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Nashville Medical News September 2015

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Nashville Medical News September 2015
ON ROUNDS ACOs or Free Market? Health:Further Debate Examines Pros and Cons of Leading Reimbursements Models Are ACOs and value-based payments panacea or placebo? That was the question put to some of Nashville’s top healthcare policy gurus at the Aug. 20 Health:Further conference produced by Jumpstart Foundry ... 7 Healthcare Industry Annually Contributes $39 Billion Locally, $73 Billion Globally On Aug. 18, the Nashville Health Care Council released an economic impact study in partnership with the Business and Economic Research Center (BERC) at Middle Tennessee State University that found the healthcare industry contributed $38.8 billion to the region’s economy in 2014 ... 14 PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 PRINTED ON RECYCLED PAPER September 2015 >> $5 FOCUS TOPICS REIMBURSEMENT & COMPENSATION PEDIATRICS ONLINE: NASHVILLE MEDICAL NEWS.COM Advancing the Revolution in Retina Care Nashville Retina Specialists Work to Improve Outcomes, Reduce the Burden of Care BY BILL OWENS Ten years ago, the introduction of new drug therapies revolutionized the treat- ment of retinal disease. Today, Nashville-based physicians are working hard to improve outcomes, lessen the burden of care, and deliver new breakthroughs. Carl Awh, MD, of Tennessee Retina and Amish Purohit, MD, of the Toyos Clinic are two such vitreo- retinal specialists. Since being introduced in 2005, anti-vascular endothelial growth factor medications (anti-VEGF drugs) have proven highly effective at slowing or halting the progress of a variety of disorders, including macular degeneration, central serous retinopathy, diabetic retinopathy and diabetic retinal edema. Prior to the introduction of anti-VEGF medications, there was little retina specialists could do for (CONTINUED ON PAGE 12) Ken Moore, MD PAGE 3 PHYSICIAN SPOTLIGHT (CONTINUED ON PAGE 10) Trust the Process Healthcare Gets Lean BY CINDY SANDERS As healthcare moves from volume to value with greater emphasis on both effi- ciency and quality, the need to adopt the lean practices used in other industries has become ap- parent. Conversations about big data, analytics and process engineering are becoming increasingly commonplace. Best practices are no longer limited to the clinical arena but are also a key part of the business plan. In today’s evolving delivery system, positive patient outcomes are often attributable not only to providers but also to the processes that have been put in place. During the recent INFORMS Healthcare conference in Nash- ville (see page 10), Mike Fabel, a senior health systems engineer with the Mayo Clinic, and Victoria Jordan, PhD, executive direc- tor of Strategic Management and Systems Engineering with the University of Texas MD Anderson Cancer Center, sat down to discuss their role in the healthcare delivery system. “I have a manufac- turing background,” said Fabel. “We just have a dif- ferent way of viewing things as far as looking for waste in the process. I think we bring a simpli- fied, team-based effort to looking for waste.” Fabel added that in his experi- ence, physicians, nurses and other team members have the necessary skills to rethink the status quo but need the guidance, facilitation and tools the engineering department brings to the table to help them map out new solutions. Don’t Miss the Big Event From industry conferences and continuing educational units to fun ways to support the area’s many non profits ... check the online calendar for healthcare happenings. www.NashvilleMedicalNews.com
Page 1: Nashville Medical News September 2015


ACOs or Free Market?Health:Further Debate Examines Pros and Cons of Leading Reimbursements ModelsAre ACOs and value-based payments panacea or placebo? That was the question put to some of Nashville’s top healthcare policy gurus at the Aug. 20 Health:Further conference produced by Jumpstart Foundry ... 7

Healthcare Industry Annually Contributes $39 Billion Locally, $73 Billion GloballyOn Aug. 18, the Nashville Health Care Council released an economic impact study in partnership with the Business and Economic Research Center (BERC) at Middle Tennessee State University that found the healthcare industry contributed $38.8 billion to the region’s economy in 2014 ... 14





September 2015 >> $5



Advancing the Revolution in Retina CareNashville Retina Specialists Work to Improve Outcomes, Reduce the Burden of Care


Ten years ago, the introduction of new drug therapies revolutionized the treat-ment of retinal disease. Today, Nashville-based physicians are working hard to improve outcomes, lessen the burden of care, and deliver new breakthroughs. Carl Awh, MD, of Tennessee Retina and Amish Purohit, MD, of the Toyos Clinic are two such vitreo-retinal specialists.

