Nashville Medical News November 2014

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Middle Tennessee’s Primary Source for Professional Healthcare News

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Short of BreathCOPD Foundation Sheds Light on State’s High Rate of Progressive Lung Disease

During November, National COPD Awareness Month, it seemed appropriate to share data and insights into the third leading cause of death in the United States and in Tennessee ... 15

Ebola Preparedness UpdateExpert Briefi ngs & More

U. S. Sen. Lamar Alexander (R-Tenn.), ranking member of the Senate Health Committee, met with infectious diseases experts from Vanderbilt University Medical Center ... 16

November 2014 >> $5

FOCUS TOPICS HEALTH EDUCATION RADIOLOGY & IMAGING

ONLINE:NASHVILLEMEDICALNEWS.COMNEWS.COM

The New Rules of Radiology Reimbursement

By MELANIE KILGORE-HILL

There’s no question imaging technology has far surpassed expectations, but the business of radiology is evolving every bit as rapidly. Reimbursement cuts, higher deductibles and the Affordable Care Act are challenging current business models and changing the landscape of radiology.

So how are Nashville’s radiology leaders handling an inevitable industry-wide evolution?Clete Madden, COO at Brentwood-based Touchstone Medical Imaging, said today’s radiology prac-

tice is a whole new ballgame from that of years past. “You’ve got to do things faster, better and with higher quality,” said Madden, whose radiologists see 1,200 pa-

tients a day at Touchstone’s 36 locations nationwide. “You have to look outside: at other potential structures, ven-tures and partners, and work collaboratively under regulations with hospital systems and large physician groups.”

(CONTINUED ON PAGE 10)

Dan Wunder, MD

PAGE 12

PHYSICIAN SPOTLIGHT

Clete Madden

InCharge Healthcare ‘15WHO IS LEADING THE INDUSTRY THROUGH AN ERA OF CHANGE?

WHO IS TRANSFORMING THE WAY CARE IS DELIVERED? [email protected]

615-844-9238

We have made it easy to keep you in contact with the key decision makers across the broad platform of the city’s

healthcare industry.

COMING DECEMBER 2014

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Y O U R P R I M A R Y S O U R C E F O R P R O F E S S I O N A L H E A L T H C A R E N E W SNashville

By CINDy SANDERS

A little more than a year ago, the American Medical As-sociation announced $11 mil-lion in grants to 11 academic medical centers to fundamen-tally change the way physicians are educated and trained.

“There has been a univer-sal call to transform the teach-ing of medicine to shift the focus of education toward real-world practice and competency assessment, which is why the AMA launched the Accelerat-ing Change in Medical Educa-tion initiative,” AMA President Robert M. Wah said in a state-ment. “Over the last year, we have made signifi cant progress in transforming curriculum at these medical schools that can and will help close the gaps that currently exist between how medical students are trained and the way health-care is delivered in this country now and in the future.”

In late September, a consortium of thought leaders from the

11 academic centers convened on the campus of Vanderbilt University School of Medicine in Nashville to discuss progress and barriers in implement-ing individual projects, offer insights and innovations, give and receive feedback on the conceptual model for the mas-ter adaptive learner, and share other lessons learned in the fi rst year. Much of the meet-ing’s focus was centered on the master adaptive learner (MAL), which is the AMA consor-tium’s term for an expert, self-directed, self-regulated, lifelong workplace learner. Developing this type of skill is considered critical to prepare physicians

for careers in a healthcare environment that is constantly changing and evolving.

During the two-day event, Susan Skochelak, MD, MPH, group vice president of Medical Education for the AMA, and

The Transformation of Med EdAMA Continues Quest to Accelerate Change in Physician Training


Dr. Susan Skochelak at the podium addressing the consortium meeting at Vanderbilt.

2 > NOVEMBER 2014 n a s h v i l l e m e d i c a l n e w s . c o m

By CINDy SANDERS

Although WGU Tennessee officially launched in July 2013, “The University of You” has a history of offering targeted, com-petency-based, online curriculum that dates back 15 years.

Western Governors Uni-versity was the brainchild of 19 governors who met regularly to discuss common concerns. “Their vision for WGU, when they ini-tially founded it, was a university that would focus on workforce areas where they needed more graduates … areas of workforce shortages,” explained WGU Tennessee Chancellor Kimberly Estep, PhD. Those four areas, she continued, were information technology, nursing, business and teacher education (particularly STEM and special education).

With a focus on working adults, the curriculum had to accessible at the stu-dent’s convenience. The university had to be affordable, and it had to truly provide a return on investment for students by teach-ing them the hands-on skills required in the real world to move their careers forward.

The result was a private, non-profit, online, accredited university focused on mastering concepts rather than requiring a set amount of time in a classroom. “We’re really pioneers in competency-based learn-ing,” Estep said. While the concept is be-ginning to spread, she added, “We’re the only competency-based university at scale.”

Estep said the average age of their students is 37 with most working full time. “It’s very difficult for them to access tradi-tional higher education,” she pointed out. Nationally, WGU has 50,000 students. In Tennessee, Estep said that number is about 1,500 but growing monthly.

For undergraduate programs, pro-spective students do not have to have com-pleted an associate’s degree to start any field of study with the exception of nursing, which is an RN to BSN program. However, every student must complete an entrance interview and take a readiness assessment if they don’t have their two-year degree. A number of undergraduate programs have a healthcare emphasis including health in-formatics and healthcare business manage-ment. For those who have already earned a bachelor’s degree from an accredited university, master’s programming is also available including an MBA in healthcare management and MS in nursing education and nursing leadership and management.

Mastering ConceptsEstep said the beauty of competency-

based learning is “it’s really designed to honor the knowledge students bring to the table.” For those studying in their field of work, they can leverage that practical knowledge to move more quickly through

WGU’s Competency-Based Curriculum Enhances Tennessee’s Healthcare Workforce

Expanding HorizonsA Recent WGU Grad’s Experience

When Shannon Tucker began working on her MBA at WGU, she already held an undergraduate degree from Trevecca Nazarene University and a master’s in Communication Disorders from Tennessee State University.

In fact, she had a successful career with TriStar Skyline where she had been employed since 2001. For many years, Tucker worked as a speech language pathologist focusing primarily on stroke patients. It was a promotion to director of Rehabilitation Services at the hospital that made her begin thinking about a second master’s degree.

In her very first meeting with Dustin Greene, COO of TriStar Skyline, Tucker recalled he told her she was the ‘CEO’ of Rehabilitation Services. “I didn’t feel like my clinical training really prepared me to be the CEO,” Tucker said. “I would go to talk to hospital administrators, and I sometimes felt like I was speaking a different language. I could say why we needed XYZ clinically, but I couldn’t make the business case for it.”

Wishing to boost her business acumen, and with the encouragement of TriStar colleagues, she embarked on her MBA program. “I was a weekend warrior,” she said of her WGU schedule. “I’d go to school Friday evening, and I needed to pretty much wrap up on Sunday.” Then, she continued, “I could take what I learned and apply it on Monday … and I did.”

Like many students, Tucker cited cost and timing as two appealing factors in selecting the online, competency-based program. “I could make WGU fit into my life instead of making my life fit into WGU’s schedule,” she said. Tucker completed her MBA in two years using primarily weekends. Some areas she mastered quickly, others took more time. “Financial management took me like eight weeks. That was my shortcoming, but I knew that going in.”

However, it isn’t a shortcoming anymore. Her studies gave her the confidence and tools to balance both sides of her job. “I could connect the dots between the clinical needs of the unit and the business case,” she said of her enhanced skill set.

In fact, she now has a new job at the corporate level. After graduating from WGU in May, Tucker was promoted the following month to assistant vice president for Rehabilitation Services at HCA, TriStar’s parent company.

“It wasn’t that the MBA was required for this position … I already had my master’s,” Tucker said. “But it made me more well rounded, and it made me more successful. I started making great strides at Skyline and in my department, and that caught the attention of corporate.”

the program.“You can go as fast as you want …

but you can’t go as slow as you want,” she added with a laugh. “You need to make satisfactory progress.”

Students can, however, spend more time in areas that prove to be challenging. Online lectures allow students to pause, re-wind, and hear material as often as needed. Once the concept is learned, the student demonstrates mastery. Estep said WGU

doesn’t give letter grades, per se, but the pass rate is generally set at what would be comparable to a B or higher.

“All of our students have to reach the same level of com-petency before moving forward in the program,” Estep said. Setting the bar high gives em-ployers the comfort of knowing the WGU graduate has demon-strated strong capability through-out their program. “It provides transparency and consistency,” she added.

Although WGU students must be independent learners, Estep was quick to say they cer-tainly aren’t alone on their jour-ney. All students have a faculty mentor who works with them

throughout their degree program. Addi-tionally, students have a number of course mentors, faculty members with terminal degrees in their field, who are there to help provide course-specific expertise.

Cost & TimingUnlike most universities that base rates

on course credits, WGU tuition is set at a flat rate for a six-month term. Basic tuition is $2890 for most degree programs and

$3,250 for nursing and MBA programs. Additionally, there are fees that apply to specific programs. “We have not raised tu-ition at WGU since, I believe, 2008,” Estep said of the affordability factor.

Another difference is the timing of ‘se-mesters.’ The six-month term doesn’t have a set start date. Instead, Estep explained, “We start new students every month. Every student has their own six-month term be-ginning when they do.”

The ending point is largely up to the student. Estep noted that a typical RN candidate finishes their WGU degree in 18 months. “Because it’s competency-based, some may take two years. Some may do it in as little as a year. It really puts the stu-dent in the driver’s seat in a way traditional programs can’t do.”

Drive to 55“We want to do everything we can to

help Gov. Haslam reach his goal of Drive to 55,” Estep said of the statewide initiative to have 55 percent of Tennesseans with an associate degree or higher by 2025.

She added the governor’s office es-timates 940,000 Tennesseans have some college but haven’t finished a degree pro-gram. “We’re trying to give them a good way to come back and complete a degree,” she concluded.

Dr. Kimberly Estep and Shannon Tucker at graduation this past May.

Shannon Tucker gives the commencement address at her WGU graduation.

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By CINDy SANDERS

A year ago, Indianapolis-based Marian University announced a partnership with Saint Thomas Health to bring an acceler-ated nursing degree program to Middle Tennessee to address workforce shortages by educating highly skilled professionals in a concentrated 16-month period.

Amy Stauffacher, who joined the program in February as site man-ager, said the inaugural class launched this past May. “We have three starts a year – January, May, and August,” she noted, adding there are 24 students in each class, which means Marian and Saint Thomas Health are helping launch 72 new nursing careers annually.

A secondary bachelor’s degree pro-gram, most students earned degrees in other fields and are coming back to school because they’ve discovered a passion for nursing. “Students are very attracted to the flexibility of online classes,” Stauffacher noted. “One of the nicest things about on-line learning is you can go back and listen to a lecture again. You can’t ask a professor

to do that,” she said of traditional classroom settings.

Samantha Montagno, director of Community and Corpo-rate Relations for Marian at Saint Thomas, added, “This program was cre-ated for people who didn’t do the traditional route into nursing. This is a nice, quick way to bridge over and utilize their non-nursing degree.” She said the majority of students enrolling in the program are incredibly focused. “We’re very excited about the caliber and quality of students in our pro-gram,” Montagno said.

While the nursing degree takes 16 months, students often must take prerequi-site courses before beginning the main pro-gram. “We work with them from the initial phone call forward,” Stauffacher said of the personalized approach taken with students. “We offer all our prerequisites in an accel-erated eight-week online format.”

After beginning the actual nursing coursework, students work online and come to Saint Thomas Hospital West twice a week for testing. There is one clinical faculty member for every eight students,

and the groups make good use of the nurs-ing resource center at Saint Thomas West. Based on the premise that people learn by doing, students utilize the center to add con-text to didactic classes and make the jump from theory to application. Hands-on skills include taking vital signs, operating medical equipment and transferring patients.

“Once clinicals start, which is the sec-ond eight weeks of the first semester, they come to their clinical site, and those are typ-ically twice a week,” Stauffacher explained. “That’s when you begin to think of it as a hybrid program … you’re doing half online classes and half clinical rotations.”

She added the rotations include pediat-rics, adult health, behavioral health, obstet-rics, community health, and more. “They get the opportunity to really see all types of nursing so they get a feel for what type of field they want to go into but also so they can be a well-rounded nurse.”

Montagno said the university’s location at Saint Thomas West is another unique as-pect of the program with students immersed in the hospital setting from the very begin-ning. For clinicals, she noted, “We use all of Saint Thomas Health and also go offsite.”

Although new to Nashville, Stauffacher said, “We brought in a program that was extremely successful from our main cam-pus.” The accelerated BSN she continued, began as a traditional classroom setting in Indianapolis before being moved to the on-line format in 2009. The depth and breadth of expertise behind the program has been instrumental in the growth and develop-ment of partnerships in Middle Tennessee.

“We’ve heard such an overwhelmingly positive consensus,” Montagno said. For the healthcare community, the program offers skilled graduates. For the students, she added, “This offers them a second chance to go into a profession they’re passionate about.”

Marian University at Saint Thomas … One Year Later

Amy Stauffacher

Samantha Montagno

By CINDy SANDERS

Last month, Meharry Medical Col-lege faculty, students and distinguished guests gathered at the Cal Turner Family Center for Student Education to celebrate the educational institution’s 139th Convo-cation. As expected, the event was filled with tradition and ceremony … but it was also a day of big surprises.

