markets spun off from HCA, Seraphine said the first few years of LifePoint was focused on honing the core strategies to revitalize the rural facilities … most of which were the only hospital in the community.

In the early years, Seraphine noted, “Our largest creation of value was helping those hospitals reach their full potential.”

He continued, “What we do well is understanding the needs in a non-urban hospital environment and creating value in those non-urban environments.”

Beginning with the mission of making communities healthier, LifePoint crafted five guiding principles: deliver high quality patient care, support physicians, create excellent workplaces for employees, strengthen the hospital’s role in its community and ensure fiscal responsibility.

Seraphine said the first four principles are what make the fifth one possible.

In the ensuing 14 years, LifePoint has almost tripled in size, growing from 23 hospitals to 60 facilities in three operational groups across the nation by year’s end, pending approvals by state attorney generals on the company’s three latest acquisitions in Virginia and Michigan.

Seraphine’s operational group covers Tennessee, North Carolina, Virginia and Michigan and includes the Duke LifePoint partnership.

Seraphine said it is getting harder for small hospitals to operate in isolation.

“That’s one of the reasons we’ve seen an increased pace in mergers and acquisition activity,” he noted. “What we’ve been successful in doing is creating scale for them that they cannot create on their own.”

The list of requirements for financial success is long and growing in an environment where the majority of reimbursement still comes from fee-for-service activities but is shifting to value-based payments and population health. The financial health of a hospital is impacted by operational efficiency, meeting quality benchmarks, securing needed capital to invest in key growth areas, having the right medical staff in place to offer services, of-

fering those services in the appropriate setting, and avoiding federal penalties while taking advantage of incentives, among other functions.

Seraphine said it’s difficult for a small staff to effectively manage all the operational issues that affect the bottom line.

“Do they have the resources to enroll people in the health exchange? Do they have the resources to recruit physicians in an environment where physician supply is going down not up?” he questioned. In fact, he continued, today’s environment is challenging even for large hospital companies and systems. “We’re having to create value and economies of scale from every direction we can,” he said.

He was quick to add it really is a matter of scale and resources as opposed to a lack of understanding about the complex healthcare landscape for most non-urban facilities. “They’re looking out and saying, ‘We have a pretty good idea of where we need to go … and even how to get there, but we don’t have the necessary organizational resources, expertise and access to capital,’” Seraphine pointed out.

“They know they need to get more efficient, but they don’t have access to the subject matter resources,” Seraph(CONTINUED ON PAGE 14)

Meet Some of the Faces Behind Our Healthcare Experience.

Britt Cumbie

Shatita Daniels

Meredith Douglas

Jenny Harvey

Kelly Miller

Jayme Parmakian

LBMC has assembled a uniquely experienced team of over 40 healthcare professionals that clearly differentiate us

LBMC Healthcare Services

Accounting - consulting - HR - tecHnology

NASHVILLE | KNOXVILLE | CHATTANOOGA ph: 615.377.4600 | www.lbmc.com

Where Great Companies Come to Grow.

nashvillemedicalnews

.com

from other service providers – all with deep financial experience as well as practical experience working in the field of healthcare.

Meet Jeremy Conner 615.309.2217 (direct) / jconner@lbmc.com Senior Manager – Accounting and Assurance Services Jeremy, a Certified Public Accountant, has been practicing accounting for eleven years, the last eight years in public accounting. Jeremy has spent the last six years serving the healthcare industry and is a senior manager in the Accounting and Assurance practice. He manages a number of healthcare engagements, including profit and not-for-profit hospitals, behavioral hospitals, surgery and imaging centers, continuing care retirement communities, pathology labs, urinalysis providers, fertility clinics, pharmacy and home health care companies. Jeremy is a graduate of Belmont University, and obtained his Bachelor of Business Administration in accounting in 2000. He is also actively involved in the Tennessee Society of Certified Public Accountants (TSCPA)- Health Care Conference Committee Member, Kentucky Society of Certified Public Accountants, Nashville Health Care Council, Leadership Health Care and the University of Kentucky Alumni Association.

NOVEMBER 2013

>

11

Gaining Perspective on the Reimbursement Landscape: Glass Half Empty … or Half Full

By CINDY SANDERS

To see something in a different light often requires a shift in perspective. David A. Williams, CPA, MPH, FHFMA, leader of healthcare reimbursement and advisory services for HORNE LLP, believes this certainly holds true for practices David A. Williams and facilities facing everincreasing budget pressures.

Glass Half Empty

Williams, a partner in HORNE’s Ridgeland, Miss. office, noted for many healthcare providers, any incremental increase in revenue is eaten up by rising costs — from increased wages to higher prices for supplies to hikes in rent and utilities.

He pointed out that for hospitals, the largest revenue stream is for inpatient stays, and the largest single payer is Medicare, which can represent from the low 40s to the high 60s in terms of percentage of patients. “There has been a market basket update, but for the last couple of years, it’s been less than 2 percent,” he

said.

Williams noted the government puts in the full market basket update but then begins reducing the rate by looking at adjustments tied to value-based purchasing, readmission rates and acquired conditions, in addition to other factors.

“Normally you’re seeing very minimal increases. It’s caused a flattening of revenue per patient,” he said. Then, Williams continued, after payment increases are netted out, “Medicare is subject to a 2 percent reduction to fulfill the sequestration order.”

He added that Medicaid, which typically covers anywhere from 5-15 percent of patients … or higher depending on location and a hospital’s safety net status, is not currently subjected to sequestration. Yet, he said, hospitals are faced with mounting concerns about Medicaid expansion, uncompensated care, and cuts to disproportionate share hospital payments.

For hospitals in states that didn’t opt to expand Medicaid rolls, administrators are worried about rising levels of uncompensated care for those that fall into the gap in the Affordable Care Act between traditional Medicaid eligibility and qualifying for federal subsidies on the healthcare exchange. Even for providers who

are in states that did expand Medicaid, Williams said uncertainty still exists about how reimbursement will actually net out.

Traditionally, Medicaid has reimbursed providers at a set match rate for direct patient services and a 50 percent rate for the administrative portion of the episode of care. Although the ACA Medicaid expansion plan covers 100 percent of patient services for three years and then rolls down incrementally to 90 percent over subsequent years, the administrative match remains at 50 percent so the state does incur additional cost by expanding rolls. Additionally, Williams said certain provisions of the ACA require mandatory changes for states regardless of expansion, including: welcome mat population or those who were eligible for Medicaid but had not enrolled previously, foster children expansion to age 26, expanded eligibility for children, primary care physician fee increase, and health insurer fee. In Mississippi, a non-expansion state, the estimated amount of the mandatory changes is between a $272 - $436 million increase in spending. With this amount of growth, the state is not expected to increase the reimbursement rate for a full episode of care.

Medicare DSH payments also are

causing administrators to lose sleep at night. Initially, the ACA plan called for a 75 percent reduction in Medicare DSH payments. However, Williams said part of the final regulation that went into effect Oct. 1 of this year moderated that number a bit by moving to an empirical DSH payment for uncompensated costs … a complex, calculated cut that softens the blow some by looking at a hospital’s relative share of Medicaid inpatient utilization as a proxy for uncompensated patients.

Williams said that for one hospital in the Mississippi Delta, the original Medicare DSH reduction would have meant a loss of $5.6 million. “But,” he continued, “because of the additional payment to fund the uncompensated cost, it was actually a reduction of $2 million.” While that is still a significant loss, “It could have been worse,” Williams noted.

Still, he continued, “You’re faced with the fact your revenue isn’t growing as fast as your expenses. It’s very concerning to most every healthcare organization around.”

Glass Half Full

So if revenue isn’t going up, the logi(CONTINUED ON PAGE 14)

Register Early for APhA2014 and Save!