Since being introduced in 2005, anti-vascular endothelial growth factor medications (anti-VEGF drugs) have proven highly effective at slowing or halting the progress of a variety of disorders, including macular degeneration, central serous retinopathy, diabetic retinopathy and diabetic retinal edema. Prior to the introduction of anti-VEGF medications, there was little retina specialists could do for


Ken Moore, MD




Trust the ProcessHealthcare Gets Lean


As healthcare moves from volume to value with greater emphasis on both effi -ciency and quality, the need to adopt the lean practices used in other industries has become ap-parent.

Conversations about big data, analytics and process engineering are becoming increasingly commonplace. Best practices are no longer limited to the clinical arena but are also a key part of the business plan. In today’s evolving delivery system, positive patient outcomes are often attributable not only to providers but also to the processes that have been put in place.

During the recent INFORMS Healthcare conference in Nash-ville (see page 10), Mike Fabel, a senior health systems engineer with

the Mayo Clinic, and Victoria Jordan, PhD, executive direc-tor of Strategic Management

and Systems Engineering with the University of Texas MD Anderson Cancer Center, sat down to discuss their role in the healthcare

delivery system. “I have a manufac-

turing background,” said Fabel. “We just have a dif-

ferent way of viewing things as far as looking for waste in the

process. I think we bring a simpli-fi ed, team-based effort to looking

for waste.” Fabel added that in his experi-

ence, physicians, nurses and other team members have the necessary skills to rethink the status quo but need

the guidance, facilitation and tools the engineering department brings to the table to help them map out new solutions.

Don’t Miss the Big Event

From industry conferences and continuing educational units to fun ways to support the area’s many non profi ts ... check the online

calendar for healthcare happenings.


Page 2: Nashville Medical News September 2015

2 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

Thomas F. Frist, Sr., M.D.Co-Founder, HCA

Thomas F. Frist, Jr., M.D.Co-Founder, HCA

Ernest W. Goodpasture, M.D.Physician, Pathologist, Professor

Jack C. MasseyCo-Founder, HCA

R. Clayton McWhorterCo-Founder, HealthTrust

and Clayton Associates

David Satcher, M.D., Ph.D.Former U.S. Surgeon General

Mildred T. Stahlman, M.D.Pediatrician, Pathologist,


Danny ThomasFounder, St. Jude Children’s

Research Hospital


10:30–11:30 a.m. Registration 11:30 a.m.–1 p.m. Lunch & Ceremony

Sponsorships and Individual Tickets available at tnhealthcarehall.com

Be a Part of the Historic Inaugural Induction!With a mission to honor men and women who have made significant and lasting contributions to the

health care industry, The Tennessee Health Care Hall of Fame seeks to recognize and honor the pioneers

and current leaders that have formed Tennessee’s health and health care community and encourage future

generations of health care professionals. Don’t miss the induction of the first class, featuring these health

care legends:

INCYour Primary Source for Professional Healthcare News



The Tennessee Health Care Hall of Fame has been created by

Belmont University and The McWhorter Society and is supported

by Founding Partner, The Nashville Health Care Council.

Page 3: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 3


Dr. Ken Moore: Physician & PoliticianBy CINDy SANDERS

Orthopaedic surgeon, pediatric advo-cate, mayor … no matter which hat he is wearing, Ken Moore, MD, keeps his focus on service to the community.

Growing up in Donelson, Moore knew he wanted to be a doctor from the time he was in elementary school. “That was just always my focus,” he said of going into medicine.

After earning his undergraduate de-gree at Tennessee Tech, Moore set off for the University of Tennessee Health Sciences Center. He stayed in Memphis for his internship and subsequently spent two years at Fort Bragg, N.C. as a general medical officer.

Moore then returned to Memphis to complete his training. “I toyed between plastic surgery, urology and orthopaedics … and orthopaedics won out for me,” he noted. “I like the diversity of operations and procedures and diseases.” In particu-lar, he added, “I liked the complexity and intricacies of the hand.”

After a year of general surgery with City of Memphis Hospitals, and a six-month research fellowship in rheumatol-ogy at UTHSC, Moore undertook his orthopaedic training at the renowned Campbell Clinic.