For the first time in its history, Meharry Medical College awarded four students aca-demic scholarships covering 100 percent of tuition costs for their final year. The award-ees had no idea they would be receiving scholarships prior to the announcement by A. Dexter Samuels, PhD, senior vice presi-dent of Student & Faculty Affairs at Me-harry and executive director of the Robert Wood Johnson Center for Health Policy. The four recipients were selected based on financial need, merit, academic excellence and aggregate loan indebtedness.

Officials with the medical school said the scholarships were intended to ease the financial burden of receiving a health profession education. Across the country, medical school tuition continues to rise. For many who study at Meharry, paying off loans is even more challenging in the wake of upholding the school’s mission of serving the underserved.

The scholarship recipients were Italo Brown, School of Medicine; Naila Ortega, School of Dentistry; Nchelem Ehule and Efe Oghoghome, both from the School of Graduate Studies and Re-search. Making education affordable and

attainable has been a point of emphasis for Meharry President and CEO A. Cherrie Epps, PhD, and her administration.

In addition to the scholarships, the day featured a keynote speech by cardi-ologist André Churchwell, MD, professor of Medicine and senior associate dean for Diversity Affairs at Vanderbilt University School of Medicine. Frank S. Royal, Sr., MD, chairman of the Meharry Board of Trustees, presented Churchwell and Bishop Joseph W. Walker, III, DMin, pastor of Mount Zion Baptist Church and international presiding bishop-elect of Full Gospel Baptist Church Fellowship, with honorary degrees during the ceremony.

Meharry Convocation Filled with Ceremony, Surprises

Keynote speaker Dr. André Churchwell (R) receives an honorary Meharry Medical School degree from Dr. Frank Royal, chairman of the school’s board of trustees.

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By CINDy SANDERS Parallon Business Solutions, an HCA

subsidiary offering a range of business and operational solutions, recently launched StaRN: Specialty Training Apprentice-ship for Registered Nurses — a unique educational opportunity to meet a critical need for specialty nurses in Florida.

“We have an interesting phenom-ena going on right now in nursing,” said Tony Pentangelo, ex-ecutive vice president of managed services for the Franklin-based Paral-lon Workforce Solutions business unit. “It’s very competitive for critical care nurses in particu-lar.”

In the Florida mar-ket, he added, a significant number of new nursing graduates were licensed and had passed their boards. However, a shortage of positions for beginning nurses left many of these graduates unemployed or under-employed. “We had licensed nurses work-ing as waitresses,” Pentangelo said.

On the flip side, he noted, hospitals were competing against each other for specialty care nurses or bringing in con-tract nurses to try to meet demand. “The hospitals won’t take newly licensed nurses for critical care,” Pentangelo said, adding that almost never happens. “The intensity and the acuity of the patients are just too

high. Typically, they want at least two years experience.”

The need at one end and surplus on the other had created a frustrating ‘catch 22’ for both area hospitals and young nurses. “We think this helps bridge that gap a little bit,” Pentangelo said of StaRN.

The intensive, 13-week program for nursing graduates combines classroom instruction, a robust simulation experi-ence and hands-on clinical training done in conjunction with a regional academic partner. Upon completion, the nursing graduates are equipped with the knowl-edge and skill set typically found in more experienced staff nurses.

The first half of the program is spent in the classroom and simulation labs where Pentangelo said the nurses get hands-on ex-perience in a very controlled environment. The last half of the program is spent in a clinical preceptorship. “It really helps them understand how to apply the knowledge in a patient scenario,” Pentangelo noted.

Prospective candidates interview with the hospitals so they are pre-identified for the units in need. The hospitals then pay a placement fee that covers the cost of the StaRN program. In exchange, the par-ticipating nurses make a two-year com-mitment to work at the sponsor hospital. Training during the course can be tailored to meet the specific needs of the sponsor hospital.

While there is an out-of-pocket cost to the hospitals, Pentangelo said it doesn’t

compare to the expense of bringing in contract nurses year-round, particularly if a hospital is paying signing bonuses, hous-ing allowances, and travel stipends. “We estimate that if a facility can replace a con-tract labor FTE (full-time equivalent), the savings is upward of $100,000 per (StaRN) nurse.”

Another benefit is the young nurses typically already have ties to the commu-nity unlike travel nurses that have no real reason to stay beyond their contract pe-riod. “These local nurses want to stay in the town. They’re committed to the town. They know the hospital,” Pentangelo stressed. Hiring locally also enhances the hospital’s hometown relations by reinvest-ing in the community.

“When hospitals can’t find specialty-trained nurses, they are forced to use costly alternative measures such as hiring temporary contract labor, which does not address the core problem: the shortage of experienced, specialty-trained nurses,” said Pentangelo. “StaRN offers a way for-ward that provides short- and long-term benefits to hospitals and nurses, alike.”

The first StaRN program launched this past June with a class of 52. Since then, several more classes have successfully graduated. Another 13 classes are sched-uled in both the eastern and western part of Florida for 2015. Pentangelo said Parallon is already in the process of expanding the program to other states with plans to roll StaRN out nationally in the future.

Parallon’s StaRN Program Answers Critical Nursing Need

Bonnie Miller, MD, senior associate dean for Health Sciences Education and associate vice chancellor for Health Affairs at Vanderbilt, hosted a media roundtable to discuss the transformative initiative.

Skochelak said it makes sense for the AMA to be at the forefront of such an am-bitious project. Upon being founded in 1847, the physician’s organization under-took two major tasks — to write the first code of professional ethics and to set the standards for medical education.

She added the AMA again took a lead role 100 years ago when there was a major movement to change medical edu-cation. Skochelak said the AMA published the standards of what medical education should look like and that became the basis for the Flexner Report.

“The Flexner Report really changed medical education to say it has to be sci-ence-based, and it has to be connected with knowledge generation,” she ex-plained. “It made a great leap forward in the quality of medical education. But here we are a century later, and our format for training physicians remains almost iden-tical to the structure that we described a hundred years ago.”

Skochelak added, “It’s not that the training is broken, it’s just that it hasn’t kept up with what’s going on in healthcare delivery today.”

She said the work being done as part of the Accelerating Change in Medical Education initiative is built on recommen-dations for change that have been well accepted for more than a decade by the medical education community. “We’re working in a great sense of consensus,” Skochelak noted. However, the fact that there has been broad agreement but little change points to impediments that must be addressed. “If it was easy, it would have already been done.”

To address the barriers and make it possible to move forward, Skochelak said, “The AMA wanted to provide resources and leadership to schools that are really ready to make the change.” That decision led to the grant program now in place for the 11 lead schools in the initiative.

In choosing the academic medical centers, Skochelak said the AMA was looked for programs that concentrated on key areas, including:

• Getting students into the real world environment early on so they understand healthcare systems in a way that isn’t cur-rently happening;

• Emphasizing important core con-cepts in medical school education like team-based care, patient safety and out-comes, patient-centered approaches to care, and population management; and

• Changing the way students progress through the educational system to provide more flexibility and individualized learn-ing.

Miller, a general surgeon by train-ing, has been involved in shaping medi-cal education at Vanderbilt for more than 15 years in an official capacity and even longer as a faculty member. She noted Vanderbilt had already undergone a major transformation to their traditional

curriculum from 2004-2007. Yet, she added, it became clear that even more needed to be done to support continuous learning throughout a career.

“We came to the conclusion that in order to do that you really did have to start at the beginning … that we couldn’t put our learners through our programs as usual and then expect magically at the end of their training they would be expert lifelong learners if we didn’t start to build those habits from the start,” Miller said of the decision to rework Vanderbilt’s pro-gramming for a second time.

“Curriculum revision is hard work,” she continued. “It’s not just a matter of developing new lesson plans. It really is a lot about culture change. We really felt that it was important to go back to the drawing board and start something new right away.”

Miller continued, “One of the things we thought a lot about was the context of learning. We felt that all learners need to work so that you’re really rapidly applying what you’re learning in the workplace … and that all workers need to learn.”

That mantra became a foundational principle of Vanderbilt’s Curriculum 2.0. Miller added other tenets of the program-ming was that it should be team-based,

The Transformation of Med Ed, continued from page 1

Tony Pentangelo

Participating ProgramsIndiana University School of Medicine; Mayo Medical School; NYU School of Medicine; Oregon Health & Science University School of Medicine; Penn State College of Medicine; The Brody School of Medicine at East Carolina University; The Warren Alpert Medical School of Brown University; University of California, Davis School of Medicine; University of California, San Francisco School of Medicine; University of Michigan Medical School; Vanderbilt University School of Medicine

interprofessional, modular to allow for dif-ferent entry and exit points, and include new content areas to help students under-stand the context of healthcare delivery, as well as what is happening on a molecular and genetic basis. The new curriculum rolled out last year with the incoming class of 2013.

During the recent consortium meet-ing, Vanderbilt and other participants shared their progress and discussed barri-ers to change. Skochelak said that unlike a research grant, where a recipient is given money and works on an individual project, the AMA initiative was designed to pool in-formation and work in collaboration.

“We told the schools if you receive

grant monies, you will be part of a consor-tium of schools. Right from the beginning we’ll work together, and we’re going to share ideas because we want your projects to benefit from each other … and our ul-timate goal is to share this with all of the schools,” Skochelak said.

Over the next four years, the AMA will continue to track, gather data and report on the progress of the 11 medical schools and their collective work in order to identify and broadly disseminate best practices to retool medical educational models across the country. Skochelak added the lessons learned would be shared with institutions educating other health professionals, as w

Dr. Bonnie Miller


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By KEITH DENNEN

New leadership, by nature, ignites ambiguity.

Last month, Gov. Haslam’s former chief counsel, Herbert Slatery, took the oath of office as Tennessee Attorney Gen-eral. His appointment comes at a defin-ing stage in healthcare law and its future in Tennessee, leaving doctors, healthcare groups and other providers anticipating a coming precedent regarding one of the most pressing legal issues any provider will face – a merger or an acquisition.

It’s no surprise that the rate of phy-sician practice mergers and acquisitions is on the rise. According to the New Eng-land Journal of Medicine, since 2000, there has been a near 75 percent increase in the number of active doctors employed by hospitals. With the implementation of the Affordable Care Act, which raises the need for capital to fulfill technology, data and analysis requirements, the de-mand for mergers and acquisitions is only continuing. Yet, with an increase in con-solidations among healthcare providers comes rising antitrust concerns and com-plications.

The line is already a blurry one. In order to provide the best possible care, many doctors merge with a hospital or healthcare group to gain access to essen-tial resources, technologies and collab-orative support. Yet, at some undefined point, that collaboration can appear to be too powerful, which would potentially result in loss of market share by smaller competitors, loss of negotiating power by insurers, and rising healthcare costs to patients.

Despite a great many healthcare mergers and acquisitions in our state, even in the last year – including the $4.3 billion purchase of Vanguard Health Sys-tem by Dallas-based Tenet Healthcare Corporation and Community Health Sys-tems’ acquisition of Florida-based Health Management Associates – the Tennes-see Attorney General’s office has largely remained quiet on antitrust issues … so much so that many healthcare profes-sionals are unaware the state has its own antitrust codes.

But the tide had turned. It was just months ago that Tennessee took a clear stance under the leadership of former At-torney General Bob Cooper.

Cooper joined in an opinion brief to the 9th circuit court of the United States Court of Appeals on an Idaho antitrust suit, Federal Trade Commission and State of Idaho vs. St. Luke’s Health System, Ltd. and Saltzer Medical Group P.A. The law-suit began as St. Luke’s Health System, the largest healthcare system in Idaho, merged with the largest independent physician practice in the state. The opin-

ion expressed agreement with the Dis-trict Court’s decision to order a divesture of the merger as a means of preserving competition, avoiding losses of bargain-ing power with insurers and ultimately retaining a level of affordable healthcare for patients.

Though the suit impacts Idaho alone, Cooper’s participation in the opinion served as a signal to warn Tennessee doc-tors they might not be able to trade own-ership for salaries, and that all healthcare transactions would be carefully scruti-nized to ensure there was no anti-compet-itive elements. The on-the-record action let healthcare attorneys, executives and practitioners understand, at least to some degree, that the business-as-usual stance of the AG’s office concerning consolida-tions will not continue if hints of antitrust issues emerge.

But just as attorneys and healthcare professionals received a new direction on an exigent issue, the tide turned once more with a new attorney general.

So the questions moving forward become — will Attorney General Slat-ery feel as strongly as his predecessor did about the monopolization of medicine? Will each and every future merger and collaborative effort be met with sharp scrutiny? Can we expect new legislation to emerge through the General Assembly, and will our struggling rural hospitals and smaller practitioners find that they need to source new ways of collaboration out-side of an outright sale?

Though that priority is unclear now under the new leadership, it is likely an issue that won’t be ignored for long. For one, the Federal Trade Commission has expressed its intent to focus on antitrust issues surrounding healthcare consolida-tions. And two, the number of transac-tions are not declining. Eventually, the shrinking number of networks, especially in our smaller and rural communities, will force the issue to the attorney general’s front burner.

Ultimately, time will tell if Attorney General Slatery chimes in with the same opinion as former Attorney General Cooper, but it’s something all providers should pay attention to … because if he does, the landscape of healthcare deals in Tennessee will indeed be met with a dynamic shift, and providers will have to find new ways to integrate and meet the requirements of the Affordable Care Act while maintaining the highest level of competition.