APhA2014

Get Ready to Realize the Power and Promise of Pharmacy In March 2014, the American Pharmacist Association Annual Meeting makes its mark in Orlando, Florida—and registration is open! Sign up early for a discounted rate and guarantee yourself a place at the event dedicated to your profession.

When this many pharmacists unite, the experience is powerful. Exchange ideas and recharge your bond with our profession’s promise—all while discovering the latest innovations and resources for future growth. Use the connections you make and the knowledge you gain as a positive force in your career and for the health of your patients.

It all happens at APhA2014. We’ll see you there!

Visit www.aphameeting.org now to learn more.

13-378

12

>

NOVEMBER 2013

nashvillemedicalnews

.com

Best Practices Evidence-Based Standards of Care Neuroendocrine and Carcinoid Tumors

By Eric H. Liu, M.D., FACS Neuroendocrine tumors (NETs) are unusual malignancies that most commonly arise from the respiratory and digestive tracts. The prevalence of the disease is higher than other more wellknown malignancies (> 100,000 cases) in the U.S. with an incidence of 5/100,000.1 Unfortunately, neuroendocrine tumors can be difficult to diagnose and the average time of symptom onset to diagnosis ranges from 5-7 years.

Treatment Treatment of NETs is highly dependent on the overall biology of the tumor.3 A multidisciplinary approach is critical because of the complexity of their presentation. At Vanderbilt, multiple specialties contribute to the diagnosis and treatment of patients, including: • Surgery • Oncology • Endocrinology • Pathology • Gastroenterology

Nomenclature

Previously, the terminology of the disease caused a fair amount of confusion. They went by the terms carcinoid, islet cell tumors, or APUDomas. The term neuroendocrine tumor is now the overarching name for most carcinoids originating from the luminal digestive tract and the lungs. Endocrine tumors of the pancreas are now called pancreatic neuroendocrine tumors.

Presentation

Figure – Two images of the same patient with metastatic neuroendocrine tumor with Octreoscan (left) and 68Ga-DOTATATE PET/CT (right)

One of the most challenging aspects of neuroendocrine tumors is the variety in presentation and the complexity of tumor behavior. Many of the tumors are hormonally active and can produce classical syndromes such as carcinoid syndrome (flushing and diarrhea), Whipple’s Triad (hyperinsulinemia), Zollinger-Ellison Syndrome (gastrinoma), or Werner-Morrison Syndrome (profuse diarrhea from vasoactive intestinal peptide tumors). Clinical suspicion is the most important element of making the diagnosis. Frequently, biochemical markers are indicative of tumor activity. However, about 50% of the tumors are “non-functional” in the sense that they do not produce any syndrome. They may cause subtle symptoms depending on their location, or be completely asymptomatic.

Diagnosis

Diagnosis is the first step in caring for patients with NETs. Hormone and tumor markers are very useful, including: 2

• Chromogranin A • Pancreastatin • Gastrin • Insulin • Glucagon

• ACTH • 5-HIAA • Serotonin • Pancreatic polypeptide

Imaging and biopsy, however, are the cornerstones of diagnosis. Frequently, CT of the chest, abdomen or pelvis is enough to identify the disease, though depending on the site, special protocols may be required (e.g. triple phase liver or pancreas protocol).

To definitively make the diagnosis, tissue biopsy must be performed. Fine needle aspiration may be sufficient to provide a diagnosis, but core biopsy is more informative as neuroendocrine tumors have a characteristic pathological appearance. MRI of the liver with hepatic enhancement is an especially useful tool in detecting small lesions. MRI is superior to CT because many neuroendocrine tumors can only be seen on CT with specific contrast enhanced phases that may not be routinely performed. Functional imaging of neuroendocrine tumors includes Octreoscan, a SPECT-based imaging test that is specific for somatostatin receptor expressing neuroendocrine tumors.

The next generation of functional imaging for neuroendocrine tumors will be PET based. Vanderbilt was the first center to introduce the use of 68Ga-DOTATATE PET/CT imaging of NETs to the U.S. (Figure). The study has improved sensitivity and resolution. We are currently working with other centers to provide this advanced imaging to patients across the country and developing a multi-center clinical trial.

• Interventional radiology • Pulmonology • Radiology • Nuclear medicine • Nursing

An important part of comprehensive care is symptom management. In general, surgical treatment with tumor resection and debulking is the frontline therapy for NETs. With more advanced disease or recurrence, resection is still indicated. Given the slow nature of these tumors, complications from the tumors can affect quality of life and can be well treated surgically.

Hormone therapy with somatostatin analogues still remains the foundation for managing neuroendocrine tumors. In addition to controlling symptoms such as the diarrhea and flushing from carcinoid, clinical data have shown these therapies to have anti-tumor effects such as slower growth in metastatic midgut carcinoid.4 Targeted chemotherapy is also an important treatment; two medications, everolimus and sunitinib, were approved in 2011 for the treatment of advanced pancreatic neuroendocrine tumors. For more aggressive high-grade neuroendocrine carcinoma, cytotoxic chemotherapy is still the frontline treatment.

For more local regional disease in the liver, embolization techniques are proving to be very effective. The growing field of interventional oncology encompasses the treatment of many types of malignancies, with NETs an important population.

Radioembolization with 90Y microspheres is effective at controlling symptoms and can have some tumor growth effects. Bland and chemoembolization also have an important role.

An important new therapy in testing now is Peptide Receptor Radiotherapy (PRRT). A treatment first developed and administered in Europe, it uses the somatostatin analogue octreotide and chelates a beta-emitting isotope, 177Lu, to deliver the radiation in a systemic but targeted fashion directly to tumors.

This therapy is being evaluated in a multinational, randomized clinical trial, NETTER-1, for patients with metastatic, non-resectable midgut carcinoid.

Fourteen centers are participating in the U.S. and it is open here at Vanderbilt.

There are many new and exciting changes in the world of NETs. While the therapies are novel and interesting, the most important part of improving patient outcomes is still awareness and early diagnosis.

REFERENCES: 1. Yao, J.C., et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 26, 3063-3072 (2008).

2. Vinik, A.I., et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor.

Pancreas 39, 713-734 (2010).

3. Kunz, P.L., et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas 42, 557-577 (2013).

4. Rinke, A., et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 27, 4656-4663 (2009).

All source data for this article has been provided by

nashvillemedicalnews

.com

NOVEMBER 2013

>

13

Corporate Owners & Operators Help Rural Facilities, continued from page 11 ine continued. “So they spend significant resources to hire consultants, and when those consultants walk out the door, the knowledge goes with them.”

Having access to the 10,000-foot view is a huge value. Companies like LifePoint, CHS, Ardent and others have the benefit of firsthand knowledge of what will work … or not work … in a struggling facility in a small Midwestern town because they have experience with 30 other similar facilities. “We have the resources to create datadriven strategic plans and the resources to

execute them,” Seraphine pointed out.

Going back to his company’s guiding principles, Seraphine said LifePoint’s attention immediately goes to four areas when partnering with a new hospital.

First, he noted, attention is given to quality and service lines to meet the expectations of patients, payers, providers and the community. Next is building an infrastructure for effective collaboration and to manage a growing employee/physician enterprise. Equally important is allocating resources for operational efficiency

Gaining Perspective, continued from page 13 cal place to increase margins is to decrease costs. Yet, healthcare providers want to make sure they provide the best care possible without sacrificing a patient’s well being simply to save a few dollars.

“A lot of people equate higher quality with higher cost, but that’s not necessarily true,” Williams pointed out. In fact, he said, doing the right thing in the right way is often significantly more cost efficient.