During medical school and training, Moore became friends with a young doc-tor who was a year ahead of him in the program. He and fellow orthopaedic sur-geon Eslick Daniel, MD, both knew they wanted to practice in a smaller town. “We scouted around, and Columbia, Ten-nessee looked like a good opportunity,” Moore said, adding there was a good com-

munity hospital, good schools and a good quality of life in Maury County.

Daniel founded Middle Tennessee Bone & Joint Clinic in January 1974. “I got there in January of ’75 and was there until I retired in 2004,” Moore said, not-ing the practice is still going strong today.

“My wife grew up in Franklin,” Moore said of the impetus to pull up stakes and move to Williamson County. “We saw it was a good place to start the next phase of our life.”

He continued, “I always thought I’d have another career when I retired. My real thought was I’d try to develop exper-tise in healthcare policy.” Although he had some experience in that arena from work on a regional and national stage within his specialty, Moore said he was called in a different direction.

“I had the opportunity to go over to Bhutan in 2005, and I taught orthopaedic as-sistants,” he said of working with the group Orthopaedics Overseas. “In 2006, I went and taught orthopaedics in Ethiopia. I had 13 or-thopaedic residents there for a month.”

Preparing for a similar trip to Mol-dova in 2007, a friend’s comments changed Moore’s course. “I was having breakfast with a friend who suggested I run for office … so I did,” he said with a chuckle. “In 2007, I was in a field of 13 candidates for four alderman-at-large po-sitions, and I was successful in that race.”

By 2011, Moore was vice mayor of Franklin. When Gov. Bill Haslam tapped then-mayor John Schroer to become com-missioner of the Tennessee Department of Transportation, Moore finished the last nine months of Schroer’s mayoral term before running for the office in late 2011.

“This term I’m currently serving ex-pires in October. I’m running again, and I’m unopposed,” he said of his new career leading the 14th fastest growing city in America with a population over 50,000.

While the charming city of Franklin boasts many positive qualities, Moore said he is particularly proud of one of his earli-est efforts … a sustainability initiative that includes everything from curbside recy-cling to a solar field to a $200,000 savings in annual energy costs. “Not only has the community bought into it, but all of the city departments have sustainability initia-tives, too,” he said.

With his deep medical roots, Moore is also proud of the growth in healthcare ser-vices in Williamson County, pointing to the recent opening of the Monroe Carell Jr. Children’s Hospital at Williamson Medical Center and the new Scott Ham-ilton Proton Center coming to Franklin. “We’ll be the second in Tennessee (first is in Knoxville) and the 18th in the nation,” Moore said of the cutting-edge form of radiation therapy. “We’re continuing to evolve as a major regional player in healthcare delivery.”

While Moore relishes his role as mayor, his love of medicine won’t allow him to completely step away from provid-ing care. Moore serves as medical director for the Shalom Foundation, a local non-profit that has a surgery center in Guate-mala City that provides care to children.

He calls his involvement in the or-

Brentwood Home to Unique, New Walk-In Clinic Williamson Medical Group (WMG) and The Heritage at Brentwood, a Life

Care Services™ community, have partnered together to improve access to care and patient convenience by opening a full walk-in clinic within the active senior living community.

Beginning Sept. 2, residents won’t have to worry about transportation for routine doctor’s visits. Instead, the first-of-its-kind clinic is located within the clubhouse on property at The Heritage at Brentwood. The clinic offers a range of healthcare services and treatments including: physicals, electrocardiograms (EKGs), lab testing, steroid injections, antibiotic prescriptions, suture removals and ear wax cleanings. Additionally, the clinic will offer flu, shingles and pneumonia vaccinations.

“The Heritage is the first active senior living community in Tennessee to partner with a medical group and open a walk-in-clinic specifically for its residents – giving them immediate access to a dedicated primary care physician,” said Heritage Administrator Dahlen Jordan.

The walk-in clinic, operated by WMG, is open Monday-Friday. Don Vollmer, MD, will staff the clinic on Wednesdays, and nurse practitioner Rupa Grummon will be on site the remainder of the week.  

“Thanks to our partnership, residents at The Heritage will not only benefit from the medical physician on site, but they will have better access to Williamson Medical Group’s complete physician network, including specialists,” said Tim Burton, associate administrator for operations at WMG. “This improved access will give residents the ability to streamline healthcare providers and medical records, which can lead to more efficient and effective care.”