Tennessee’s Healthcare M&A Scrutiny in Limbo

Keith Dennen is member attorney with the Nashville office of Dickinson Wright, PLLC, a full-service law firm with 12 offices throughout the United States and Canada. He focuses his practice on healthcare law and corporate law. Reach him at [email protected].

Dr. Bonnie Miller


By CINDy SANDERS

In the last few months, Nashville-based NuSirt Biopharma has initiated its first clinical trial in humans, completed one of the year’s most successful capital campaigns, and presented two papers at the American Diabetes Association’s 74th Scientific Sessions. NuSirt also holds two patents and has 13 active patent applica-tions under review for its proprietary tech-nology platform … not bad for a company that hasn’t even celebrated its first decade in business, yet.

Incorporated in 2010 by Michael Zemel, PhD, who has authored more than 200 peer-reviewed articles primarily fo-cused on metabolic regulation, NuSirt’s technology combines the essential amino acid leu-cine with existing human medications that target diabetes, obesity and other metabolic diseases. Zemel served as a professor of Nutrition and Medicine and director of the Nutri-tion Institute at the University of Ten-

nessee for more than two decades. The company’s chief scientific officer left his academic post in 2012 to focus his full ef-forts on growing NuSirt’s technology and applications.

On the business side, Joe C. Cook, Jr., a veteran pharmaceutical industry executive, leads NuSirt in his role as president and executive chairman of the board. After retiring from Eli Lilly in 1993, Cook led a small biotech company for the next 10 years. Upon ‘retiring’ again, he returned to his native Tennessee where he was in-troduced to Zemel’s research.

“All of his work was focused on the components of nutrition that affected en-ergy and metabolism,” Cook explained, adding the science was similar to other research he had seen throughout his pharma career. However, Zemel’s work focused on leucine and took a different approach by honing in on fat cells.

“Of all the amino acids he had stud-

ied, leucine was the only one that re-ally promoted efficiency in animals

and humans handling energy,” Cook said. “A gram of pro-

tein has four calories; a gram of carbohydrate

has four calories; but a gram of fat has nine calories,” he contin-ued. “On a mass-to-mass basis, the body’s

most efficient stor-age mechanism is a fat cell.”

Cook said the data was convincing that Zemel’s methodology could positively impact cel-lular activity by adding a specific amount of the branched chain amino acid leucine to amplify metabolism. A principal and co-founder of Nashville-based Mountain Group Capital, Cook decided to invest in the fledgling company that had the poten-tial to improve the treatment of obesity and type 2 diabetes.

“Diabetes is growing in the United States at a rate greater than our popula-tion,” Cook said. “That kind of epidemi-ology clearly illustrates that we haven’t solved the problem.”

He added the multifactorial nature of most metabolic conditions and result-ing impact on body systems has made it difficult to create a cure. However, he believed Zemel’s approach offered a way to achieve much better glucose control by enhancing the effectiveness of the existing pharmaceutical metformin.

Less is MoreMetformin is used by millions of

Americans as the recommended first-line oral treatment for type 2 diabetes if con-trol cannot be achieved through diet and exercise alone. “Metformin is the most widely prescribed medicine for diabetes in the world,” Cook stated.

Although quite effective and with fewer issues than other glucose control medications, the popular drug still comes with a significant profile of side effects, typically manifesting as gastrointestinal distress. “It’s always been my experience that almost every drug has side effects and almost always it’s associated with the quantity of drug needed,” Cook noted.

He continued, “The literature has shown between 30-50 percent of people who take metformin experience some GI distress from mild to major. A much smaller percentage … estimated between 6-10 percent … suffer more serious ad-verse events with metformin to the point where they take it less frequently, lower the dose, or stop taking it altogether.”

NuSirt’s working theory was to uti-lize leucine to amplify the effect of met-formin thereby allowing for lower, more tolerable dosing levels. The theory was

borne out in animal models resulting in glucose control with a reduction in fatty deposits with a significantly lower dosage of metformin.

“Most drugs activate a signal in the body. They either bind to or block a receptor … you either stimulate a cell or suppress it,” Cook explained. “Leu-cine works on the sirtuin pathway,” he continued. “It makes that receptor system more sensitive to metformin, and that gives rise to a poten-tially lower dose. That’s the really novel observation.”

Human Trials LaunchedCook said the success demonstrated

in animal models in 2013 led the company to file an investigational new drug (IND) application with the U.S. Food & Drug Administration earlier this year. “In July, the FDA gave us the green light to pro-ceed with our human studies,” he added.

The first randomized, double blinded study is currently active at eight sites, in-cluding Vanderbilt and Meharry in Nash-ville. To reduce any latent effects of the drug, Cook said all participants in the study must come off of their oral diabetes

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November is American Diabetes Month

Diabetes is a chronic condition at epidemic proportions in the United States. According to the American Diabetes Association nearly 30 million children and adults in the U.S. have diabetes and another 86 million Americans have pre-diabetes.

Whether or not medication management is required, the ADA stresses everyone with diabetes benefits from healthy lifestyle choices. For 2014, the national organization has adopted the theme, “America Gets CookingSM to Stop Diabetes.” The message this year centers on engaging in improved nutrition and moderate physical activity in a social manner to make it fun to opt for the healthy choice.

For promotional materials and more ideas to share with your patients, go online to diabetes.org and click on “In My Community.”

Dr. Michael Zemel,

Founder

Joe C. Cook, Jr., President



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This fall, the American Medical Asso-ciation, along with the YMCA of Middle Tennessee, the Tennessee Medical Asso-ciation and the Tennessee Nurses Asso-ciation, held a summit for area physicians, nurses and other medical professionals to learn about new resources for preventing type 2 diabetes and introduce a new dia-betes prevention program.

“More than one out of every three American adults has pre-diabetes and only about 11 percent are even aware that they are at risk of developing type 2 dia-betes,” AMA President Robert M. Wah, MD, said of his organization’s push to raise awareness. “In addition to crippling the health and well-being of our patients and citizens, type 2 diabetes is also one of the key drivers of healthcare costs. The AMA is working with the YMCA, Ten-nessee Medical Association and Tennessee Nurses Association to improve health out-comes of individuals in Nashville through better prevention, thereby contributing to reduced healthcare costs for this disease.”

The September summit focused on specific goals of diabetes prevention pro-grams, including:

Increasing education and awareness

of pre-diabetes by promoting physician practice screening of those at risk; and

Increasing physician and other healthcare provider referrals of people with pre-diabetes to the evidence-based YMCA’s Diabetes Prevention Program.

Recent reports rank Tennessee as having the sixth highest incidence of dia-betes by population in the United States with more than one in 10 adult Tennesse-ans with diabetes and an estimated 50,000 more struggling with pre-diabetes.

“Changing outcomes often means changing behaviors that have led to Ten-nessee’s high rates of diabetes, such as obe-sity, poor diet and lack of regular physical activity. We want to give patients, through their healthcare providers, resources to help address these lifestyle issues and avoid unnecessary medical complications,” said Ted Cornelius, vice president of Health Innovation for the Middle Tennessee Y.

The YMCA initiative is part of the CDC’s National Diabetes Prevention Program, which includes 16 weeks of core education on healthy eating and physi-cal activity from a trained lifestyle coach, as well as peer and goal-setting support. Following the initial sessions, participants

meet monthly for up to a year to monitor their progress. The program is based on research funded by the National Institutes of Health, which has shown, among adults with pre-diabetes, a 58 percent reduction in the number of new cases of type 2 dia-betes and a 71 percent reduction in new cases among those over age 60.

In his opening remarks, Nashville Mayor Karl Dean thanked the participat-ing organizations and acknowledged the increasing number of Middle Tennesseans affected by diabetes and pre-diabetes. He added physical activity plays a major role in prevention.

“By investing in greenways, bike-ways and parks that encourage physical activity, Nashville has made a strong statement that we are committed to being a healthy city,” Dean pointed out. The mayor, who has spearheaded more than $130 million in public infrastruc-ture to support active lifestyles, is hosting his next community-wide healthy living event on Sunday, Nov. 9 with the annual Mayor’s Challenge 5K.

For more information about the YMCA Diabetes Prevention Program, visit ymcamidtn.org/diabetes-prevention.

medication for a month prior to beginning the active phase of the trial.

Inclusion criteria include being on only one oral medication for glucose con-trol and having an A1C between 7 and 8.5. “If during the four-week washout pe-riod their glucose goes up too much, there is an escape route to get them out of the study and back onto medication,” Cook said of the careful monitoring.

During the 28-day trial, the 100 par-ticipants wear a blood sugar monitoring device and measure their blood glucose levels frequently. The control arm of the trial is receiving standard doses of metfor-min as clinically prescribed compared to the other three arms receiving one of three lower doses of the metformin combined with the NuSirt technology. The goal is to assess the general effectiveness of the combination therapy and find the lowest dose possible to achieve glucose control. Initial results are expected by first quar-ter 2015. NuSirt plans to substantially in-crease its clinical trial program leading to the filing of a New Drug Application with the FDA pending positive results from this first clinical trial.

If the success seen in animal mod-els is replicated in humans, it could signal transformational change in how healthcare providers approach and manage glucose control and pave the way for new treatment options for other metabolic conditions.

NuSirt, continued from page 8 Medical Groups, Area YMCA Collaborate to Prevent Type 2 Diabetes


Cuts & Co-paysAmong radiology’s most recent

changes was the 2014 Medicare Physi-cian Fee Schedule, which decreased pay-ment to providers by nearly 20 percent for many procedures. (Some saw a slight increase, while more common tests – CT and MRI – took the biggest hit). It also lowered the interest rate assumption for purchased equipment and increased the equipment utilization rate from 75 to 90 percent for MRI and CT.

Another pinch felt industry-wide is the challenge of recovering payment from healthcare’s newest payer: the patient. As more Americans opt for high deductible plans, providers can no longer afford to write off co-pays without taking a substan-tial hit.

Making it WorkWith so many cuts – and more antici-

pated with 2015’s Physician Fee Schedule – how do radiology practices stay afloat?

Kirk Hintz, CEO of Nashville-based Radiology Alliance, said the private prac-tice is focusing on quality improvement and tech-nology utilization to be-come more efficient.

“We’re seeing a shift from volume to value-based healthcare and don’t really have a full handle on what that means yet,” Hintz said. “That’s a lot to digest from a practice standpoint, but what we’re looking at is trying to drive value back to the system, carriers and patients.”

To that end, Radiology Alliance has implemented double-blinded, peer review studies for 5 percent of all cases, improv-ing quality and value proposition in a competitive marketplace. They’ve also in-vested in zVision, an innovative software offering from Clario Medical designed to ease radiologists’ workloads, create work

lists and manage workflow across systems. Similarly, Madden noted, “We’re

seeing a lot more dedicated analytical approach to monitor quality, including a more efficient use of information tech-nology. We’re looking at a more formal approach to patient satisfaction measure-ment.”

He also anticipates further consolida-tion of smaller radiology practices driven by accountable care organizations, the ability to leverage and negotiate, and the need for consistent quality across the con-tinuum of care.

In the midst of ongoing regulatory changes, radiologists also are spending more time consulting with referring phy-sicians. Both Hintz and Madden said their radiologists welcome these discussions and often are called upon to educate providers on best practices in the rapidly changing field.

“They’re very concerned about making sure the right procedure is per-formed at the right time,” Hintz said of his 40-plus radiologists. “We work with hospitals to discuss correct protocols in lowest doses to obtain the highest quality.” Providing more education and fewer tests with the least amount of doses has become a national effort, resulting in initiatives like Image Gently and Choosing Wisely. (See related story on page 11.)

Another challenge for radiologists is the temporary lack of reimbursable codes for newer modalities like tomosynthesis — a 3-D technology that provides Radi-ology Alliance patients with clearer breast scans. While approved by the U.S. Food and Drug Administration, tomosynthesis is not yet considered the standard of care for breast cancer screening.

“Some practices wait for reimburs-able codes before getting technology, but we look at what’s best for the patient and how it will help our partners,” Hintz said.

Radiology & the Stark Law LoopholeAnother goal for radiologists is to bet-

ter educate CMS and payers on imaging practices. As a whole, Madden said radi-ology lacks the big lobby and extra funds needed to fight industry-wide cuts.

However, one initiative gaining mo-mentum on Capitol Hill is a proposal supported by the Association for Quality Imaging (AQI) petitioning Congress to adopt provisions in the FY2015 budget. Their goal is to close the in-office ancil-lary exception for advanced diagnostic im-aging services … essentially, to eliminate self-referring non-radiologists steering patients toward their own in-office equip-ment rather than advanced diagnostic centers. According to the AQI, closing the loophole would save $6.1 billion over 10 years.

Madden, an AQI board member, claimed the prevalence of in-office imag-ing violates the original intent of the ex-ception to the Stark Law, which was to provide limited incremental services in a physician’s office, such as blood draws, basic lab work and small x-rays for same day patient convenience. According to the AQI, “broad cuts by CMS have not targeted the actual ‘over-utilizers’ – i.e. self-referring physicians, but have incen-tivized those physicians to make up for the lost revenues from CMS cuts by directing more patients to their own imaging equip-ment.”