“A major cost in providing care to patients is variation in the clinical process of care,” Williams said. He added it is easy to find real world examples of this type of variation where one hospital’s cost for an average hip replacement is $45,000, yet another one might have an average cost of $22,000. “What’s the disconnect?” he asked of the two cost scenarios. “A lack of standardization of using evidence-based protocols,” he answered.

By using data available through electronic health records coupled with a partnership with technology company Health Catalyst, Williams said HORNE is able to mine the available information to look at clinical pathways and search out deviation from standard protocols that adds to the cost of care. He was quick to add that the technology doesn’t seek to stop physicians from exercising their medical judgment but does highlight where there are outliers when it comes to following clinical protocols. “Best practices and evidence-based medicine say that these are the best protocols out there,” he pointed out.

Following those protocols not only saves money, but also should optimize quality. With increased transparency, payers and patients will have access to information regarding those positive outcomes and lower costs, which could ultimately drive volume.

A Foot in Both Boats

Administrators and chief financial officers are caught between the fee-forservice and value-based payment worlds right now. Williams said they are trying to keep their heads above water in the current payment system … and now reimbursement experts want them to shift their focus to population management.

Although making the move is understandably frustrating, Williams believes it is also the best option to ultimately improve the bottom line.

“There has to be a change in culture from what it’s been in the past,” he noted. “We tell them, ‘Let’s prepare for it by being the most efficient, effective deliverer of care and eliminating patient waste.’ That puts you in a competitive advantage over those providers that have a higher cost structure.”

It is a different mindset, Williams continued, to stop attacking reimbursement from the top and instead improve revenue by cutting costs. “If you deliver high quality at a lower cost, then your margins are going to be greater. We see opportunities,” he concluded.

Nov. 23-24 • Total Health Fest • A Game Sportsplex • 11 am-7 pm Nashville’s first annual Total Health Fest sets the stage for a healthy holiday season. Focused on health, fitness and wellness, the expo will feature the latest information on getting – and staying –healthy and happy. Attendees of all ages, from toddlers to seniors, will be able to interact with expert exhibitors to learn more about fitness, health and wellness services. The event also offers activities for the whole family – a toddler zone, ice skating, fitness sessions, basketball, volleyball and football throwing contests and laser chase. Proceeds benefit the local Alzheimer’s Association chapter. Tickets are $10 at door, $7 advance; children under 10 and senior are free. www.totalhealthfest-nashville.com.

Dec. 3-4 • TAMHO Annual Conference • Embassy Suites Hotel & Convention Center • Murfreesboro The Tennessee Association of Mental Health Organizations will host its annual meeting next month with a focus on integrated care. Regional and national keynote speakers will address the growing healthcare delivery model. Providers and administrators from all healthcare disciplines are welcome to attend. For information and registration, www.tamho.org.

14

>

NOVEMBER 2013

and growth.

Fourth is truly becoming part of the community and investing in it. “We make these commitments on the front end, and they know we’re going to invest in their communities,” Seraphine said. “We feel healthcare is local.” By becoming part of

the community, he noted, “We create hospitals where patients want to go for care, where physicians want to practice and where employees want to go to work.”

He concluded, “When we do all the things we’ve talked about, we find the financial results come with that.”

From the Provider Perspective The Benefit of Being Part of a Big Family

By CINDY SANDERS Small pond, big ripples.

As CEO of HighPoint Health System, part of LifePoint Hospitals, Susan Peach, RN, MBA, has the interesting viewpoint of operating both suburban and rural facilities. She has oversight of four hospitals, home health and hospice services, and a number of outpatient facilities spanning several counties in Middle Tennessee. The flagship hospital in the system is the 155-bed Sumner Regional Medical Center in Gallatin, part of the Nashville MSA. Livingston Regional Hospital near Cookeville just came under the HighPoint umbrella last month, and the system is rounded out by two critical access hospitals in Trousdale and Smith counties.

Susan Peach “There are some similarities in the challenges they face, and then there are some pretty big differences between the smaller and larger hospitals,” Peach noted. Bigger facilities, she continued, are better able to weather the ebb and flow of patient volumes and staffing that can throw a wrench into operations in smaller facilities.

It’s also harder to weather financial storms. Over the past few years, Peach said hospitals of all sizes have faced an escalating rate of bad debt and increased number of denials from payers. “Bad debt is a significant problem for all hospitals, but a bigger problem for smaller hospitals because their margins are so tight,” Peach said.

The bad debt, she noted, comes from two buckets — those with no health coverage and those with coverage that comes with such high co-pays that the insured cannot cover the out-of-pocket cost. “The second one is rising at a faster rate. That’s the hidden secret that is overwhelming many families,” she added of the increasing financial responsibility for individuals.

Payment denials can stem from a variety of issues ranging from poor documentation to a difference of opinion about clinical necessity. “We are writing off increasing numbers of bills where the payers … the insurers … are refusing to pay, and most of these are managed Medicare payers,” she said.

To combat the problem, Peach said hospitals are increasing functions that address payer criteria. “In almost all our facilities, we’ve added nurses with case management experience in our Emergency Room. They work with the physicians to make sure the documentation meets the requirements,” she said.

“There’s an enormous value in being part of a larger system,” Peach continued. She said the LifePoint Hospital Support Center provides resources that might otherwise be out of reach … at least in an affordable manner.

Tapping into expertise on health reform, case management, technology, and marketing can help minimize the financial hits. Legal and regulatory advice is also critical to avoid fines and penalties.

For all the supports available from LifePoint, Peach noted, “Probably the one I rely on the most is the support we get from our strategy group.” She noted the demographic information, usage patterns and population trends are invaluable in planning growth.

Peach said benchmarking data and survey information is also key to growing the bottom line. She noted patient satisfaction scores will begin playing into reimbursement rates next year. In addition to that overt impact, quality and satisfaction also play a subtler role in future income.

Peach said in a series of focus groups and studies from last year, they found a patient’s experience in the Emergency Room determined whether or not that person would use or recommend the hospital later for other services.

“Door to doctor … we have a 15 minute promise,” she said of cutting ER wait times. By eliminating non-essential steps and conducting some registration functions in the room while the doctor has begun the patient exam, Sumner Regional has sustained their short wait time for more than 18 months. Peach said the process is now beginning at Livingston and launching in the critical access hospitals in early 2014.

“It took a lot of culture change because our staff grew up thinking all those steps were necessary, but now they wouldn’t do it any other way. Our Emergency Room volume is up significantly over the last three years. Our volume is up almost 30 percent … so that’s how it impacts the bottom line,” she stated.

nashvillemedicalnews

.com

My practice benefits from faster reimbursement.

Practicing medicine is my passion.

However, paperwork and reconciling insurance claims can be a burden. So I went to SunTrust.

They customized a solution that helps me with claims reimbursement, saving time and providing a steadier cash flow.

Now I have more time to concentrate on patient care.

To learn more about the benefits of eClaim Revenue GatewayŽ for your practice or hospital, contact David Duvall at david.l.duvall@suntrust.com or 404.588.7534 SunTrust Bank, Member FDIC. Š 2013 SunTrust Banks, Inc. SunTrust, How Can We Help You Shine Today?, and eClaim Revenue Gateway are federally registered service marks of SunTrust Banks, Inc.

nashvillemedicalnews

.com

NOVEMBER 2013

>

15

HealthcareEnterprise

Thinking Inside the Box Healthbox Helps Entrepreneurs Build Sustainable Success

By CINDy SANDERS

Most innovators don’t want to be put in a box … unless of course it’s Healthbox.

Launched in Chicago in January 2012 by founder and CEO Nina Nashif, this business accelerator, which is focused on healthcare technology and technologyenabled companies, quickly differentiated itself from other incubators and accelerators. Nashif, who was named a ‘2013 Young Global Leader’ by the World Economic Forum, envisioned a collaborative environment to help nurture healthcare entrepreneurs with ideas to address some of the industry’s most vexing challenges.