The Tennessee Department of Human Services/Disability Determi-nation Services is now hiring medical doctors for full and part-time independent contract to perform medical consultation and case assessment for disability claim applications fi led with the Social Security Administration. Our offi ce is located in Nashville Tennes-see. Qualifi cations: Must be a licensed physician (medical or osteo-pathic doctor) with computer experience.

Interested applicants may call Kelly Long at (615) 743-7843 or mail your CV to:

Disability Determination SectionA  n: Kelly Long 3rd Floor

P.O. Box 775Nashville, TN 37202

Dr. Don Vollmer


Page 4: Nashville Medical News September 2015

4 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m


Spoons Are for Dinner … Not Dosing

Mary Pop-p ins might have famously claimed a spoon-ful of sugar helps the medicine go down, but the American Academy of Pediatrics would beg to differ.

Not only would the AAP not sug-gest downing raw sugar … the national organization wants pediatricians, nurse practitioners and pharmacists to rethink the way they describe dosing to parents. The AAP is urging prescribers and phar-macists to use only metric measurements on prescriptions, medication labels and dosing cups to ensure children receive the right amount of medicine. When dos-ing is described as a teaspoon or table-spoon, parents are apt to grab a spoon from the silverware drawer.

“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” said pediatrician Ian Paul, MD, FAAP, lead author of the policy statement, “Metric Units and the Preferred Dosing of Orally Administered Liquid Medications,” which was released earlier this year. “For infants and toddlers, a small error – especially if repeated for multiple doses – can quickly become toxic.”

Each year more than 70,000 children visit emergency departments as a result of unintentional medication overdoses. “One tablespoon generally equals three teaspoons. If a parent uses the wrong size spoon repeatedly, this could easily lead to toxic doses,” Paul pointed out.

Research has shown common over-the-counter liquid medications for chil-dren often have metric dosing on the label but include a measuring device marked in teaspoons, or vice versa. Cutting down on caregiver confusion, a recent study demonstrated medication errors were significantly less common among parents using only mL-based dosing rather than teaspoons or tablespoons.

NextGxDx, Seattle Children’s Partner on Genetic Test Utilization Management

In late June, Franklin-based Next-GxDx announced a collaborative part-nership with Seattle Children’s Hospital to develop a joint genetic test utilization management (UM) solution that could be used by children’s hospitals and pediatric practices across the country.

The collaboration will combine the hospital’s PLUGS UM – Pediatric Labo-ratory Utilization Guidance Services – program and its team of genetic testing experts with NextGxDx’s GeneConnect platform, a technology solution designed to bring highly specialized data and tools to help curb rising genetic testing send-out costs.

PLUGS helps provide practical re-

sources, expert advice and a peer net-work for members to develop sustainable utilization management programs. Gene-Connect leverages NextGxDx’s indus-try-leading database of genetic testing products and U.S.-based, CLIA-certified labs, called GeneSource™. GeneCon-nect offers hospitals administrative tools

to further streamline the genetic test ordering process, including the

ability to establish preferred reference lab relationships,

track electronic orders and results, monitor physician/department test utilization,

and easily compare testing options.

“The growth in the cost and com-plexity of genetic testing is overwhelm-ing children’s hospitals and their ability to manage genetic test ordering,” said Michael Astion, MD, PhD, medical direc-tor in the Department of Laboratories at Seattle Children’s Hospital.

NextGxDx CEO Mark Harris, PhD, said his team is excited to develop a comprehensive UM solution that merges PLUGS’ clinical expertise and network with his company’s analytics, GeneCon-nect technology, and customer base of children’s hospitals. “We’re excited to support PLUGS’ mission to significantly reduce laboratory testing expenses while increasing the value of testing to pa-tients,” Harris concluded.

Exercising as a Teen Pays Off Later in Life

A new study by investigators at Vanderbilt University Medical Center and the Shanghai Cancer Institute in China has found women who exercised during their teen years were less likely to die from cancer and all other causes during middle-age and later in life.

Published online at the end of July in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American As-sociation of Cancer Research, the study highlights the long term public health im-plications of making modifiable lifestyle choices among adolescents.

Lead author Sarah Nechuta, PhD, MPH, assistant professor of Medicine in the Vander-bilt Epidemiology Center, said, “Our results support the importance of promot-ing exercise participation in adolescence to reduce mortality in later life and highlight the critical need for the initiation of disease prevention early in life.”