Closure of the loophole would be a huge win for radiology practices but a blow to specialists who offer imaging in-house. An online statement from the American Society of Nuclear Cardiology (ASNC) asserts: “Congress and regulatory agencies should focus on the promotion of high quality, accredited imaging regard-less of the site of service. Moreover, ASNC regards patient choice as a fundamental tenant of the healthcare system. The re-moval of the in-office ancillary exception may drive patients to a hospital setting,

disrupting established physician-patient relationships and subjecting patients to higher co-payments.”

It’s just one more piece of a very com-plex puzzle affecting millions of patients and providers nationwide.

“As we look to the future, radiology is a specialty that touches all departments, which makes it one of the most unique specialties,” Hintz concluded. “We’re uniquely positioned and endowed with a great responsibility as we transition to a fu-ture beyond where we imagine we can go.”

The New Rules of Radiology Reimbursement, continued from page 1

Kirk Hintz

Save the DateThe Vanderbilt University

Institute of Imaging Science (VUIIS) will host the Frontiers of Medical Imaging V Conference May 12-15, 2015.

The conference will bring together researchers from various sub-fields of imaging sciences to review the state-of-the-art technology and potential breakthroughs in an informal venue. Themes for Frontiers V will include:

• Metabolic Imaging,

• Imaging and Aging,

• Imaging Technologies,

• Nanotechnology in Imaging,

• Image Guided Interventions,

• Young Investigators Symposium.

VUIIS pursues research in developing new imaging methods and applications in cancer, neuroscience, metabolic disorders, cardiovascular disease and other areas. The Institute also supports advances in physics, engineering, computing, chemistry and other sciences for the development and application of new and improved imaging techniques.

Email [email protected] for more information.

Online Event Calendar

To submit or view local events visit the Nashville Medical News website and click on the calendar icon on the right hand sidebar.

nashvillemedicalnews.com


By MELANIE KILGORE-HILL

A concerted effort to eliminate un-necessary medical procedures is underway across America, and radiology experts are taking a lead role.

One such initiative is the Choosing Wisely campaign by the ABIM Foundation. Choosing Wisely outlines five goals aimed at eliminating over-utilization and increasing communication between physicians.

Choosing Wisely“We’re all trying to do the right thing

for patients, and we all understand the need to cost-set healthcare,” said Chad Calendine, MD, of Nashville-based Premier Radiology. “As radiologists, we evaluate orders and procedures when they come in and often talk to physicians about changing orders to make sure the appropri-ate test is being ordered.”

The Choosing Wisely campaign’s im-aging goals, which were developed by the American College of Radiology, include:

• Don’t image uncomplicated head-aches.

• Don’t image for suspected pulmo-nary embolism without moderate or high pre-test probability.

• Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.

• Don’t perform CT for the evalua-tion of suspected appendicitis in chil-dren until after ultrasound has been considered as an option.

• Don’t recommend follow-up imag-ing for clinically inconsequential ad-nexal cysts.

“We only want to use radiation if it’s needed, and if the benefits far outweigh po-tential risks,” Calendine said. “Having an eye toward reduction is at the heart of what radiologists have done for decades.”

Image WiselySimilarly, Image Wisely is the joint

awareness campaign of the ACR and Ra-diological Society of North America to address concerns about the surge of pub-lic exposure to ionizing radiation from medical imaging. A joint task force col-laborated with the American Association of Physicists in Medicine and the Ameri-can Society of Radiologic Technologists to create the campaign aimed at lowering radiation doses and procedures in adult patients. Image Wisely provides extensive educational resources including up-to-date research and radiation news, and asks ra-diology professionals to take a pledge to honor their commitment to safer standards.

Image GentlyImage Gently is an initiative aimed at

pediatric imaging awareness. With a motto

of ‘one size does not fit all,’ the campaign hones in on appropriate medi-cal and dental imaging for young patients. Ra-diology Alliance’s Ketsia Pierre, MD, who special-izes in diagnostic and pe-diatric radiology, said a primary goal is to use ul-

trasound instead of CT for abdominal pain in peds patients.

“There’s been ongoing training of so-nographers to become more skilled in scan-ning for acute appendicitis … and in most cases, they’re so good that we’re rarely using CT to evaluate for appendicitis,” Pierre said. “When CT is necessary, one of the Image Gently principles is limiting the field of use to the area where the appendix

lives and lowering the dose, as well.”Pierre estimates she now spends up to

25 percent of her day on the phone edu-cating physicians about the latest recom-mendations surrounding risk vs. benefit of various imaging options.

“There always needs to be an open line of communication between radiolo-gists and physicians caring for patients, and we’re happy to talk them,” she said

National Campaigns Urge Physicians to Image Gently, Wisely

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PhysicianSpotlight

By LARRy MCCLAIN

Many people mistakenly think radi-ology is used solely for diagnoses … not for life-enhancing procedures … but Dan Wunder, MD, is quick to disagree.

“I use cutting-edge technology guided by imaging to fi x things,” said Wunder, who serves as chief of the Vascular & Interventional Division of Premier Radi-ology. The organization, a joint venture with Saint Thomas Health, has 13 radiol-ogy centers in Middle Tennessee with the facility on Briarville Road in Madison fea-turing the broadest range of services and procedures.

“Our Briarville location is the most comprehensive interventional radiology center in this area,” said Wunder. “There are only about 100 like it across the na-tion. In addition to the usual services (CT, ultrasound, mammography, x-ray), we perform image-guided procedural stud-ies. This includes far more than arterial revascularization. We can do everything from diagnosing tumors with biopsies and providing venous access for chemotherapy

to treating painful compression fractures of the back.”

There are only a few vascular proce-dures – such as carotid stents and fi xing aortic aneurysms – that require hospi-talization. Many procedures can now be performed using minimally invasive tech-nologies in an outpatient setting. One of the most common procedures is the ather-ectomy. “That’s where we cut the plaque out of an artery and remove it from the body to restore blood fl ow to the legs,” said Wunder. “I explain it to my patients as ‘Roto-rootering’ the artery.”

Atherectomies can help alleviate leg pain caused by peripheral arterial disease (PAD). “We offer a free PAD screen-ing, and we check to make sure there’s no major blockage in the arteries,” said Wunder. “An atherectomy takes about two hours, and the patient walks out of the center without the painful leg cramp-ing because we’ve cleaned out the plaque and made sure that blood is fl owing prop-erly to the leg.”

Wunder noted there could be many root causes for leg pain, including arthri-tis, varicose veins and pinched nerves in the back, but the usual culprit is arterial plaque.

“A lot of patients think, ‘I’m getting older … I’ve just got to live with this pain,’ so they’ve never had an evaluation,” said Wunder. “At Premier, the screening doesn’t cost them a cent. If we fi nd some-thing abnormal, we send a report to the primary care physician and proceed from there. There’s no reason for people to suf-fer leg pain when it’s totally fi xable.”

Premier screenings also help patients get a better understanding of their body-wide arterial health, including increased risk of stroke. “We can listen to the carotid artery that takes blood to the brain,” said Wunder. “We do a lot of carotid ultra-sounds, plus arteriograms of carotid arter-ies at the Briarville center.”

Wunder added the Briarville offi ce doesn’t operate like a hospital radiology department. “We’re not trying to see 16 patients a day,” he noted. “We con-centrate on just a couple of major cases per day. That might involve doing some arteriograms – or maybe a kyphoplasty. That’s where we sedate a patient that has an acute vertebral compression fracture and percutaneously treat the fracture in about two hours so it doesn’t hurt them anymore.”

Because Briarville patients don’t have to navigate a multi-story building, under-ground parking garage or busy admitting area, Wunder said they seem pleased with the Premier experience. “They always get the personal touch,” he added. “We have plenty of time to explain things to them, and they get pictures of the procedures to take home with them. It’s the kind of experience I’d want to have if I were in their shoes.”

In a radiologist’s world, an array

of images sometimes takes the place of human interaction – something that Premier guards against. Personal experi-ence has taught Wunder that healing is not just about the skill of the physician or the technology involved in the treatment. “The human touch has a powerful effect on healing and trust-building,” he said. “That’s the way we do it at Premier.”

Wunder grew up in a town of 4,000 in rural South Dakota. His family had a 5,000-acre farm so it isn’t surprising that he now lives on a 30-acre farm in Hen-dersonville. He and his wife Melinda have a blended family of fi ve boys ranging in age from 10 to 20. The oldest has raced through college and has already been ac-cepted into medical school for next year.

In addition to chickens and horses, the Wunder farm includes some pretty exotic animals for Tennessee. The family raises miniature Zebu cows and Nigerian dwarf goats. “The goats are like little dogs – very sweet and tame,” Wunder said.

When not working hard on the farm, the family likes to vacation in the Caribbean, where they enjoy scuba diving and deep-sea fi shing. They’ve even accomplished what few (other than Ernest Hemingway) have achieved: reeling in a shark.

His family’s boundless energy makes Wunder appreciate that Premier helps patients enjoy greater vitality, too. “These are life-changing and life-enhancing con-ditions we’re treating,” he said. “We help patients who fi nd it too painful to walk get back on their feet again. Radiology is much more than looking at images. It helps dramatically improve patients’ lives.”

Interventional Radiologist Dan Wunder Keeps the Focus on Quality of Life

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Growing up on a farm, Dr. Dan Wunder is happy outdoors feeding his Zebu cattle (above) and Nigerian dwarf goats or going deep-sea fi shing with his family.

Enhanced technology and treatment innovations give the clinical team at Premier Radiology new options to improve patients’ quality of life.


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By CINDy SANDERS

Perhaps it is only appropriate the Centers for Medicare & Medicaid Ser-vices is scheduled to announce its highly anticipated coverage decision for low-dose computed tomography (LDCT) lung can-cer screening in November. After all, this is officially ‘National Lung Cancer Aware-ness’ month.

For proponents of using the diag-nostic imaging study for early detection, the cost/benefit analysis is simple … LDCT saves lives in a cost efficient man-ner among a targeted, high-risk population. Medicare already cov-ers broad-based screen-ings for colon, breast and prostate cancers. Accord-ing to the American Cancer Society Can-cer Facts & Figures 2014, the combined estimated annual deaths from those three types of cancer is still significantly less than deaths from lung cancer (120,220 vs. 159,260).

One of the most vocal supporters for extending coverage to Medicare ben-eficiaries is Ella A. Kazerooni, MD, MS, FACR, associate chair for Clinical Affairs and division director for Cardiothoracic Radiology at the University of Michigan. “I firmly believe that screening for lung cancer with CT saves lives,” she stated. An expert in the field, Kazerooni’s long list of credentials includes serving as a trustee on the American Board of Radiology, chair of thoracic imaging for the American Col-lege of Radiology’s Commission on Body Imaging, chair of ACR’s Committee on Lung Cancer Screening, vice chair of the National Comprehensive Cancer Net-work’s Lung Cancer Screening Panel, and past president of the American Roentgen Ray Society.

“Medicare received two formal re-quests for a national coverage decision,” she explained of actions taken earlier this year precipitating the CMS determina-tion. “They statutorily have until Nov. 10 to post their draft coverage decision,” Ka-zerooni continued, noting a final decision was expected in February 2015 following a comment period.

The ScienceWhile CMS will complete the cover-

age decision process in a 12-month period, proponents say the science supporting CT scans for diagnosing lung cancer goes back several decades. Considering the current poor survival rates, this delay in integrat-ing the scientific research into routine practice has been particularly frustrating for providers.

Kazerooni said more than three-quarters of lung cancers are found in a late stage when the disease has spread, making surgical intervention ineffective or impossible. Patients are typically asymp-tomatic until the disease has progressed, which contributes to dismal survival rates. Currently, more than 90 percent of those diagnosed annually with lung cancer will die from the disease.

Research from the International Early Lung Cancer Acton Program (I-ELCAP), which was formed in 1992, has shown annual CT screening to be an effec-tive tool. In the original study, more than 1,000 high-risk, asymptomatic patients were screened. Of those who received a lung cancer diagnosis, more than 80 per-cent were at a clinical Stage 1.

Subsequently, findings from a much larger international pool were published in several publications in 2006 after long-term follow-up of more than 31,000 as-ymptomatic study participants. While less than 2 percent of those screened received a lung cancer diagnosis, 86 percent were found in Stage 1 with an overall cure rate of 80 percent.

Similarly, the National Lung Screen-ing Trial (NLST), one of the largest and most expensive clinical trials ever under-taken in the United States, evaluated the impact of screening methods on surviv-ability. The trial, which ran from 2002-2010 and included more than 53,000 participants, compared outcomes when screening with standard chest x-ray vs. LDCT. The results published in 2011 in the New England Journal of Medicine demonstrated a 20 percent reduction in lung cancer mortality for those screened by LDCT.

In both arms of the trial, more than 94 percent of positive screening results turned out to be false positives upon further testing, which is one of the argu-ments against annual screening. It should be noted, however, that the false positive difference between LDCT and conven-tional x-ray was less than 2 percent, yet decreased mortality with LDCT was 20 percent.

The available science led the United States Preventive Services Task Force (USPSTF) to assign a grade of B to lung cancer screening among high-risk patients —current or former heavy smokers, ages 55-80, with a smoking history of at least 30

pack-years. The USPSTF website defines the evidence behind a grade of B as being strong enough to recommend the service be provided.

The task force isn’t the only orga-nization to support LDCT screening for high-risk patients. In fact, Kazerooni said most every major clinical healthcare pro-fessional society, including the American Medical Association, has stepped up to voice support for CMS adopting coverage.