“Traditionally, accelerators have been focused on companies that fit into that unique stage of development — postprototype development and pre-seed funding,” Nashif noted. “As we continue conversations in the market though, we realize that innovative providers want to source and collaborate with the best solutions overall … regardless of funding and revenue,” she continued of Healthbox’s decision to accept companies at varying stages of devel- Nina Nashif opment into the four-month program.

In less than two years, Healthbox has launched seven accelerator programs — two in Chicago (the second one rolling out this month); two in Boston; London; Jacksonville, Fla.; and Nashville. In each community, Healthbox has reached out to members of the established industry to form strategic partnerships and tap into expertise to help their portfolio companies achieve rapid development and growth.

In Nashville, those strategic community partners are BlueCross BlueShield of Tennessee, HCA, the Entrepreneur Center and the Nashville Health Care Council.

“We started out knowing entrepreneurs needed funding, as well as knowledge, to carve out a space in healthcare,” Amy Len explained of the initial purpose behind launching the accelerators. Len, a company director who leads operations for Healthbox Nashville, continued, “But then we quickly realized it’s a dual mission. The second part of our mission is really to bring industry partners together into a collaborative ecosystem to enable and to support entrepreneurship.”

She added, “We’re really at a turning point in our industry. Innovation has always been critical … now more than ever.

Innovation is all well and good, but it’s really hard to go it alone.”

Not only does Healthbox help nurture young portfolio companies but established community partners also appreciate and recognize the need to drive innovation through collaboration. From the large stack of applicants seeking to 16

>

NOVEMBER 2013

Entrepreneurs representing seven portfolio companies make up the Nashville Healthbox team. On the first row, the innovators are pictured here with Healthbox CEO Nina Nashif (2nd from L), Healthbox Director Amy Len (2nd from R), and BCBST sponsor representative David Criswell (far R).

be included in the Nashville accelerator, Healthbox and its local partners brought in more than two dozen startups for a panel of interviews before winnowing that group to the final seven selected. While the local partners are on hand to support the growth and development of the young companies, the industry veterans also appreciate the mutually beneficial relationship.

“It was a unique opportunity for us to sit at the same table with providers and entrepreneurs to discuss ways to better healthcare delivery,” Sherri Zink, vice president of Medical Informatics for BCBST, said of the selection process.

“We walked away with an increased understanding of the needs and pain points of our counterparts in other industry segments.” She added, “This initial collaboration is the start to leaders from across the continuum working in tandem, rather than in the traditional silos, to solve critical challenges.”

In discussing the difficult task of narrowing the field, Len noted, “First and foremost, we look for solutions that address key challenges in healthcare.” Then, she added, the panel looks for that something extra … that “spark in the eyes” … that signifies the entrepreneurs are passionate about what they are doing and capable of executing their visions. The third key is having a prototype. “We find we can provide value if they are past the idea phase,” she said.

Len added Healthbox portfolio companies typically sit at the intersection of healthcare and technology. “That’s our sweet spot,” she said of the role technology plays in bringing about innovation across the healthcare spectrum.

Selection, of course, is just the first step in the process for the portfolio companies. “The most intense portion of our relationship is the four months of the accelerator whey they are under one roof,” said Len. “But,” she continued, “that’s just phase one … we continue to work with the

companies to grow them post-program.”

Success is measured by a number of metrics. Len noted that in their other markets, the portfolio companies have been very successful in securing capital, with seven out of 10 companies that have actively sought outside funding receiving it. “We think of it as more than just funding, though,” she said. “It’s about making a real difference. The Healthbox companies, through their products and services, will touch a million lives in 2013.” Of

course, Len added with a laugh, the funding is key, too.

Even after portfolio companies leave the accelerator, Healthbox continues to provide strategic guidance and advice, as well as to help entrepreneurs make valuable connections. Market traction for the young companies is another indicator of the program’s success.

The seven Nashville portfolio companies (see box) are in the middle of their intensive accelerator experience leading up to Healthbox Nashville 2013 Innovation Day on Dec. 10. The event brings together innovators and investors as the accelerator companies prepare for the next phase of development.

Len certainly doesn’t think this first Nashville program will be the last. “The entrepreneurial scene is rich and vibrant,” she said of the city and its well-established healthcare industry. “We think Nashville was a fantastic location for us. We do plan to grow our network, and we do plan to continue to establish our presence here.”

The Nashville Class Healthbox Selects Seven Companies for the Nashville Accelerator On Sept. 19, Healthbox announced the companies selected for the four-month Nashville accelerator program. Although the “Nashville” class could be a bit misleading as companies in the local accelerator could originate anywhere, six of the seven selected companies are actually rooted in Middle Tennessee. The seventh company in the program came from Raleigh, N.C. “We were extremely impressed with the applicant pool for this program.

Many of them were already well connected within Nashville’s healthcare ecosystem and founded by seasoned professionals and serial entrepreneurs,” Nina Nashif, Healthbox founder and CEO, said in announcing the inaugural accelerator group.

Atlas Health: provides a cloud-based platform that helps HIT organizations launch new solutions and exchange data with partners while staying compliant with federal HIPAA and HITECH regulations.

Axial Healthcare: automates evidence-based decision support for chronic pain therapy to reduce variability in interventional procedures, opiate prescribing and spine surgeries.

Clariture: helps providers communicate the right message to the right person at the right time in order to drive patient volume, improve payer mix, and keep patients both loyal and healthy. eClinic Healthcare: allows providers to use two-way video, voice and secure messaging to deliver consultative healthcare to their patients within a web-based and HIPAA-compliant environment.

Gema Touch: offers a patent-pending product linked to a cloud-based service that improves mobile patient engagement and remote monitoring.

PRSM Healthcare: features a seamless solution for managing gastroenterology patient follow-up, cancellation and no-show needs by identifying and engaging patients regarding follow-up care events.

Remedify: has created cloud-based software that takes the guesswork out of sterile processing at hospitals and surgery centers.

nashvillemedicalnews

.com

GrandRounds

COMPLIANCE

IN THE CLOUD Peak 10 is HIPAA Compliant.

Let me say that again, Peak 10 is HIPAA Compliant. Not many cloud computing and data storage companies can say that. We have history. We are one of the few cloud computing and data storage companies that have been HIPAA Compliant for a long time.

Our HIPAA-compliant Cloud is a secure cloud environment that eases the burden of those seeking HIPAA/HITECH compliance, specifically in regard to the Health Insurance Portability and Accountability Act (HIPAA).

It’s secure, flexible, scalable and always supported. But more importantly, it’s independently audited and it saves you money.

In addition, Peak 10 will execute a Business Associate Agreement, further demonstrating our commitment to working with our customers to maintain the security and integrity of electronic protected health information (ePHI) and mission-critical data and applications.

For much more information, please call 877-281-5979 or visit our website at: peak10.com/cloud/hipaa-compliant-cloud 425 Duke Drive Suite 400 Franklin, TN 37067

IT INFRASTRUCTURE | CLOUD | MANAGED SERVICES NMN.10.15.13.indd 1 nashvillemedicalnews

10/17/2013 1:41:20 PM

.com

NOVEMBER 2013

>

17

Tennessee Hospital Association Reinventing Tomorrow’s Healthcare Every Day for 75 Years

By CINDY SANDERS

Established in 1938, the Tennessee Hospital Association has adopted the tagline “reinventing tomorrow’s healthcare every day for 75 years” as an ongoing theme for 2013.