 Designed to ascertain potential as-

sociations between adolescent exercise and cancer, cardiovascular disease or other causes of death among women in middle age and later life, the study uti-lized data from the Shanghai Women’s Health Study — a large, ongoing pro-spective cohort study of 74,941 Chinese women between the ages of 40 and 70. The women, who enrolled in the study be-tween 1996 and 2000, were interviewed at the onset about exercise during ado-lescence, including participation in team sports, as well as other adolescent life-style factors.

Participants were also asked about exercise during adulthood and other adult lifestyle factors and socioeconomic status, and participants were interviewed again every two to three years. Regular exercise was defined as occurring at least once a week for at least three continuous months. Women who reported regular adolescent exercise were also asked how many hours a week they participated and for how many years they had exercised regularly.

“In women, adolescent exercise par-ticipation, regardless of adult exercise, was associated with reduced risk of cancer and all-cause mortality,” explained Nechuta. Participation in team sports during the teen years also was associated with a re-duced risk of cancer death later in life.

Investigators found that participation in exercise both during adolescence and recently as an adult was significantly as-sociated with a 20 percent reduced risk of death from all causes, 17 percent for cardiovascular disease and 13 percent for cancer.

Diagnosable Psychiatric Disorders in Children

In May, the Child Mind Institute re-leased the organization’s first Children’s Mental Health Report, synthesizing ev-idence-based data on the prevalence of mental illness in children. The report found an estimated 17.1 million young people in the United States have, or have had, a diagnosable psychiatric disorder.

The report went on to say the major-ity of children aren’t being treated and estimates 80 percent of children with di-agnosable anxiety disorder, 60 percent of kids with diagnosable depression and 40 percent of adolescents diagnosed with ADHD are not receiving treatment.

“The results are in and they are re-markable in that they defy the general public’s perception of childhood men-tal illness,” said Child Mind Institute Founder and President Harold Koplewicz, MD. “Many more kids than we realized struggle with mental illness, and nearly

two thirds do not get treatment. This is a wake up call. Mental illness and learning disabilities are the common disorders of childhood.” 

The full report is available at http://childmind.org/speakup. 

Children’s Healthcare of Atlanta First to Use Robotic Exoskeleton in Peds Rehab

This summer, Children’s Healthcare of Atlanta announced it had become the first pediatric hospital in America to offer patients enhanced neuro-rehabilitation services through the use of Ekso Bionics’ patented technology.

The hospital is incorporating Ekso—a wearable robotic exoskeleton— into its Center for Advanced Technology and Ro-botic Rehabilitation to continue offering the latest technology to help children and teens recover from injuries or disorders that have hindered their motor skills. The exoskeleton enables patients with lower-extremity paralysis or weakness to stand and walk with minimal assistance.

Using motors and sensors, along with the patient’s assistance with balance and positioning, the exoskeleton allows the child to walk over ground with an effi-cient, repetitive gait pattern, helping the body re-learn proper step pattern and weight shifts. The exoskeleton can pro-vide therapists with immediate feedback from each step the patient takes show-ing how much work the machine is doing verses how much work the child is doing. Research has shown therapy with repeti-tive and random patterns helps the brain and spinal cord work together increasing strength, coordination, function and inde-pendence.

“Neuroplasticity is the adaptive ca-pacity of the central nervous system to respond to repeated changes in stimuli, which it may do by reorganizing its struc-ture, function or neural connections,” explained Joshua Vova, MD, medical di-rector of Rehabilitation Services at Chil-dren’s Healthcare. “In effect, it can help patients recovering from stroke, brain injuries, and spinal cord injuries to learn to walk again, with a proper gait pattern which may help to minimize compensa-tory behaviors.”

News of Note to Help Young Patients Thrive

Dr. Sarah Nechuta

Page 5: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 5

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According to statistics from the Cen-ters for Disease Control and Prevention, one in 68 children falls somewhere on the autism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost five times more common in boys (1 in 42) than girls (1 in 189). Additionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still no cure for ASD, research has shown early intervention can have a significant impact on a child’s development and ability to more fully interact with peers at school. It’s at this intersection of education and healthcare where Educational Services of America (ESA) offers resources to help these chil-dren thrive.

Headquartered in Nashville, the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primar-ily with public school systems,” he said, noting the company partners with about 250 different systems. He added ESA also works directly with some state gov-ernments and insurance carriers.