“There’s overwhelming professional support,” Kazerooni said. “We also have a lot of support from the House and Sen-ate,” she added, noting congressional sup-port is bipartisan.

The DecisionThe irony, Kazerooni continued, is

the USPSTF recommendation led to a screening inclusion in the federally man-dated Affordable Care Act requiring third party payers cover LDCT for those at high risk of developing lung cancer. “It’s not a ‘recommended;’ it’s not a ‘they should;’ it’s a ‘must,’” Kazerooni said of the screening becoming a covered benefit beginning Jan. 1, 2015.

If CMS doesn’t reverse current pol-icy, then those who have received annual screenings for as much as a decade will abruptly lose the benefit when they hit 65 and qualify for Medicare coverage.

“The average age of lung cancer di-agnosis is 70 so to not offer lung cancer screening as they enter their peak years of risk would be a tragedy,” Kazerooni stated.

Among the issues being weighed by CMS are patient safety, frequency of test-ing, impact of false positive results, con-sistent quality across screening facilities, evidence-based data to identify eligible patients and inform follow-up and treat-ment, and cost of screening in relation to improved outcomes.

Kazerooni noted CMS is undertaking the normal due diligence that goes into re-leasing a national coverage analysis deci-sion. She and colleagues across a number of medical specialties have provided infor-mation and parameters for the screening. For example, she noted, the American As-sociation of Physicists in Medicine has cre-ated specific exam protocols. The ACR, which is one of three bodies that accred-its CT facilities, has developed a practice standard for the screening. Proponents, she stressed, are specifically calling for low-dose, rather than standard dose, scans to improve the safety profile. Providers also agree smoking cessation counseling should be part of the overall professional intervention for all high-risk individuals who qualify for screening.

As for cost, Kazerooni said, “Low-dose CT screening is at least as cost ef-

The Case for Covering Low-Dose CT Lung Cancer ScreeningProponents cite ROI of early detection, reduced mortality

Dr. Ella A. Kazerooni

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INCHARGE HEALTHCARE 2015The healthcare industry continues to grow as a powerful force in Nashville

so knowing who is ‘in charge’ is important. Each December Nashville

Medical News provides the defi nitive list of who’s who with the annual

InCharge Healthcare issue formatted as a glossy color magazine.

INCHARGE HEALTHCARE WILL SHOWCASE:• Leaders of the top hospital management companies

• Healthcare attorneys who are setting the bar higher

• Research sector leaders

• Mentors who are guiding the next generation of providers

AD CLOSE: November 11, 2014

MATERIALS DUE: November 14, 2014

For more information contact Mike Smith 615-844-9238 or [email protected]

By CINDy SANDERS

With 8.7 percent of residents suffering from chronic obstructive pulmonary dis-ease, Tennessee has one of the highest rates of COPD in the country. During Novem-ber, National COPD Awareness Month, it seemed appropriate to share data and in-sights into the third leading cause of death in the United States and in Tennessee.

Unlike most major illnesses, chronic lower respiratory diseases have actually increased in frequency over the past three decades, and the numbers rise even higher when factoring in those who are misdiag-nosed or underdiagnosed. Currently, close to 15 million Americans are living with known COPD. However, Jamie Sullivan, senior direc-tor of Public Policy and Outcomes for the COPD Foundation, noted, “The NIH estimates there are about 12 million nation-ally who have COPD symptoms but haven’t received a diagno-sis.”

Sullivan continued, “There tend to be more women who are misdiagnosed than men.” Compounding the issue, COPD tends to affect women disproportionately

with a national average of 6.7 percent hav-ing COPD compared to 5.2 percent of men. “That disparity between men and women is actually worse in Tennessee than in the nation.” Sullivan said data from the Behavioral Risk Factor Surveillance Sys-tem shows the COPD rate for women in Tennessee is 11.7 percent compared to 6.7 percent for men.

The Volunteer State, she added, has the third highest rate of COPD overall in the country at 8.7 percent compared to the national average of 6.3 percent. Tennes-see trails only Kentucky and Alabama in prevalence.

Deb McGowan, senior director of Health Outcomes for the COPD Foun-dation, noted the rea-sons behind Tennessee’s higher rates are multi-factorial including en-vironmental issues and smoking rates in the South. Although Tennes-see has made significant strides in sharing smoking cessation strategies, nearly a quarter of the state’s adult men (24.7 percent) and one-fifth of the state’s adult women (19.7 percent) still smoke.

While there can be a genetic compo-nent to COPD, McGowan said smoking

leads the way as a key contributor to the chronic illness. A quarter of those with COPD have never smoked with the condi-tion likely linked to genetics, occupational and environmental pollutants, leaving the other 75 percent related to smoking.

Sullivan added, “Definitely exposure to tobacco is the main risk factor, but it’s not just current smokers who are at risk, it’s people who had a history of smoking.” She noted these are individuals who followed the recommendations and quit smoking but 10-15 years later begin to have trouble with their breathing.

The COPD Foundation embarked on a listening tour this past summer and spent time in East Tennessee to learn more about the incidence rates for COPD. Sullivan said one thing they heard over and over again was the air quality in the valley exac-erbated asthma and the ability to breathe easily. The problem isn’t limited to the east-ern part of the state, however. The Asthma and Allergy Foundation of America rou-tinely includes Tennessee’s largest cities in its annual list of “Most Challenging Places to Live with Asthma.” In 2014, Memphis ranked second, Chattanooga sixth, Nash-ville 38th and Knoxville 41st.

In addition to smoking history and en-vironment, Sullivan said other risk factors include a history of asthma, early nutrition

and prenatal events, early childhood infec-tions, age, and socio-demographic status. She noted nearly one in five adults with an-nual incomes under $15,000 (19 percent) have COPD.

As with most chronic diseases and conditions, early detection, intervention and education improve quality of life and reduce healthcare costs and economic bur-den. McGowan said providers could help by being more aware of COPD when tak-ing a patient’s personal history. Instead of asking if someone smokes, McGowan urges physicians and nurses to ask if an individual has ever smoked. “Around 100 cigarettes lifetime is where you start thinking differ-ently,” she said of risk factors for COPD. Additionally, McGowan said providers should be attuned to any respiratory symp-toms that seem to be ongoing.

“We don’t have to have a patient hit the hospital before we test them,” she noted of diagnosing COPD. “You do that through spirometry testing. It’s a simple breathing measure and can be done in a primary care office.”

Although billable, McGowan said most outpatient clinics and practices are not aggressively utilizing the test to screen appropriate patients with symptoms. Many practices don’t have spirometers … or if

Short of BreathCOPD Foundation Sheds Light on State’s High Rate of Progressive Lung Disease

Jamie Sullivan

Deb McGowan



By KELLy PRICE & CINDy SANDERS

U. S. Sen. Lamar Al-exander (R-Tenn.), rank-ing member of the Senate Health Committee, met with infectious diseases experts from Vanderbilt University Medical Cen-ter and state health offi-cials on Wednesday, Sept. 24, to ask:

“Do we know what we need to do to prevent an outbreak of the Ebola virus in this country? If we do know, are we prepared to do it?”

Little did Alexander know his questions would come into play a few short hours later as Thomas Eric Duncan headed to the Emergency Department of Texas Health Presbyterian Hospital in Dallas. After initially being sent home, Duncan returned a few days later and was diag-nosed with Ebola. By Oct. 8, patient zero was dead.

The Nashville BriefingAt the time Alexander met with

Nashville experts, participants were still unaware Ebola would dominate every media outlet in America as the viral threat reached our shores. Despite the new viewpoint, much of the information shared with Alexander in late September is still relevant … perhaps even more so … today.

The Nashville briefing included Wil-liam Schaffner, MD, a nationally known infectious disease expert and professor 0f Preventive Medicine at Vanderbilt Uni-versity Medical Center; James Crowe Jr., MD, director of the Vanderbilt Vaccine Center; Thomas Talbot, MD, MPH, chief hospital epidemiologist at Vanderbilt; and other faculty members who take a lead role in emergency preparedness and pub-lic health.

Alexander said he came away from the meeting with a clear diagnosis … “We should not panic over Ebola, but we shouldn’t ignore it either.” The sena-tor added, “I believe we should treat the Ebola epidemic as seriously as we treat ISIS … and I’m not given to overstate-ment.”

In the wake of Ebola arriving in America, the virus certainly hasn’t been ignored. On the other hand, the panic level has varied among stakeholders and the general public.

Although Alexander said he was re-assured by Tennessee’s ability to control Ebola, he remained alarmed by CDC predictions that if the often-fatal virus continues to spread in West Africa at its current rate, as many as 1.4 million people

could be infected by January. “This could endanger our national security interests,” Alexander warned.

Members of the briefing felt the U.S. government had been slow to react to the disease outbreak. Given the events last month, that assertion now seems particu-larly prescient.

Cognizant that many Americans were nervous about flying infected aid workers back to the U.S., the expert panel sought to reassure the public that every precau-tion would be taken during those medical transports. The bigger concern, as is now known, would be undiagnosed individu-als arriving from Ebola hotspots. In late October, the CDC announced it would

actively monitor travelers from Ebola-affected countries who arrive in the U.S. for a period of 21 days.

“Should Ebola come here via an airplane, we can diagnose it, we can contain it, and we can treat it safely and effectively,” Schaffner said during the briefing. While most believe that is true for Vanderbilt, Emory and a number of other hospitals around the country, it

became painfully appar-ent from lapses in Dallas that not every hospital is well equipped to handle patients presenting with Ebola symptoms.

Crowe called for increased funding for vaccine research and a hastened timeline. His-torically, it has taken 25 years to bring a new vac-cine to market. Given the current situation, that tim-ing won’t work for Ebola. Crowe and colleagues have isolated monoclonal antibodies from human survivors (see below). “We have them, but they’re not ready for use because they have not been scaled up so we’re working 24/7 here,” he noted of this next gen-

eration of treatment. The experts reminded Alexander and

the public that Ebola could only be trans-mitted through contact with the bodily fluids of someone who is already symp-tomatic. Although Ebola is mutating into different strains, Crowe said, “The chance of it developing the capacity to be trans-mitted through the air is very low.”

While the mortality rate of the cur-rent outbreak in West Africa is about 50 percent, Schaffner said the death rate could be brought down significantly with basic supportive care, even without a spe-cific drug treatment. “But there has to be more care than sending the patient home with bleach and a mask, which is about all

they can do without help from the inter-national community,” he said. Schaffner added, “If we could provide … as we’re now trying to do in West Africa … more supportive care, I think we could move the needle and improve survival in Africa.”

Alexander asked, “What would you say to an American MD about treating the disease?”

The VUMC experts replied there

are three critical three steps: the patient should be transported to a dedicated loca-tion, evaluated, and put in the care of the medical ICU team. At VUMC, the care team had already begun practicing details of this procedure.

Schaffner noted, “We are function-ing on the premise that (Ebola) will come here. We know what to do about infec-tious disease.” He continued, “We need to be sure that patients are put into a treat-ment situation where they are attended to by trained and equipped providers, not just people who want to help.”

More on Ebola Drug TherapiesVanderbilt University researchers

have partnered with Mapp Biopharma-ceutical Inc. to develop their new human antibody therapies to provide short-term protection for people exposed to the deadly Ebola and Marburg viruses. These hemorrhagic filoviruses kill, in part, by causing massive bleeding.

The San Diego-based company has developed an experimental treatment, called ZMapp, which contains antibod-ies manufactured in plants. ZMapp has prevented lethal disease in rhesus mon-keys but has not yet been tested for safety and efficacy in humans. At Vanderbilt, researchers are using a high-efficiency method to isolate and generate large quan-tities of human antibodies from the blood of people who have survived Ebola and Marburg infections and are now healthy. No live virus is used in the research.

“We’re the only lab in the world that has a high-efficiency human hybridoma technique for isolating human monoclonal antibodies,” explained James Crow, Jr., MD. He said Vanderbilt has been isolat-ing antibodies to major human pathogens to better understand the basic science of immunity.

“However, with the current urgent medical need for treatments for Ebola in-fection, we are thrilled to be working with Mapp Biopharmaceutical to produce the antibodies we have discovered as antivi-ral drugs that may benefit patients and healthcare workers facing this terrible epi-demic,” Crowe said.

Notes from the TDHLast month, Tennessee Depart-

ment of Health Commissioner John Dreyzehner, MD, MPH, FACOEM, led a media briefing regarding the state’s level of pre-paredness and response to Ebola and followed up with additional guidance.

While stressing there had been no confirmed or suspected cases of the deadly virus in Ten-nessee, Dreyzehner said should the need arise, “We’re confident we can provide patient care and mitigate

Ebola Preparedness UpdateExpert Briefings & More

Vanderbilt infectious disease experts (L-R) Drs. Thomas Talbot, William Schaffner, and James Crowe, Jr. update U.S. Sen. Lamar Alexander on the Ebola crisis.