Over the years, the staff of the THA might have had many days … often stretching into many months … to help members prepare for and implement change. However, in the face of industrywide transformation, being nimble enough to reinvent the hospital’s role in healthcare delivery on a daily … if not hourly … basis has become the norm. Helping its membership navigate the challenges that come with sweeping reform is a central theme of the programming at the THA Annual Meeting, held Oct. 31-Nov. 1 at Gaylord Opryland Resort and Convention Center.

“I’ve always said healthcare moves glacially, but we’re getting up to lightening speed now,” THA President Craig Becker said with a rueful laugh. “It has been a tough road to hoe right now for our members.” Yet, Becker continued, he ultimately views the transformation process as ‘constructive deconstruction.’

Going into 2014, he continued, “Our number one issue is the Affordable Care Act and trying to get people enrolled …

not only the ones that are eligible through the federal exchange but to try to convince the governor and Legislature to expand TennCare to include the poorest of the poor.”

Craig Becker Becker added there are approximately 500,000 Tennesseans who should be eligible for enrollment through the federal exchange. However, there are another 400,000 currently left out of coverage opportunities unless Gov. Haslam and the Centers for Medicare and Medicaid Services can come to an agreement about expanding TennCare rolls, and the Tennessee Legislature approves the plan.

“We’re having a hard time getting the Legislature to separate this from Obamacare,” Becker said. However, he noted negotiations with CMS are ongoing, which he said was an encouraging sign.

“We’ve got $5.4 billion worth of cuts over 10 years under the Affordable Care Act,” Becker pointed out. Those cuts were more palatable when hospitals thought Medicaid rolls would be expanded. When the individual mandate was upheld but not the Medicaid expansion, anticipated coverage for large chunks of the popula-

tion evaporated.

“I’m really concerned about my rural hospitals. They don’t have the reserves some of the bigger hospitals do,” Becker said. However, he added no facility is immune to the looming financial stressors.

Addressing the key point of coverage for the 400,000 left out, Becker stated, “If we don’t get it, some of our hospitals cannot make it. I guarantee that.”

Three hospitals have recently shut down operations in Tennessee. While two in West Tennessee probably had more to do with the number of facilities in comparison to the population, one in East Tennessee simply couldn’t make it in healthcare’s new financial reality. Scott County residents now have to go elsewhere for care. “The hospital was struggling. When the (ACA) cuts came, it was the death nail for them,” Becker said.

The Tennessee Hospital Association is also focused on the Tennessee Payment Reform Initiative, which is initially slated to be rolled out for the TennCare and state employee populations. Tennessee has received a CMS grant to transform the state’s healthcare payment system.

While details are still being ironed out, the governor’s vision is to incentivize ‘quarterbacks’ (typically physicians) to provide the highest quality, least costly care. As part of

that plan, the quarterbacks would receive a bonus for sending patients to facilities with the best quality and lowest prices.

However, Becker said there are concerns arising from geographic location and from skewed price comparisons. He pointed out large academic medical centers with high-cost service lines including trauma centers and burn units and other unusual expenses such as graduate medical education cannot fairly be compared to community hospitals without those same factors. In areas with only one nearby hospital, referring patients to a facility farther away that has a better cost structure might not be feasible … or desirable … depending on the urgency of the situation.

Becker noted, “Seventy-five percent of physicians admit to one hospital only so I’m not sure it makes a lot of sense. I’m not sure that this will change physician admitting patterns.” However, he continued, the general consensus is that the plan will move forward so THA staff is preparing for implementation while addressing their issues with government and provider stakeholders in an effort to design a workable plan.

Despite any reservations about the plan’s mechanics, Becker applauded the general concept of shared information. “I (CONTINUED ON PAGE 19)

6:30

a.m.

already behind schedule Lunch Skipped. and a late-night urgent call

about the one thing your practice cannot heal ––

a downed computer server.

Healthcare professionals need technology professionals. Jackson Thornton Technologies is on call 24/7, keeping your IT networks up and running. Helping ensure HIPAA compliance with secure systems.

Converting paper to Electronic Medical Records. Now you can concentrate on patient care—while JTT takes care of IT.

877.226.9091

|

jttconnect.com

It’s time for professional IT help.

18

>

NOVEMBER 2013

nashvillemedicalnews

.com

Exchange News & Notes

GrandRounds

On Oct. 1, the federal Health Insurance Marketplace, commonly referred to as the health exchange, officially opened for business. A new tool to help the uninsured get covered and those with insurance shop around to see if other options might better suit their needs, the exchange helps people meet the individual coverage mandate that is part of the Affordable Care Act. With a few exceptions, most individuals must have health coverage in 2014 or pay a fee. The penalty in 2014 is typically $95 per adult, $47.50 per child or 1 percent of a family’s income (whichever is higher). The fee for non-coverage will increase each year.

Major technical glitches have plagued the federal exchange since the launch. The president, who was clearly displeased by the website issues, reminded Americans they still have five months to enroll. At press time, the administration had not changed the March 31, 2014 deadline for enrolling but did clarify that insurance coverage didn’t actually have to begin on that date as long as a person had completed the enrollment process by then.

To assist patients who turn to you as a healthcare provider or executive with questions about the Health Insurance Marketplace, the following is a synopsis of several resources and notes surrounding this new venture.

Mid-Tennessee Bone and Joint Welcomes Dr. Cason Shirley

General Notes

The main online site for help is www. healthcare.gov. Questions can also be answered via phone 24 hours a day by calling toll free 800-318-2596 (TTY: 855889-4325). The ‘one page guide’ online is a quick primer with links to more detailed information.

There are five types of plans: • Catastrophic: less than 60 percent of the total average cost of care, • Bronze: 60 percent of the total average cost of care, • Silver: 70 percent of the total average cost of care, • Gold: 80 percent of the total average cost of care, • Platinum: 90 percent of the total average cost of care.

Signing Up in Tennessee

Tennessee did not opt to run a statewide exchange so individuals must use the federal marketplace. However, individuals will be asked to answer a few questions, including state and county, before being directed to plans specific to Tennessee.

There are four ways to apply: • Paper application, available to download at the healthcare.gov site.

• Online application, available at the healthcare.gov site.

• Phone application, available through the toll free number. nashvillemedicalnews

.com

• In-person assistance, available through navigators, state agencies, certified application assistants and others. To find help, go online to https://localhelp. healthcare.gov.

More than 65 local assisters are available in the Nashville area.

Learn More

The Advisory Board Company has created a quick video primer, white paper and web updates to help explain the exchanges and implications for hospitals. Go online to www.advisory.com/Research/Financial-

Leadership-Council.

Baptist Healing Trust oversees “Get Covered Tennessee,” a private collaboration to help uninsured Tennesseans understand and enroll in new healthcare coverage options. Information on Get Covered Tennessee, is available at http:// healingtrust.org under the “Programs” tab.

The Tennessee Hospital Association provides information and links to outreach and enrollment resources through the THA site at www.tha.com/?pid=150.

The Tennessee Medical Association offers a similar resource with the option to subscribe to health system reform news updates. The TMA site includes links to additional resources including “10 things providers need to know” and “10 things to tell your patients” about the Health Insurance Marketplace. To access the information or signup for updates, go to www.tnmed.org/ for-physicians/health-system-reform.

More Insurance Marketplace news online nashvillemedicalnews.com

Tennessee Hospital continued from page 18 think the more transparent and the more information you get in the hands of our physicians and hospitals, the better off we are,” he said.

While the immediate future brings many challenges, Becker said the message of the annual meeting is a hopeful one.

“This is the constructive destruction of the health system as we knew it. It will be very different going forward.”

As for the THA’s role in helping hospitals shift to population management models, Becker succinctly noted, “It’s coming, and we’re here to help you do it.” He continued, “We’ve really put an increased emphasis on quality. We’ve put an increased emphasis on education and on sharing best practices and process improvement data. Our data is all geared toward giving transparent information to our members so they understand how they stack up against others.”