“Providing quality services to chil-dren and young adults who need them is more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in busi-ness for more than 15 years, Claypool said many of the programs being used have been around much longer with mea-surable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early intervention space,” Claypool explained. “Autism is a very dy-namic disability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.” Today, EAP reaches four times the num-ber of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida,

Georgia, Kentucky, South Carolina and Tennessee in the Southeast.

“We’re growing very rapidly,” Clay-pool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied BehaviorAt the heart of the program is the use

of Applied Behavioral Analysis (ABA). “We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive liv-ing skills including self-care, toileting, un-derstanding time and money, and honing work skills.

“The same model of behavioral ther-apy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individ-ual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of chil-dren diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable out-comes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to

have their potential unlocked,” he contin-ued.

That was certainly true for one South Carolina mom. Told it would be best to find her son a residential program because he would never function on his own, she took matters into her own hands and be-came the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with autism will perform at that level, Clay-pool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education

Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the In-dividuals with Disabilities Education Act requires public school systems to identify preschool children with special needs. However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with au-tism to find another way to have their chil-dren identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law. “That’s important because it was built on

a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than educa-tion systems to bridge the gap.”

According to the Autism Health In-surance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law. While the specifics vary from state-to-state, each of the mandates requires insur-ers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of en-acting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016. Additionally, the federal govern-ment has recently told all states their Med-icaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

At the Intersection of Education and Healthcare

For More Info & ReferralsFor more information on autism and other programming by Educational

Services of America, go online to esa-education.com. For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

Mark Claypool

Page 6: Nashville Medical News September 2015

6 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

MGMA Releases Latest Provider Compensation Data


In late July, the Medical Group Man-agement Association (MGMA) released fi ndings from the 2015 Provider Compen-sation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating offi cer of the national or-ganization for healthcare administration and medi-cal practice management. “For the last 25 years, we’ve also been special-izing in the space of phy-sician compensation and non-physician compensa-tion.”

Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary care phy-sician increases outpacing those of special-ists (3.56 percent increase vs. 2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compen-sation of $241,273 for primary care physi-

cians.The 2015 bench-

marking report included information on nearly 70,000 providers across the United States. In addition to geo-graphic diversity, Evenson said the data was repre-sentative of both large and small practices, vari-ous ownership structures in-cluding hos-p i t a l - b a s e d providers, and more than 170 specialties.

Evenson said the collected data is im-portant for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

While primary care physicians en-joyed a 3.5 percent increase in median compensation between 2013 and 2014, the fi gures are even more interesting when taking a slightly longer view. Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012.

“Will primary care physicians be compensated at the same levels as special-ists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Pri-mary care physicians are truly the lynch-pin of the new practice model as we move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be productivity based,” explained Evenson. “In 2012, 50 percent of respondents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data high-lights the gradual shift toward rewarding practitioners for improved operational ef-fi ciencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physician compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 per-cent,” he said. “That value over volume concept that physicians seem to be em-

bracing is really beginning to pay off for them.”

He added, “The behaviors

they are trying to promote are tied

to that triple aim (of healthcare) … reduc-

ing the per capita cost of healthcare, improv-

ing the health of popu-lations, and improving

the patient experience of care.”

Evenson said those in the behavioral health sec-

tor are also seeing improved compensation as their work

complements that of primary care providers in managing a

population’s health.The industry is really recognizing a

need to look to behavioral health services to better deliver quality care. The likeli-hood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evi-dent in the MGMA compensation survey over the last few years. “Since 2009, there has been a 21.9 percent increase in com-pensation for psychiatrists. Now, their me-dian compensation is $244,796,” Evenson said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts.

Economic forces of supply and de-mand are another issue factoring into phy-

sician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensa-tion rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between 46,000 and 90,000 physicians by 2025.

In addition to compensation fi gures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefi ts, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data al-lows those in healthcare to dissect the in-formation in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for effi ciencies and for providing bet-ter care by understanding your colleagues’ activities in the industry,” Evenson con-cluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataD-ive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare management will be explored in depth at MGMA’s annual conference scheduled for Oct. 11-14 in Nashville.

Todd Evenson

The 2015 bench-marking report included information on nearly 70,000 providers across the United States. In addition to geo-graphic diversity, Evenson said the data was repre-sentative of both

providers, and more than 170 specialties.

Evenson said the collected data is im-

bracing is really beginning to pay off for them.”

they are trying to promote are tied

to that triple aim (of healthcare) … reduc-

ing the per capita cost of healthcare, improv-

ing the health of popu-lations, and improving

the patient experience of care.”