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Dr. John Dreyzehner


Dr. James Crowe, Jr. (R) looks on as graduate student Andrew Flyak adjusts equipment in the Vanderbilt Vaccine Center used in the production of anti-Ebola antibodies.


transmission to others.”He added the TDH had been pro-

viding guidance to hospitals and facilities for several months … not only on Ebola but on MRSA and other contagions, as well. Dreyzehner noted, “Fear, mistrust and stigma are really thriving with this epidemic.” For that reason, he said it was critically important healthcare pro-viders and media outlets help the public understand the facts about Ebola includ-ing that it can’t be spread through the air, by mosquitos, in the water and typically not through food. Instead, it is spread through bodily fluids or on items grossly contaminated by bodily fluids, such as a needle. “Ebola cannot live long outside the human body and is easily killed by common disinfectants,” he said.

Asymptomatic patients and those who have recovered from the disease are not a public health threat. However, once someone shows symptoms, Dreyzehner said the viral load increases as the person becomes sicker. While the incubation pe-riod is generally three weeks, days 8-10 are often the time when symptom onset oc-curs. Some individuals have taken longer than 21 days to test positive for the virus, and Dreyzehner said it appears people are capable of transmitting Ebola for about 90 days through semen.

Since bodily fluids can transmit through open wounds or through the eyes, nose, mouth and skin, it is critically important for healthcare providers to pro-tect themselves. “The most basic thing we can do is washing our hands,” Dreyzehner said. “We touch our faces about 16 times and hour,” he added to emphasize the im-portance of killing germs through proper hand-washing protocols.

Equally, he said, healthcare provid-ers need to be sure to follow the specific order of putting on and taking off personal protective equipment (PPE). Recently, the CDC (cdc.gov) updated PPE guide-lines to more closely match protocols in place by Doctors Without Borders, which has a successful history of fighting Ebola and other contagious diseases around the world.

With cold and flu season approach-ing, many people across Tennessee will develop fevers and have nausea, which may cause additional concern this year. However State Epidemiologist Tim Jones, MD, pointed out, “If you have not trav-eled to Liberia, Guinea or Sierra Leone within the last 21 days; and if you have not been exposed to body fluids of a con-firmed Ebola virus disease patient, you do not have an appreciable risk for Ebola.”

There is, however, a very real chance Tennesseans who do not get their flu shot could be exposing themselves to that air-borne virus. “Flu represents a clear and present danger and every year too many Tennesseans unnecessarily die from this common illness,” Dreyzehner said. “Some incorrectly regard flu as a really bad cold. It’s not; it can and does kill many every flu season. If you have not had your flu shot or nasal spray yet, we urge you to get it now. It could save your life.”

If you or your patients have concerns

over Ebola, the TDH announced three new information resources about the dis-ease in late October:

Tennesseans with questions about the disease may call a toll-free number to obtain accurate, timely information: (877) 857-2945.

TDH is providing additional informa-tion about Ebola virus disease, including summaries of weekly activities and adding links to other sources of reliable informa-tion: health.state.tn.us/Ceds/ebola.htm.

Should a confirmed case occur in Tennessee, the department will make a public announcement and post informa-tion to the TDH website: health.state.tn.us.

HCA’s GiftIn late September, HCA made a $1

million cash donation to the CDC Foun-dation’s Global Disaster Response Fund to help support international Ebola re-sponse efforts involving the CDC and their work with partners on the ground in West Africa.

HCA has a long history of supporting relief efforts including those following the earthquake in Haiti, the Indonesian tsu-nami, Hurricane Katrina and Typhoon Haiyan in the Philippines. The donated funds will be used to provide much-needed supplies and equipment to aid workers in-cluding personal protective equipment, infection control tools, ready-to-eat meals, generators, exit screening tools and sup-plies at airports such as thermal scanners to detect fever.

“Ebola continues to spread rapidly in West Africa, and CDC and others have made it clear that the window of opportu-nity to contain the virus is closing quickly,” said R. Milton Johnson, pres-ident and CEO of HCA. “The time to act is now, and we strongly encour-age other companies, particularly those in the healthcare industry, to join us in this important effort to save lives.”

Waller Launches Ebola Legal Resource Site

In late October, Waller Lansden Dortch & Davis, LLP announced the launch of a comprehensive online resource to help healthcare leaders and other or-ganizations impacted by the Ebola virus tnavigate diverse issues pertaining to the arrival of the virus in the United States. The website can be accessed at EbolaLeg-alResource.com.

“The immediate and long-term legal implications of the Ebola virus on all fac-ets of hospital, clinic and practice manage-ment must be seriously considered,” said Mark Peters, a partner in Waller’s Labor and Employment practice who works extensively with healthcare employers. “Waller’s Ebola legal resource website comes in response to the many questions we’ve received from clients. Preparation in this situation is important, whether an Ebola patient walks through your doors or

if you are simply dealing with the climate it has created.”

The site launched with a compila-tion of media articles, links to outside re-sources, and original articles from Waller attorneys including:

• The Role of Healthcare Employers during the Ebola Crisis,

• Patient Privacy Concerns,• FAQs on Employee Discipline, Dis-

crimination & Harassment,• Workers’ Compensation for those

Contracting Ebola, and more.The site, which will be updated as

new information becomes available and is analyzed, is tailored to healthcare ex-ecutives, board members, risk managers, human resources professionals and others who are asking what Ebola means, from a legal perspective, for their organization, employees and patients.

Joint Statement on Ebola from

Tennessee Hospital Association, Tennessee Medical Association & Tennessee Nurses Association

Across the country, healthcare pro-viders, workers and citizens share con-cern on the possible spread of Ebola in the United States. Here in Tennessee, our hospitals, physicians, nurses and other healthcare workers continue to prepare for such an event in our state.

Nothing is more important than the safety of our patients, their families and our colleagues who care for the sick day in and day out. Safely providing high-quality care to our patients in any situation is our chief priority and the healthcare providers of our state are committed to this goal.

In the past few weeks, we have learned much from our colleagues around the nation who have had to deal with ac-tual Ebola cases and have implemented appropriate practices as a result. We are now on heightened awareness for anyone showing up in our emergency rooms and physicians’ offices who exhibit symptoms similar to the Ebola virus.

While we know the threat of Ebola in the U.S. is very different from the real-

ity in West Africa, it is vitally important for healthcare providers to prepare for a worst-case scenario. For this reason, Tennessee Hospital Association, Tennes-see Medical Association and Tennessee Nurses Association are working in concert with the Tennessee Department of Health, as well as appropriate federal agencies, to ensure appropriate protocols and policies are in place.

ACEP Calls for More ResourcesThe arrival of the Ebola virus in the

United States has prompted the nation’s emergency physicians to urge policymak-ers to provide more resources for personal protective equipment (PPE) and training for emergency care workers as they man-age the front lines.

“The response to Ebola should be re-gionalized, with emergency departments screening and identifying patients who are infected, and then transporting them to facilities specially equipped to care for them,” said Alex Rosenau, DO, FACEP, president of the American College of Emergency Physicians (ACEP). “Rapid identification of infected patients com-bined with a regional response will pro-tect both patients and healthcare workers, in particular emergency physicians and nurses, from spreading the infection.”

Rosenau said the top priorities should be increased funding for emergency de-partment disaster preparedness, increased training, and supplies of PPE for all healthcare workers in emergency depart-ments. Additional resources are needed to train EMS medical staff, including para-medics and emergency medical techni-cians.

“Emergency physicians are asking Congress to restore funding to the federal Hospital Preparedness Program, a pro-gram designed to help hospitals plan for emergencies,” Rosenau stated. “Funding to this program has been cut by 50 percent since 2003. In addition, all emergency de-partments need rapid “yes/no” testing for the Ebola virus in labs dedicated to identi-fying Ebola patients.”

Ebola Preparedness Update, continued from page 16

R. Milton Johnson

Short of Breath, continued from page 15they do, too often the equipment is sitting on a shelf collecting dust. Yet, she noted, getting that early diagnosis is critical to properly educating and treating patients. She added a number of studies have shown “patients who are uneducated and not ac-tivated in their care are twice as likely to be admitted to the hospital.”

Unfortunately, she continued, “We find a lot of patients don’t even know how to use their inhalers correctly. Not all in-halers work the same.” She added patients should call their doctor if they aren’t get-ting relief from their inhaler, have a fever, stronger cough, more productive cough, or noticeable discoloration in mucus. “All those signs and symptoms indicate you’re heading down the wrong path.”

McGowan said a common, easy way for patients to think about COPD is to use the ‘green, yellow, red light’ approach. The green light, she explained, is no change in

what a patient is able to do. A yellow light means a patient is showing some symptoms and signs and should call a doctor. The red light means nothing is working, and the patient should proceed directly to the ER. “It’s more about taking care of yourself and being aware of your body every day,” she said of managing COPD.

Sullivan added, “We do have re-sources that are designed for healthcare providers. We also have resources they can use with their patients.” The Pocket Consultant Guide (PCG) even has an app attached to it for information on the go. Physicians could also join a moderated online community with discussion about particularly difficult cases and various treatment options. Additionally, there is a quarterly digital magazine tailored to providers. To sign up for the magazine or access other resources, go online to copd-foundation.org.


By LyNNE JETER

When Cherie Sibley was a teenager, she spent a great deal of time in the hospi-tal with her terminally ill grandfather.

“I always appreciated the nurses, the great job they did, and the difference they made with my grandfather’s care and well-being,” said Sibley, CEO since May 2013 of LifePoint’s 79-bed Clark Regional Medical Center in Win-chester, Ky.

Sibley, whose back-ground is surgical services nursing, is one of many CEOs who has risen through the nursing ranks, a move that makes sense in the new patient-centered health para-digm.

“I speak the clinical language, under-stand the industry changes, and can pro-actively head off many issues at the pass,” she said. “Being able to understand qual-ity, patient safety, and the financial opera-tions of the industry is a strength clinical leaders possess.”

The HR AspectPam Belcher, vice president of

human resources and talent management for Brentwood-based LifePoint Hospitals, called the RN-to-CEO path “possibly an emerg-ing trend.” At the time of the interview, 11 percent of LifePoint CEOs have CNO experience; 18 percent of the company’s COOs were promoted from CNO positions.

“We’re certainly seeing more candi-dates with nursing experience wanting to get into that executive hospital leadership role,” she said, adding industry changes have also impacted the progression. “We saw a shift in nursing from simply a care-giver role that involved primarily car-ing for patients at bedside – turning and bathing them, for example – to that of a well-educated clinician with high expec-tations. The depth and breadth of their knowledge is amazing. As we changed the model of our hospitals to focus on how we were caring for patients, we put a greater responsibility on our lead clinician, which is mainly the CNO role. In addition, we began to ask them to manage the largest part of the facility – people, processes, equipment, and inventory – so their job has expanded significantly as healthcare has evolved.”

Ahead of the CurveSusan Peach broke gender and age

barriers at Rockdale Medical Center in

Conyers, Ga., when at the age of 38, she became the state’s youngest and first fe-male hospital CEO. She also rose through the ranks of CNO to other C-suite roles.

“Early on, I re-ceived some grief from my board and a few local business leaders who were concerned whether I could make hard busi-ness decisions because I was a compassionate, empathetic nurse,” said Peach. “Some also won-dered if I understood enough about busi-ness and finance to lead an organization as CEO. The first challenge wasn’t diffi-cult to overcome because I’ve made many hard choices and hard decisions with re-spect and compassion. On the business side, it’s all about results. You can talk a good game, but you have to produce good results. I’ve been very fortunate … achieving wonderful financial results every time.”

Peach chuckled when recalling the steep financial learning curve needed in her first CNO role.

“I’d never done a budget,” admitted Peach, who earned a nursing degree from Clayton College. “When the CFO, back in the paper days, handed me a stack of spreadsheets, he said, ‘Here, I need this by Friday.’ I went home to my dad, a con-troller with Coca-Cola, and said, ‘You’re going to have to help me. I don’t have any clue how to do this.’ He looked me right in the eye and said, ‘I’ll help you one time, and then you best learn how to do it on your own.’ He was very strict. At that point, I decided to get my MBA so I’d know as much about business as I did about nursing and healthcare.”

Since July 2012, Peach has been CEO of LifePoint’s HighPoint Health System, overseeing more than 300 licensed beds on four campuses. The recipient of Sum-ner County’s Impact Award for two con-secutive years and LifePoint’s prestigious 2013 CEO of the Year Award, she makes a point of devoting time to mentoring ris-ing stars, generally working concurrently with four potential leaders.

“When I look back, I realize I was somewhat naïve to believe I could be the latest and greatest CEO at a young age,” joked the mother of two and grandmother of two. “The staff makes my job wonder-ful every day. I know my job is to get out of the way and make sure they have the tools and processes to do a good job.”

Full CircleBelcher, the HR executive who joined

LifePoint in 2006, has enjoyed watching the collaborative leadership traits CNOs bring to the table.

“When I got here, and it came to the

C-suite executives, the CNO was part of it, but the COO and CEO were the two stronger leaders in that group,” she noted. “It’s been fun for me to watch the CNO step up. We have some really good CFOs (without clinical experience) who ap-proached us a few years ago and said for their jobs to be easier, and for the hospi-tal to reach the organization’s goals, they needed to partner more often with CNOs. Once we began to see those collaborations happen, and the value it brought to both of those critical positions, we’ve encour-aged it and have put programs in place,” such as the LifePoint Learning Academy’s Leadership Development & Training Pro-gram, a 4-day event designed to develop and enhance leadership competency. There’s also a component, Finance for the Non-Financial, to help clinicians un-derstand LifePoint’s specific financial ex-pectations.

“I’ve never had a conversation with a CEO who felt threatened by the rise of the nurse ranks to C-suite levels,” said Belcher. “Our organization appreciates and recognizes talent in a unique way.”