He added the THA has also been hands-on in helping hospitals help their

patients. In a move unique among hospital associations, Becker said, “We actually took $3 million out of reserves and put it aside for grants for hospitals to enroll people in the exchange.”

He continued, “We touch 350,000 uninsured people every year in our emergency rooms.” Becker noted identifying those who qualify for the federal exchanges and getting them covered is a win/win for families and facilities. Hospitals have until the end of November to apply for the grants.

“We’re excited to have a good opportunity to give back to our members and hopefully help our hospitals get ahead of the curve in signing people up,” he said.

Despite the obvious pain points that come with transformational change, Becker and his staff are keeping an eye on the prize. “We’ll have a far better healthcare system once we get to the other side,” he concluded.

THA’s New Board Chair Before the final bell sounds on the Tennessee Hospital Association’s 2013 annual meeting, an important transition of power will take place. Joe Landsman, president and CEO of the University of Tennessee Medical Center in Knoxville, will pass the gavel to new board chair Reginald Coopwood, MD, Dr. Reginald Coopwood president and CEO of Regional Medical Center at Memphis.

A graduate of Meharry Medical College, Coopwood practiced in Nashville as a general surgeon and served as chief medical officer for Nashville General Hospital. In 2005, he was named CEO of the Metropolitan Nashville Hospital Authority. In March 2010, he made the move to Memphis to take the top position at The Med. In addition to his role with THA, Coopwood also serves on the boards of several nonprofit organizations including March of Dimes, Leadership Academy, QSource and MidSouth eHealth Alliance.

Mid-Tennessee Bone and Joint Clinic recently welcomed W. Cason Shirley, MD, to the practice. He received degrees in biology and chemistry from David Lipscomb University and his medical degree with highest honors from the University of Dr. W. Cason Tennessee Health Science Shirley Center. Shirley completed his orthopedic surgery residency at the University of Tennessee – Campbell Clinic in Memphis.

NHC-Tullahoma: Construction Complete, Opening Slated for Nov. 4 Construction is now complete on National HealthCare Corp.’s new skilled nursing facility in Tullahoma, and it is expected to open to residents on Nov. 4. The 90-bed skilled nursing and rehabilitation facility, located on Cedar Lane in Tullahoma’s emerging medical zone, represents an $11 million investment

by NHC and will employ approximately 100 people. Veteran administrator Jaine Colley, who has worked as a healthcare administrator for NHC since 1998, will serve as the center’s director.

Sumner Regional Adds Third Ob/GYN in 2013 Sumner Regional Medical Center (SRMC) recently announced Suzanna Chatterjee, MD, has joined the medical staff and will be offering obstetrics and gynecology services to patients throughout Gallatin and the surrounding communities.

Chatterjee graduated from Vanderbilt University and attended medical school at the Medical University of Lublin in Poland, where she was the class ambassador and a top five student. She completed her residency at Oakwood Hospital and Medical Center in Dearborn, Mich.

Feather Takes AHA National Role Nashvillian Paula Feather has been promoted to national program manager for Mission: Lifeline for the American Heart Association, directing the national effort to improve healthcare system readiness and response to acute STEMI heart attacks, and improv- Paula Feather ing quality of care and patient outcomes. Previously, she served as the program’s regional director for Tennessee and Mississippi.

More Grand Rounds Online nashvillemedicalnews.com NOVEMBER 2013

>

19

GrandRounds New Imaging Tool Tracks Breast Cancer Therapy Effectiveness in Days A group of Vanderbilt University researchers has used laser technology and a custom-built multiphoton microscope to distinguish breast cancer subtypes and determine if specific therapies are working against the cancer cells in as little as two days. The technology allows investigators to see how molecules “light up” through autofluorescence and to measure the molecules’ activity.

The study, led by Vanderbilt PhD candidate Alex Walsh, was published in the AACR journal Cancer Research.

The new optical metabolic imaging (OMI) measures the metabolic activity in cells. “By looking at the different ways the cells are metabolizing glucose we’ve been able to differentiate the different subtypes of breast cancer and also see how anticancer drugs are affecting the metabolism,” said Walsh, who works in the Department of Biomedical Engineering.

The technology Walsh and her colleagues used to study the metabolic activity of cells involved the multiphoton microscope and a titanium-sapphire laser. They used special filters to see the fluorescence emitted by two molecules — NADH (nicotinamide adenine dinucleotide) and FAD (flavin adenine dinucleotide).

“NADH and FAD are molecules that are present in every cell in the body, and when these molecules are excited with laser light, electrons jump to higher

orbital levels,” said Walsh. “When they return to the normal states, instead of releasing the energy as heat, they emit fluorescent light.”

Using OMI, the investigators were able to capture images of cellular metabolism and to differentiate between estrogen receptor positive or negative breast cancer cells and HER2 positive or negative cells. The investigators also used the technology to test the effects of anti-HER2 therapy trastuzumab in breast cancer cell lines, then grew human breast tumors in mice and treated some of the mice with trastuzumab.

They were able to image the tumors in live mice and see a difference in response between trastuzumab-sensitive or resistant tumors as early as two days after the first dose of the cancer therapy.

TDH, Meharry Partner to Provide Dental Services

We don’t just have insurance.

Tennessee Health Commissioner John Dreyzehner, MD, MPH, joined officials from Meharry Medical College and other state and local officials on Oct. 22, for an open house at the Maury County Health Department Dental Clinic in Columbia. TDH is partnering with the Meharry School of Dentistry to enhance provision of comprehensive dental care for children and targeted populations of uninsured adults at the facility and at the Montgomery County Health Department Dental Clinic in Clarksville.

Fourth-year students at the Meharry Medical College School of Dentistry in Nashville provide services in two-week rotations at the Maury clinic, as part of a new partnership with the college. Meharry students are also serving rotations at the Montgomery County Health Department Dental Clinic in Clarksville.

We own the company.

Paul C. McNabb II, M.D. Baptist Hospital Nashville, TN Internal Medicine/Infectious Disease

Raymond S. Martin, M.D. The Surgical Clinic PLLC Nashville, TN General and Vascular Surgery

Recent Certifications, Accreditations & Commendations

Medical Professional Liability Insurance “These are uncertain economic times. So the way we see it, this is the time to be more diligent than ever when choosing a professional liability insurance carrier. We need a company with the proven ability to protect our livelihoods for the long haul. That’s the reason we chose SVMIC. Their long commitment to physicians in our state, through an extensive physician governance system and consistently high ratings from A.M. Best, is unmatched. Only SVMIC has the track record and financial stability our careers deserve. And, our careers are much too important to settle for anything less.”

Mutual Interests. Mutually Insured.

Contact Amy Brown or Susan Decareaux at mkt@svmic.com or 1-800-342-2239.

SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies.

Follow us on Twitter @SVMIC

20

>

NOVEMBER 2013

www.svmic.com

RJ Young Chief Financial Officer Sam Shallenberger recently earned the Certified Lease Professional (CLP) designation from the Certified Lease Professional Foundation. Shallenberger is now one of only 186 Certified Leasing Professionals worldwide.

Let’s Give Them Something to Talk About!

Awards, Honors, Recognitions

Keith B. Churchwell, MD has been named president of the American Heart Association’s Greater Southeast Affiliate board of directors for the 2013-2014 fiscal year.

Churchwell, the executive director and chief medical officer for the Vanderbilt Dr. Keith B. Heart and Vascular InstiChurchwell tute, has been affiliated with the AHA for a decade and recently served as president of the Greater Nashville board. The Greater Southeast Affiliate services the region covering

nashvillemedicalnews

.com

GrandRounds Alabama, Florida, Georgia, Louisiana, Mississippi, Tennessee and Puerto Rico.