Evenson said those in the behavioral health sec-

tor are also seeing improved compensation as their work

complements that of primary care providers in managing a


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ganization a God thing that came about when a mutual friend introduced him to Steve Moore (no relation), chairman and founder of the Shalom Foundation. “I en-joyed my trips overseas and was sharing this at a Christmas breakfast,” he recalled of the casual fi rst encounter. The two men, both passionate about helping chil-dren in poverty-stricken areas, struck up a friendship and then a working relationship through Shalom.

“We do every type of pediatric surgery except cardiovascular and neurosurgery,” Moore said of their work in Guatemala. “This year, we’ll do about 1,000 cases at no charge.” He added, “We’ll have some of the best surgeons in the world come to the surgery center.” In fact, Moore said Shalom partners with Monroe Carell at Vanderbilt, Duke University, Dell Chil-dren’s Hospital in Austin, the Miller Clinic in Los Angeles, and Denver Children’s Hospital, among others.

Moore traveled to Guatemala City fi ve times last year and expects to go that many times again this year. He said they partner with the local Ronald McDonald House to help families traveling to the sur-

gery center, which has 23 overnight beds, and with physicians throughout the coun-try to provide follow-up appointments and monitoring. “We’ve been blessed with the opportunities we have there to render care to a lot of these kids,” Moore stated.

At fi rst glance, it might not seem like physicians and politicians have a lot in common, but Moore pointed out both professions take a similar skill set. “As a physician, your career is talking and lis-tening. My career as mayor is meeting and talking and listening to people,” he said.

While there isn’t much down time in Moore’s ‘retirement’ years, he does love to play golf when he gets the opportunity and has recently taken up learning to play the guitar. He and his wife, Linda, also enjoy traveling, and Moore noted that be-tween them they have fi ve children and six grandchildren.

Whether spending time with his own family, working to improve his commu-nity or reaching out across the globe to children in need, it’s clear that Moore will never retire from his lifelong profession of helping others.

Ken Moore: Physician, continued from page 3

Page 7: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 7


Are ACOs and value-based payments panacea or placebo? That was the ques-tion put to some of Nashville’s top policy gurus at the Aug. 20 Health:Further con-ference produced by Jumpstart Foundry.

Moderated by Jim Lackey, chairman and CEO of Complete Holdings Group, the friendly debate took place between Larry Van Horn, executive director of Health Affairs and associate professor of Economics at Vanderbilt University’s Owen Graduate School of Management, and Richard Cowart, chair of Baker Do-nelson Bearman Caldwell & Berkowitz’s Health Law and Public Policy Depart-ments.

ACOs 101As defined by Centers for Medicare

and Medicaid Services, accountable care organizations (ACOs) are groups of doc-tors, hospitals, and other healthcare pro-viders who come together voluntarily to give coordinated, high quality care to the Medicare patients they serve. Theoreti-cally, coordinated care helps ensure pa-tients, especially the chronically ill, get the right care at the right time in the right set-ting … with a triple aim of reducing errors and improving outcomes while avoiding unnecessary duplication of services and delivering care in a more cost effective manner.

When an ACO succeeds in delivering quality care while spending healthcare dol-lars more wisely, the ACO partners share in the savings the model has achieved for the Medicare program in a classic win/win/win for patient, provider and payer.

Under CMS, ACOs agree to manage all of the healthcare needs for a minimum of 5,000 Medicare beneficiaries for at least three years. While the exact number of ACOs fluctuates, common estimates range from 500-700, including more than 150 non-Medicare ACOs.

ACO vs. Free MarketCowart, who leaned in favor of

ACOs, noted the Medicare/Medicaid programs, now celebrating 50 years, have evolved to include parts A-D, with the most recent Pharmaceutical Drug Benefit (Part D) added 10 years ago.

With the numerous moving parts, Cowart said, “Nine years ago, ACOs provided a way to sit in the middle and discuss how to engage everyone as a team. There needs to be a pluralistic pric-ing model for a robust future. We don’t need two bookends; we need something in the middle.”

A free market proponent, Van Horn noted that healthcare spending represents 18.5 percent of the nation’s GDP, with 12-13 percent of expenses paid out-of-pocket. “There’s nothing wrong with a fee-for-service model. It pains me to think about the central payer,” said Van Horn, who also co-directs the Nashville Health

Care Council Fellows program.“The ACO doesn’t start with how we

solve customer’s problems. Would it be better to create an ACO or allow easy ac-cess to innovation to solve problems?” he asked, noting that what an ACO deems “value” might not align with the average citizen’s idea of value.