From CNO to CEOLifePoint Nurses are Rising Through the Ranks to Top Leadership Posts

Cherie Sibley

Pam Belcher

Susan Peach

fective, if not more so, than breast cancer screening. When you’re talking about breast cancer screening, you’re talking about every woman of a certain age. Even though CT scans are more expensive, we’re targeting resources to a smaller, high-risk group.”

Bolstering that assertion, a study published in August in American Health and Drug Benefits found LDCT to be cost effective in the Medicare population. The researchers found implementing the screening cost less than $20,000 per life-year saved, which is less than the costs as-sociated with cervical and breast cancer screening.

Kazerooni is favorably encouraged CMS will follow suit with private payers and cover LDCT screenings for those with the necessary inclusion criteria who are not suffering from another medical condition that would significantly limit life expectancy. However, she added, she is interested to see what conditions CMS attaches to approval.

“It’s hard to believe they would do anything else but cover it,” she concluded of CMS. “There is a huge need for this, and we want to see it brought forward to benefit individual patients and the public at large.”

The Case for Covering Low-Dose CT Lung Cancer Screening, continued from page 14

GrandRounds

Nov. 11 • 8 am-4:30 pm • Mental Health Law Seminar • Bass Berry & Sims Office

Mental Health America of Middle Tennessee (MHAMT) is hosting their an-nual Mental Health Law seminar, which includes lunch and 6.0 CLE/CEUs for attorneys, mediators, social workers, counselors and other professionals. For more information, contact Tom Starling, MHAT president and CEO, at (615) 269-5355 or go online to ichope.com and click on ‘Events.’

Dec. 2-3 • TAMHO Annual Conference • Embassy Suites Hotel & Conference Center • Murfreesboro

“Time for Change,” with a focus on suicide prevention, is the theme of the 2014 Tennessee Association of Mental Health Organizations Annual Confer-ence. For registration and more infor-mation on the two-day agenda, visit tamho.org.

Breast Cancer Study by Whitworth Points to Promising New Treatment Options

Research by Pat Whitworth, MD, a Saint Thomas Health physician, could eventually change the way breast can-cer is treated and help women get ther-apy that is customized to their particular condition.

A new study says the molecular BluePrint test is superior to standard pa-thology tests at helping decide the best preoperative treatment. Whitworth, a surgical oncologist at Saint Thomas Midtown Hospital, led the study, which appears in the Annals of Surgical On-cology journal. It reports the BluePrint molecular test is better at determining the subtype of a woman’s breast cancer. When doctors have a clearer idea of the actual subtype, they can more precisely tailor and personalize cancer treatment.

“This test gives us a better picture of which patients will and won’t respond to preoperative therapy and also helps suggest the best course for therapy,” said Whitworth. “I believe we will even-tually end up evaluating and treating many breast cancer patients differently than we do now. That’s because we will rely on their molecular subtype, rather than just the standard results of clinical pathology tests.”

The BluePrint test, along with a companion test called MammaPrint, is typically performed on breast biopsy tissue, and therefore doesn’t require an extra procedure.

UL Workplace Health & Safety Donates Online Training Courses to Healthcare Organizations

Franklin-based UL Workplace Health & Safety, an industry leader in workplace health and safety solutions,

(continued on page 19)


GrandRoundsrecently announced the company has donated a series of its online training courses to healthcare organizations in the United States. The courses – which cover infection controls through hand-washing, blood borne pathogens, per-sonal protective equipment (PPE) in healthcare, and universal precautions – is being offered free of charge to any organization that requests them. As influenza season begins and concern about infectious diseases continues to grow, the company hopes to amplify ex-isting health and safety training already underway at healthcare facilities around the country.

“Healthcare workers are on the front lines of infection, working tire-lessly to keep us and our families safe,” said Bill Grana, president of UL Work-place Health & Safety. “They are crucial to ensuring that the public stays out of harm’s way, and as such, their health and safety should be one of our top pri-orities. We are pleased to offer several of our courses to help keep healthcare workers safe, healthy, and on the job.”

For more information or to acquire the courses, please visit www.ULWork-place.com or call 888.202.3016.

LifePoint Hospitals Announces Three VPs

Recently, Brentwood-based Life-Point Hospitals announced three senior leadership appointments adding depth to clinical and operational support for hospitals.

Mary Kiger has been named vice president of service line development and will lead the devel-opment of a standard set of integrated ser-vices lines to improve quality, operational and cost efficiency, and grow market share. She joins LifePoint from Guard-ian Healthcare Provid-ers, Inc., where she was responsible for strategy, business development and marketing. Past managerial experience includes roles with Vanderbilt-Ingram Cancer Center, National Council on Aging, Duke Health System, The Och-sner Medical Institutions, and the Joint Legislative Audit and Review Commis-sion for the Virginia Legislature. Kiger holds bachelor’s degrees from Oberlin College in Ohio and a master’s degree in public policy from Duke University.

Conrad Deese joins as vice presi-dent of finance for LifePoint’s Eastern Group, which includes hospitals in Michigan, North Carolina, Ten-nessee and Virginia, in-cluding hospitals affili-ated with Duke LifePoint Healthcare. He will pro-vide oversight and direc-tion of financial opera-tions for the Eastern Group, including integration of new acquisitions, budget

preparation, capital planning, fiscal accountability and operational assess-ments. For the past nine years, he was with Health Management Associates (HMA), where he was most recently group chief financial officer/VP of op-erations finance with oversight of finan-cial operations for 38 hospitals in five states. Deese holds a bachelor’s de-gree from Coker College in Hartsville, S.C., and an MBA from the University of Florida.

Rick Phillips has moved to a new role as vice president of clinical operations where he will guide the clinical deployment of specific service lines in LifePoint’s hospitals. He also will bring leader-ship to efforts related to performance improve-ment, standardization, coordination of resources, and application of evi-dence-based best practices. Phillips has more than 30 years of experience in healthcare operations management. He joined LifePoint in 2008 and was previously vice president, supply chain and clinical services. Prior to that, Phil-lips was with HCA in various clinical and operational leadership roles. He holds a bachelor’s degree in healthcare ad-ministration from Macon State College in Georgia, and a degree in radiologic technology and applied health sci-ences from Albany Technical College in Georgia.

Recent CON ApprovalsThe Tennessee Health Services

and Development Agency has recently considered and approved a number of certificate of need applications for the Nashville area.

TriStar Centennial Medical Cen-ter won approval for a $96 million proj-ect that will include a Joint Replace-ment Center of Excellence despite opposition from Saint Thomas Health, which won approval for its own joint re-placement center project in April. The TriStar Centennial project will add 10 new operating rooms and an additional 29 med/surg beds. The project also calls for the redesign of the hospitals Emergency Department.

Earlier this fall, Vanderbilt Univer-sity Hospital got the green light for a $118 million project that will add 108 licensed beds to the Midtown medical center. The project relocates VUH’s ob-stetrical program, newborn nursery and neonatal unit to Monroe Carell Jr. Chil-dren’s Hospital and adds 23 obstetrical beds and 24 pediatric critical care beds. Vanderbilt will also add 61 adult acute care beds in the space made avail-able after the obstetrical and newborn units move. In the space vacated by the units, Vanderbilt plans to add 61 adult acute-care beds. The CON for Baby + Co. to build a birthing center, the city’s first such outpatient facility, on 21st Ave.

S. was also approved. The expected $2.5 million project will include five birthing suites, three exam rooms, a laboratory and other support areas and will be staffed through an agreement with VUMC’s nurse-midwife program. Baby + Co. is a subsidiary of Maternity Centers of America.

Capella Announces New Hires

Capella Healthcare recently an-nounced the appointment of Rich-ard W. Brasher, CPCU, ARM, as vice president of Risk Management. Prior to joining Franklin-based Capella, Brasher held the same position with Vanguard Health Systems for six years. Before that, as a vice president with Marsh, he was the outsourced risk manager for Vanguard for nine years. Brasher has earned numerous certifications, including Chartered Property Casualty Un-derwriter (CPCU) and As-sociate in Risk Management (ARM). He earned a bachelor’s degree in market-ing from the University of Alabama.

Angie L. Mulder has been named corporate compliance officer. With more than 20 years of leadership experience in healthcare, Mulder be-gan her career at Ernst & Young where she was pri-marily assigned to health-care audit clients, includ-ing HealthTrust. She then held various financial and audit roles for Symphony Home Care and HCA. Most recently Mulder was senior director, ethics and compliance, for LifePoint Hospitals, having joined the company shortly after its spin-off from HCA in 1999. She graduated with honors from the University of Georgia.

Novel Cardiovascular Procedure at TriStar Centennial Helps Those with Long-Term Dialysis Complications

The CDC estimates more than 10 percent of U.S. adults – more than 20 million people – suffer from Chronic Kidney Disease (CKD). If kidney fail-ure occurs, patients have two options: transplant or dialysis.

The requirement for chronic vascu-lar access comes with its own compli-cations such as infection, clotting off or occasionally causing the veins to per-manently scar and become occluded. The solution? Seenu Reddy, MD, MBA, cardiovascular surgeon at TriStar Cen-tennial Medical Center is now able to create vascular access on both sides of the heart by creating a new vein or patching open others from an engi-neered biomaterial, which is an acel-lular matrix that harnesses the body’s own innate ability to repair damaged

heart and vascular tissue.“This material has the potential to

eventually turn into a vein like any other in your body,” said Reddy. “Although this procedure has been done success-fully before to replace a vein on one side of the heart … creating a solution for both sides with is material is novel.”

The approach was recently used on patient Patricia Beard to great result. Years of dialysis had resulted in steno-sis in Beard’s heart. Because of the oc-clusion, she suffered from swelling and was rendered almost completely inac-tive because of the resulting pain. Both the swelling and pain associated with it are gone as a result of the vascular access procedure, and Beard has been able to undergo multiple dialysis treat-ments with her new veins that drain di-rectly into the heart.

Unity Medical Clinic Welcomes New Physicians

Unity Physician Partners, Inc., a pro-vider of integrated primary care-based medical and ancillary healthcare servic-es, recently announced the addition of two new physicians.

Carol Varnado, MD, FAAFP, has joined the clinic located at Center-stone’s Dede Wallace campus. Previ-ously, she practiced family medicine for the Family Wellness Group of Middle Tennessee and served as a locum te-nens physician at different locations in South Carolina, Tennessee, New Mex-ico and Colorado. She also served as the medical director at the Lovelace Healthcare Services in Santa Fe, N.M. Varnado received her undergraduate degree from David Lipscomb Univer-sity, a master’s from Peabody College at Vanderbilt, and her medical degree from St. George’s University School of Medicine in Grenada, West Indies. She is certified as a diplomat on both the American Board of Family Medicine and American Board of Integrative Ho-listic Medicine.

Gina Dudley, MD, is now accept-ing patients at the Unity Medical Clinic in Antioch. She previously served as an attending physician at Mercy Hospital in Chicago, and as a primary care phy-sician at The Hammond Clinic Family Practice in Munster, Ind. Dudley also was the adult sickle cell care team direc-tor, general internist and pediatrician and at the University of Chicago Medi-cal Center. Dudley was a member of the medical staff of the Christ Community Health Services, serving as medical di-rector of Operation Outreach Program for the Homeless in Memphis.

More Grand Rounds Online


Mary Kiger

Rick Phillips

Richard W. Brasher

Angie L. Mulder

Conrad Deese


GrandRounds

omenW to WATCH2015

Call For Nominations!To nominate, please visit nashvillemedicalnews.com and click the Women to Watch icon.

NOMINATION DEADLINE: FEB. 13, 2015

For advertising and event sponsorship opportunities, please contact Heather Cantrell, 615.844.9410 or hcantrell@southcomm.

Our annual Women to Watch issue and event is coming in May 2015, 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.

HCA Breaks Ground on Capitol View in North Gulch

Last month HCA held a groundbreaking ceremony at its Capitol View site, which will be the new headquarters location for Parallon and Sar-ah Cannon when it is com-pleted in 2016. HCA’s ap-proximately 11-acre Capitol View site in the North Gulch will feature a 16-story tower, and other structures, with a total of more than 500,000 square feet of office space, about 30,000 square feet of retail space, a parking ga-rage and some surface parking. This approximately $200 million project will bring about 2,000 jobs to Davidson County during the next several years.

Clearwater Compliance Takes Leadership Role in Cybersecurity, Introduces New Risk Assessment Tool

In response to a changing health-care landscape and a stark increase in the threats posed to maintaining the confidentiality, integrity, and availabil-ity of healthcare information, Nashville-based Clearwater Compliance has introduced a new capability advance-ment model to help organizations more

comprehensively operationalize their information privacy, security, compli-ance and information risk management efforts.

In a detailed white paper (acces-sible through the company website), Clearwater has outlined an extensive, proprietary framework that guides orga-nizations as they shape their information privacy, security and risk management programs. The Clearwater Information Risk Management Capability Advance-

ment Model™ (IRMCAM™) describes six levels of risk management process maturity based on five key practice ar-eas from governance to documentation to creating a risk-aware culture.

The company also unveiled the Clearwater Information Risk Manage-ment Capability Advancement Model Index™ (IRMCAMi) a -web-based sur-vey instrument that helps organiza-tions better understand where they fall on the Clearwater Information Risk Management Capability Advancement Model™ and how their current program compares to industry best practices.