Mark Edwin Frisse, MD, MS, MBA, professor in the Department of Biomedical Informatics, and Elizabeth (Betsy) Elder Weiner, PhD, RN-BC, FACMI, FAAN, senior associate dean for Informatics, Centennial Independence Foundation Professor of Nursing, and professor of Biomedical Informatics at Vanderbilt were among the 70 new members and 10 foreign associates elected to the Institute of Medicine during the 43rd annual meeting. Election to the IOM is considered one of the highest honors in the field of medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment.

Frank Knobbe, partner with LBMC Security & Risk Services, has been named a Fellow of the Information Systems & Security Association.

Susan Alcorn, senior vice president with Frank Knobbe Jarrard Phillips Cate & Hancock, Inc. was announced as the recipient of the 2013 Award for Individual Professional Excellence from the Society for Healthcare Strategy & Market Development (SHSMD) of the American Hospital Association. SHSMD’s Award for Individual Professional Excellence is the highest honor the Society can bestow on one of its members.

Gina Pruitt, CPA, CISA, CGMA, CRISC, CQA, CITP, the member in charge of KraftCPAs’ information systems assurance and consulting practice, has been appointed as a member of the American Institute of Certified Public Accountants Board Gina Pruitt of Examiners (BOE) for the 2013-2014 term.

LBMC Technologies LLC has been selected for the 2013 Tennessee Excellence Award amongst all its peers and competitors by the Small Business Institute for Excellence in Commerce (SBIEC). The consulting firm has also been recognized as one of the top accounting technology value-added resellers (VAR) in North America in a special report from ACCOUNTING TODAY entitled VAR 100.

values-based purchasing initiative for nursing facility and home and community-based services.

Vanderbilt University Medical Center has received a five-year, $1.2 million grant from the National Institutes of Health (NIH) to develop “bold and innovative approaches to broaden graduate and postdoctoral training.”

Vanderbilt is one of 10 academic medical centers in the country to receive “BEST” (Broadening Experiences in Scientific Training) grants from the NIH’s Common Fund, which has a goal of helping train U.S. scientists for today’s more diverse array of employment opportunities. The Vanderbilt program is called ASPIRE (Augmenting Scholar Preparation and Integration with Research-Related Endeavors).

UnitedHealthcare Community Plan of Tennessee is allocating $1 million in grant funding to increase housing options available for Tennesseans who suffer from mental illness. The funding will help support development of appropriate housing for people who need a place to live after having been discharged from a mental health facility.

The Tennessee Department of Mental Health and Substance Abuse’s Creating Homes Initiative estimates that nearly 190,000 Tennesseans with mental illness are in need of some sort of housing assistance.

The Vanderbilt Vaccine Research Program (VVRP) has received a contract from the National Institutes of Health to continue its work as one of the nation’s Vaccine and Treatment Evaluation Units (VTEU). Vanderbilt is one of nine institutions that have the potential to receive funding up to $135 million per year from the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, over a seven-year period.

UNHS Opens New Clinic Last month, United Neighborhood Health Services opened a new clinic inside Casa Azafran Community Center.

The new Unity Family Clinic, located on Nolensville Pike, will serve patients from the surrounding community including a diverse group of immigrants and refugees. The clinic is utilizing about 1,500 square feet of the community center and expects to serve close to 25 people a day.

patients and their families at all times. The PAC will have an active role in the patient care experience by identifying opportunities, gathering and sharing feedback and perspectives on plans and programming related to patient-centered health.

Elections were held at the inaugural meeting in late September. George Boswell was named chair; Gwen McKinney, co-chair; and Jane Boram, secretary. Mary Arnold, JoAnne Hill, Theresa Park and Barbara Hornal round out the PAC.

Huddleston Takes on Tech Council Bryan Huddleston has been named president and CEO of the Nashville Technology Council. Huddleston, a technology veteran, has been with Microsoft Corporation for the past eight years in Bryan the Nashville office. Prior Huddleston to that, he worked with Ingram Industries as a micro systems specialist.

NorthCrest Names New CEO Cutting the ribbon on Unity Family Clinic are: (L-R, front row) Mayor Dean, Renata Soto, UNHS CEO Mary Bufwack, Councilwoman Sandra Moore (LR, back row) Rep. Jason Powell and Metro Health Director Dr. Bill Paul.

St. Thomas Medical Group Launches ACO PAC St. Thomas Medical Group, a 28-physician, multi-specialty practice, recently achieved Level 3 NCQA certification and has launched a Patient Advisory Council for their Accountable Care Organization.

Seven patients from within the group will serve in advising STMG on its performance-improving activities and alignment with the ACO’s goals of delivering care in a safe, effective, efficient, patient-centered manner while preserving the dignity of

Randy Davis has been tapped to lead NorthCrest Medical Center as president and chief executive officer. He has been part of the senior leadership team at the Springfield hospital since 2008, most recently serving as senior vice president and Randy Davis chief operating officer.

He has also served as vice president and chief information officer.

Davis received his undergraduate degree from Vanderbilt and holds an MBA with a healthcare management concentration from Lipscomb University. The hospital board selected Davis after a nationwide search.

With several locations throughout Nashville...

We’re right in your neighborhood!

$

59

NEW PATIENT SPECIAL We LOVE to see you SMILE!

Wishes Granted

UnitedHealthcare has announced the company is providing $600,000 in support of Healthier Tennessee, the inaugural initiative of the Governor’s Foundation for Health and Wellness.

Lipscomb University’s School of TransformAging has been contracted

by Princeton to provide technical assistance to the Bureau of TennCare through a grant from the Robert Wood Johnson Foundation as part of the state’s Quality Improvement in LongTerm Services and Supports (QUILTSS) nashvillemedicalnews

.com

Bellevue Family & Cosmetic Dentistry

(615) 823-1542

7640 Hwy 70 South #205 • Nashville, TN 37221

http://www.demandforce.com/b/Bellevue-Family-and-Cosmetic-Dentistry

Dickson Family & Cosmetic Dentistry

Dickson Family Dentistry & Oral Surgery

401 Center Avenue • Dickson, TN 37055

306 E. College St. • Dickson, TN 37055

(615) 326-1517

http://www.demandforce.com/b/Dickson-Family-and-Cosmetic-Dentistry Offer Expires in 30 days. Includes exam, cleaning and x-rays.

New Patients Only.

(615) 326-1520

http://www.demandforce.com/b/Dickson-Family-Dentistry-Dickson

Affiliated with Dental Partners

A Proud Member of the Dental Practice Group of Tennessee: D0150, D0330, D0272, D0210, D1110, D0140, D0220, D0230, D9972

NOVEMBER 2013

>

21

GrandRounds TriStar StoneCrest Names Tyrer COO

Seebach Joins TriStar Southern Hills Medical Staff

Drew Tyrer has assumed the role of chief operating officer for TriStar StoneCrest Medical Center in Smyrna.

Most recently, he served as associate chief operating officer of Eastside Medical Center in Snellville, Ga. Tyrer Drew Tyrer earned his bachelor’s degree in sport administration from University of Dayton in Ohio and his master’s of sport administration from the University of Louisville in Kentucky.

He later earned a master’s degree in healthcare administration and a master’s degree in business administration from Xavier University in Cincinnati, Ohio. He is also a graduate of HCA’s Chief Operating Officer Development Program.

Jeff Seebach, MD, has joined the medical team at TriStar Southern Hills Medical Center. The general surgeon received his medical degree from University of Kentucky College of Medicine in Lexington. He then completed a general surgery Dr. Jeff Seebach residency at Walter Reed Army Medical Center in Washington, D.C. Seebach is board certified with the American Board of Surgery.

HCA, Jason Foundation Partner to Prevent Youth Suicide The Jason Foundation, Inc. (JFI), a youth suicide prevention and awareness organization, and Hospital Corporation of America (HCA) announced this fall that HCA has become a JFI National Community Affiliate and will establish Community Resource Centers at 10 hospitals that provide adolescent behavioral health services. The Community Resource Centers will serve as hubs where parents, teachers, guidance counselors, students, churches and other community organizations can get educational materials and learn about training programs available through JFI. According to the Centers for Disease Control and Prevention, suicide is the second-leading cause of death for youth between the ages of 10 and 24, resulting in approximately 4,800 lives lost each year.

The MedEvolve Solution Fully Integrated EHR/PM/RCM n ICD-10 Ready n Turnkey Billing and Collections n Improved Bottom Line n Peace of Mind n

97% 27% 38%

Clean Claims Rate Average Increase in Revenue

Amplion Taps Grant as New Chief Sales & Marketing Officer Nashville-based Amplion Clinical Communications recently announced Frank Grant has been named chief sales and marketing officer. In his role, Grant will oversee the company’s sales, business development and marketing efforts. Grant brings more than 30 years of integrated sales and marketing experience in the healthcare and technology industries, and has a strong history of growing businesses. Previously, Grant held the same position for Adreima, a Phoenix-based company providing revenue cycle and reimbursement services to hospitals. He also spent more than a decade with technology juggernaut, Cisco Systems.

Jeff Gould, who previously served in this position, has transitioned to chief strategy officer for Amplion.

McDonough Named Optimal Radiology CEO Joe McDonough has been named CEO of Optimal Radiology, the national imaging company that moved its home office to Nashville from Birmingham this summer.

An industry veteran, McDonough

comes to Optimal having led Soteria Imaging Services from 2007 until earlier this year and before that working as president and CEO of IRG/American Imaging Management for four years. He takes the top spot at Optimal from Jon Grimes, who has moved over to lead the company’s business development efforts.

Aegis Adds Two Nashville-based Aegis Sciences Corporation, a leading forensic toxicology and healthcare sciences laboratories, recently announced two additions to the team.

Adam Meyer, MD, has been named medical director, overseeing laboratory medicine operations, development, regulatory requirements, direct strategic operations of Aegis technologies and applications, and assisting in client and management relations.

Previously, he was a clinical pathology resident at Vanderbilt and before that at Saint Louis University (SLU) School of Medicine, where he worked in the forensic toxicology lab. Meyer received his medical degree from SLU and his master’s in organic chemistry from Washington University in Saint Louis.

Ali Roberts, PharmD, has joined the company as clinical scientist of healthcare services. She will assist in the growth of service lines by offering guidance on healthcare research and outcomes, answering pain management and toxicology-related questions that arise during patient treatment, and providing continuing education related to healthcare and drug testing practices. Previously, Roberts was a pharmacy resident at Memorial Hospital. She received her undergraduate degree in chemistry from Middle Tennessee State University and her pharmacy degree from Belmont University.

MedEvolve offers the complete solution for the medical practice: Electronic Health Records, Practice Management Software and Revenue Cycle Management. See why thousands of physicians trust MedEvolve as their practice partner.

“MedEvolve’s PM software and Revenue Cycle Management services have absolutely improved our practice’s collections. MedEvolve really does stand out not only in software performance, but particularly in customer service.”

- Barry S. Seibel, MD Ophthalmic Surgeon Beverly Hills, California

Call to speak to an ICD-10 specialist today! medevolve.com 22

>

PUBLISHED BY: SouthComm, Inc. MARKET PUBLISHER Tori Hughes thughes@southcomm.com 615.844.9410 SALES 615.844.9237 Maggie Bond, Adam Cross, Heather Cantrell, Mike Smith LOCAL EDITOR Cindy Sanders editor@nashvillemedicalnews.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Lynne Jeter, David Lister, Jerry Moss, Kelly Price, Cindy Sanders ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78

SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains Nashville Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

Average Reduction in AR days

1-800-964-5129

Middle Tennessee’s Primary Source for Professional Healthcare News

MedEvolve offers ICD-10 Consulting

NOVEMBER 2013

nashvillemedicalnews.com nashvillemedicalnews

Learn More

Learn More

.com

GrandRounds Myers Takes the Helm at Corizon Last month, officials with Brentwoodbased corrections healthcare company Corizon announced Woodrow Myers, Jr., MD, has been named CEO. Since 2011, the physician has been a member of the board for Valitas, Corizon’s parent company.

Dr. Woodrow Myers, Jr. Previously, he served as executive vice president and chief medical officer of WellPoint.

Prior experience also includes a stint as director of healthcare management for Ford Motor Co. and as health commissioner for the city of New York and state of Indiana. Myers received his undergraduate degree from Stanford and medical degree from Harvard. He also holds an MBA from Stanford’s Graduate School of Business. He is a diplomat of the American Board of Internal Medicine and Master in the American College of Physicians.

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.”

I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

Burden Named VP Human Resources for TriStar Centennial TriStar Centennial Medical Center recently announced Jennifer Burden has been named vice president of Human Resources. She joins the TriStar Centennial leadership team with over 20 years of human resource experience. Burden has held positions within Jennifer Burden the discipline in the TriStar Health network since 2004, serving most recently as the vice president of human resources for TriStar Hendersonville Medical Center.

She earned her undergraduate degree from Belmont University and anticipates completion of her master’s of Professional Studies in Human Resources Leadership from Austin Peay State University in May 2014.

Banick Named Market Medical Director for UnitedHealthcare

Paul D. Banick, MD, PhD, MBA has been named market medical director for UnitedHealthcare’s MidSouth Health Plan. He will provide leadership for shaping the benefits and services UnitedHealthcare provides to employer and individual health plan Dr. Paul D. members in Arkansas and Banick Tennessee.

Banick joined the company in 2008 as an associate medical director for UnitedHealthcare Community Plan of Tennessee and most recently served as the inpatient medical director for Tennessee and Arkansas. He earned undergraduate degrees in chemistry and humanities from Villanova University, a medical degree and doctorate from Georgetown University, and an MBA from the University of Tennessee, Knoxville.

nashvillemedicalnews

.com

Our Medical Specialty Group provides a dedicated team with tailored solutions to meet the unique financial needs of physicians and their practices.

Visit suntrust.com/medicine to find an advisor near you.

Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured • Are not Bank Guaranteed • May Lose Value. SunTrust Private Wealth Management Medical Specialty Group is a marketing name used by SunTrust Banks, Inc., and the following affiliates: Banking and trust products and services, including investment advisory products and services, are provided by SunTrust Bank. Securities, insurance (including annuities) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC registered investment adviser and broker-dealer, member FINRA, SIPC, and a licensed insurance agency. SunTrust Bank, Member FDIC. © 2013 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. How Can We Help You Shine Today? is a service mark of SunTrust Banks, Inc.

NOVEMBER 2013

>

23

Our tailored approach to solving health care industry legal issues is just what the doctor ordered.

Baker Donelson is recognized nationally as a leading healthcare practice. With 650 attorneys in 19 off ices across the Southeast, Texas and Washington, D.C., we have the experience and strength to help you solve your legal issues.

Learn how Baker Donelson’s innovative legal services can be tailored to meet your business needs.

THIS IS AN ADVERTISEMENT. Ben Adams is Chairman and CEO of Baker Donelson and is located in our Memphis off ice, 165 Madison Avenue, Suite 2000, Memphis, TN 38103. Phone 901.526.2000. Š2013 Baker, Donelson, Bearman, Caldwell & Berkowitz, PC

To learn more about our financial services industry capabilities, visit www.BakerDonelson.com.