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

David R. Reagan, MD, PhD, has been named the 2014 Tennessee Medi-cal Association Public Health Champion. The honor recognizes TMA member physicians for their outstanding pub-lic health contributions across the state. Reagan, CMO for the Tennessee Department of Health, was instrumental in developing a cohe-sive, long-range strategic plan for the TDH and advancing its use of technolo-gy and data to support evidence-based decision-making. Additionally, he has

earned national recognition for his role in the development and use of Tennes-see’s Controlled Substances Monitoring Database, which has positively impact-ed the state’s prescription drug abuse epidemic. Reagan has also been instru-mental in supporting legislation impact-ing public health.

Vanderbilt Heart & Vascular Insti-tute’s Procedural Area 5th Floor CCT Unit has been selected as one of the nation’s “Most Outstanding Learning Environments.” The project, designed by Earl Swensson Associates (ESa), was published in American School & University’s 2014 Educational Interiors Showcase. A jury of American Institute of Architects (AIA) members and educa-tion administrators evaluated submis-sions from architectural firms, schools and universities across the country.

In late October, the Institute of Medicine (IOM) announced the names of 70 new members during its 44th an-nual meeting. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding profes-sional achievement and commitment to service. New members from Nash-ville are Nancy J. Brown, MD, Hugh Jackson Morgan Professor of Medi-cine and Pharmacology, and chair and

Dr. David R. Reagan

(continued on page 21)


GrandRounds

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Novel Therapy Offered at Vanderbilt Eases Stress of Retinoblastoma Treatment

Conventional therapy for patients diagnosed with retinoblastoma, the most com-mon ocular cancer in children, includes systemic chemotherapy, external beam radiation and/or surgical removal of the eye. But doctors at Vanderbilt Uni-versity Medical Center are on track to radically change the way the disease is treated using an emerging therapeutic approach called intra-arterial chemo-therapy, or IA chemo.

The procedure, performed on an outpatient basis, delivers chemother-apy directly to the tumor via the oph-thalmic artery, using a catheter that is inserted into the groin and threaded to the eye under X-ray guidance. In this way, IA chemo is able to limit the ad-verse effects typically associated with systemic chemotherapy.

“It is transformative,” said Anthony Daniels, MD, assistant professor of Ophthal-mology and Visual Sciences at the Vanderbilt Eye Institute. “We are able to tailor this treatment to each individual patient and each tumor. It is our expectation that this will become the primary modality of treatment of retinoblastoma at Vanderbilt.”

Eighteen-month-old Jude Kee, Vanderbilt’s first patient, is showing signs of im-provement. After two treatments in both eyes, administered four weeks apart, the tumors are shrinking —indicators of the success of the novel therapy.

Vanderbilt, the only center offering IA chemo in the region, is one of just a few centers in the country offering the novel therapy. On average, patients undergo at least three treatments to fully destroy the tumor.

“The other amazing thing about IA chemotherapy is that it has the ability to pre-vent new retinoblastoma tumors from forming elsewhere in the eye,” Daniels said. “Historically, we would kill the tumor, only to have new tumors pop up elsewhere in the eye. With IA chemotherapy the patient almost never gets another new tumor in the eye because any early cancer cells that are present are killed before they can grow.”

Amy Kee plays with her son, Jude, as his grandmother, Ann Westerbeck, looks on. Jude is undergoing a new therapy at Vanderbilt to treat his retinoblastoma.

PHO

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Scott Mertie

physician-in-chief, department of medi-cine, Vanderbilt University; and James E. Crowe Jr., MD, director, Vanderbilt Vaccine Center, and Ann Scott Carell Chair Professor, departments of pedi-atrics, pathology, microbiology, and im-munology, VUMC.

Last month, Meharry Medical Col-lege handed out three prestigious awards during its 139th Convocation. Edith Faye Smith Rayford, MD, (Class of ’88), an OB/GYN with Central Missis-sippi Medical Center and South Central Regional Medical Center won the Axel C. Hansen, MD, Distinguished Physician Award. Robert S. Elam, DDS, (Class of ’80), a Nashville practitioner spe-cializing in comprehensive restorative and cosmetic dentistry, won the Fred C. Fielder, DDS, Distinguished Dentist Award. Cynthia M. Harris, PhD, (Class of ’85), director of the Institute of Public Health at Florida A&M University, won the Harold D. West, PhD, Distinguished Biomedical Scientist Award.

Saint Thomas West Hospital was the only Tennessee hospital honored in Becker’s Hospital Review 2014-15 edition of “100 Hospitals and Health Systems With Great Heart Programs.” The hospitals featured on the list lead the nation in cardiovascular and tho-racic healthcare. Many have pioneered groundbreaking programs, treatments or research, and all have received rec-

ognition from reputable sources for top-of-the-line patient care.

Centerstone Research Institute’s (CRI) Christina VanRegenmorter, di-rector of the Center for Clinical Excel-lence and national policy, was recently named to Carequality’s Advisory Coun-cil. Carequality is a national collabora-tive to develop and maintain interoper-ability standards for health information networks in order to interconnect and exchange data.

United Neighborhood Health Services (UNHS) recently elected its 2014/15 officers and new board mem-bers. Scott Mertie, president of Kraft Healthcare Consulting, LLC, was elected board chair. Other officers in-clude Vice Chair Brenda Morrow, Edgehill Family Resource Center; Trea-surer Glenn Hunter, Hunter and Beyond; and Secretary Mary Robert-son, community volunteer. The officers began serving a one-year term in Sep-tember.

Gresham, Smith and Partners, a multi-disciplinary design and consulting firm for the built environment, has been selected to provide architectural, inte-rior design and engineering services for a new 269,000 square-foot, 100-bed hospital in Ningbo, China.


Wishes GrantedUnited Neighborhood Health

Services has been awarded $294,764 through the Expanded Services Capac-ity Grant, funded through the Afford-able Care Act. Grants were awarded to a total of 23 organizations throughout Tennessee that operate federally quali-fied community health centers. UNHS will use part of the funds to add a pe-diatrician to the physician staff and to support dental services for the home-less that are cared for at the Downtown Clinic and the Mission Clinic.

Franklin Named TDH Director of Minority Health

Tené Hamilton Franklin, MS, has been named director of the Tennessee Department of Health Of-fice of Minority Health and Disparities Elimination. In this position, Franklin will facilitate and advocate for the development of poli-cies, programs and ser-vices that appropriately respond to population health disparity issues across the state, especially those of racial and ethnic minority populations.

She will also work to foster coopera-tion and collaboration among minority communities and disparity populations with TDH programs and services. The office also provides oversight and guid-

ance for the Office of Faith-Based Health Initiatives that engages faith commu-nity organizations to help address their health disparities.

Franklin has more than 15 years of experience as a project director and con-sultant in the areas of genetic counseling and research, community outreach and education, grant operations and policy recommendations. She is the 2011 re-cipient of the National NAACP Dr. Mon-tague Cobb Award for outstanding work and special achievement in the areas of social justice, health justice advocacy, health education and promotion, fund-raising and research. Previously, she was a genetic counselor at Meharry Medical College and has also served as a genetic research consultant for Vanderbilt. She received her undergraduate degree in biology from the University of Virginia and her master’s in genetic counseling from Howard University.

TriStar StoneCrest Welcomes New Directors

TriStar StoneCrest Medical Center has welcomed two new directors to the hospital’s leadership team.

Meagen Green has been named director of materials management where she will be responsible for all facility sup-ply chain operations, implementing a new supply chain focused operating room materials manager in coordination

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Tené Franklin

Accreditations & Certifications

TriStar Summit Medical Center is the first hospital in Davidson County to be certified as a StormReady facility. This designation comes after a thorough evaluation by the National Weather Ser-vice. The StormReady program started in 1999 and seeks to equip America’s communities with the communication and safety skills needed to save lives and property – before and during the event. TriStar Summit’s emergency prepared-ness coordinator Lee Trevor led the effort to achieve this designation.

TriStar Hendersonville Breaking Ground on AdditionTriStar Hendersonville Medical Center has just broken ground on its women’s

center and neonatal intensive care unit (NICU), marking the beginning of the most visible project in the facility’s much-anticipated $33 million expansion plan. The new women’s center and NICU space will total almost 22,000 square feet with an addi-tional 18,000 shelled out for future use.

The scope of the project includes and emergency room ex-pansion from 15 beds to 20; food services renovation to expand dining areas; reno-vation of the current women’s center on the second floor of the main building to accommodate post-surgical patients; cosmetic renovations of all patient rooms on the third floor Med/Surg unit; and various electri-cal, mechanical and exterior upgrades.

Although it will take almost three years to complete all work, new facilities will come online as they are completed. The expanded ER is expected to be ready next spring and the women’s center and NICU is anticipated to house patients in the fourth quarter of 2016. Earl Swensson Inc. is the project’s architect while Batten and Shaw is the contractor.

with the director of surgi-cal services, and identi-fying and implementing cost savings initiatives and conversions. Green began her HCA career five years ago when she worked in the TriStar StoneCrest supply chain department. She then served as supply chain coordinator for TriStar Skyline and most recently as the facility operations coordinator with HCA’s HealthTrust Purchasing Group in Brentwood. She received her bachelor’s degree from Tennessee State University.

Elizabeth “Beth” Nielsen, BSN, MHA, brings more than 26 years of experience to her new role as director of mater-nity services. She most recently served as director of maternal child health for St. Joseph Regional Medical Center in Read-ing, Penn. Her HCA ex-perience includes working as director of women’s services in Southern Hills Hos-pital and manager of women’s services at Sunrise Hospital, both in Las Vegas. She received both her undergraduate and master’s degree in health administration from St. Francis University in Illinois and a bachelor’s in nursing from Grand Canyon University Arizona.

Bass, Berry & Sims Welcomes Former Assistant U.S. Attorney Lisa Rivera

Last month, Berry & Sims announced the addition of veteran healthcare pros-ecutor Lisa S. Rivera, for-mer Assistant U.S. Attorney with the United States At-torney’s Office for the Mid-dle District of Tennessee, as a member in the firm’s Litigation and Healthcare Fraud practice group. With more than 20 years of com-bined legal experience including com-mercial litigation, criminal prosecution and pursuing healthcare False Claims Act cases, Rivera’s practice will focus on advis-ing healthcare providers, pharmaceutical manufacturers, medical device compa-nies and other clients on matters related to both civil and criminal healthcare fraud and abuse, as well as government investi-gations and enforcement.

For the last 13 years, Rivera served in Nashville as an Assistant U.S. Attor-ney in both criminal and civil divisions, with a focus on healthcare fraud during the last 10 years. She served as the civil and criminal Healthcare Fraud Coordina-tor for the Middle District of Tennessee and was responsible for the intake, re-view and coordination of all criminal and civil healthcare fraud investigations and cases in the U.S. Attorney’s Office. She also carried her own cases, investigat-ing, prosecuting and resolving civil and criminal healthcare matters. Additionally, Rivera served on the Medicaid Fraud Control Unit with the Tennessee Bureau of Investigation.

Meagen Green

Beth Nielsen

Lisa Rivera


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have you seen a purple ribbon this month? november is national stomach cancer awareness Month. the american cancer society estimates 22,220 cases of stomach cancer will be diagnosed, and 10,990 deaths will occur this year. early detection is the best prevention against the disease. i would also encourage awareness of these two risk factors: helicobacter pylori (h. pylori) bacteria and pernicious anemia.

stomach cancer is still an incurable disease, but we now have better than ever treatment options at tennessee oncology. Whereas chemotherapy has been used exclusively for treatment, we are now moving toward targeted therapies. We are discovering cancer cells’ triggers and attacking those cells directly – this is creating more stomach cancer survivors.

Just in april, the u.s. food and Drug administration approved a promising, new targeted therapy called ramucirumb. this drug is for patients battling advanced or metastatic, gastric or gastroesophageal junction (GeJ) adenocarcinoma that is progressive and unresponsive to specific types of chemotherapy. ramucirumb, a monoclonal antibody administered by intravenous (iv) infusion, starves tumors by stopping their blood supply. ramucirumb, when used with chemotherapy, increases patients’ chances of survival. tennessee oncology utilizes the drug in clinical trials.

for her2-Positive patients, hope can be found in trastuzumab. approved by the u.s. food and Drug administration in 2010, trastuzumab is a targeted therapy for patients with her2-overexpressing metastatic gastric or gastroesophageal (Ge) junction adenocarcinoma who have not received prior treatment. this drug, administered by intravenous (iv) infusion, aims at the her2/neu protein and suppresses tumor growth. trastuzumab, in conjunction with chemotherapy, increases patients’ chances of survival.

i highly recommend clinical trials to stomach cancer patients because potential improvements are possible – even when past treatments have failed. at tennessee oncology, we encourage patients to join clinical trials because of the potential to not only help themselves but help others, too. in addition to clinical trials, we offer many options for stomach cancer patients with a good response rate. every patient deserves the chance to beat their cancer. Whether a patient is newly diagnosed or terminally ill, tennessee oncology’s cancer care approach is comprehensive – physical, emotional and financial needs are acknowledged. We understand that caring for cancer patients is a privilege.

Habib Doss, M.D.

Promising New Therapies in Stomach Cancer TreatmentTennessee Oncology’s Habib Doss, M.D.

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Nashville Medical News November 2014

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