“We’re broke as a country,” Van Horn stated. “We need to pull back the amount of healthcare consumed in the U.S.” He theorized a free market health-care supply would regulate itself or drop to reflect a decreased demand and that spending more out of pocket would reduce overall expenses.

“You’ve got two competing models, “ he said. “One is driven by supply-side, and that’s population health, accountable care organizations, value-based stuff … and the industry is all headlong on this. On the parallel side, you’ve got demand changes affecting consumers — high-de-ductible plans, defined contributions. It’s a race to see who’s going to win, and I think demand changes are winning.”

No “One Size Fits All”But the idea of healthcare without

federal involvement isn’t a welcome con-cept to all. “Pulling government out of healthcare would mean a total collapse,” Cowart predicted. “The self-pay system is nuts. We need some private and some government.”

Cowart added the notion of a private market driven by consumer technology simply wouldn’t hold up across the board, especially among elderly patients who lack the tech skills needed to navigate health-care online.

Still, even ACO proponents agree there are weaknesses and that the govern-ment-based payment model might not be sustainable as is. According to Cowart, the 1990s was a great … albeit cautionary … experiment in groups wandering into areas outside their core competencies, and he urged the industry not to go there again.

He also agreed that the fatal flaw of

many ACOs is not really knowing their population – a view shared by Van Horn. “They can’t know the population be-cause the population doesn’t stand still … 15 percent of Americans move yearly,” pointed out Van Horn.

“None is the equilibrium when the dust settles,” he continued. “The private sector is key in solving problems.” And while many providers might consider an-other network competition, Van Horn said to think again. “HCA isn’t your com-

petition,” he said. “Wal-Mart is. Teledoc is.”

But patient experience matters, Cow-art countered, and clinical enterprise can do what big box retailers can’t. “The core of healthcare is chronic disease and seniors, and public policy demands that government be involved,” said Cowart. He added that he is supportive of tax-favored vouchers to buy coverage off of private exchanges and to utilize emerging tools like health data analytics to provide population health insights to improve quality.

“In an ACO, quality is defined by the industry, not consumers,” Van Horn ar-gued. “You can’t trust any ACO to solve problems of where I should get care, or what I should pay.”

He continued, “Let the private mar-ket create such amazing solutions that Medicare beneficiaries want to buy it. ACOs are antithetical to innovative com-panies. High-deductible plans increase pain points, cutting down on demand and lowering costs.”

While the debate will continue, most people in healthcare are in agreement that the time is ripe for innovation and trans-formation in delivery and reimbursement.

No matter which side you land on, Cowart concluded, “It’s a very exciting time.”

ACOs or Free Market?Health:Further Debate Examines Pros and Cons of Leading Reimbursements Models

(L-R) Moderator Jim Lackey oversaw a lively debate between policy experts Larry Van Horn and Dick Cowart as to the best way to innovate delivery and create a sustainable reimbursement path for healthcare at Jumpstart Foundry’s Health:Further conference on Aug. 20.


With the passage of SB0284, Ten-nessee physicians and surgeons will now have a new process in place for reimburse-ment of services during the pendency of a credentialing application before a health insurance entity.

Yarnell Beatty, vice president of Ad-vocacy for the Tennessee Medical Asso-ciation, said the salient point of the law, found at TCA 56-7-1001, is that “Tennessee commercial health plans are required to provide any medi-cal group practice with which the health plan has an existing contract, a list of all information and supporting documentation required for a credentialing application to be con-sidered complete.”

There is a set timetable by which this must happen; and within five days of re-ceiving the required items, the health in-surance entity must inform the applicant if the application is complete or incomplete.

If it’s the latter, the insurer must share the information and documentation needed for the application to be considered complete.

“It also allows for a process by which a provider/practice may be paid for claims provided by the applicant during his/her pending credentialing application. This will help medical practices be able to serve the commercial health plans’ enroll-ees soon after a new physician is hired,” Beatty said.

He noted that previously, there could be a lag time of several months before phy-sicians knew if they had been approved even though providers were eventually credentialed more than 99 percent of the time.

Beatty continued, “It also allows these billion dollar companies to pay for services provided to their enrollees during a pend-ing credentialing application.” Before this new law passed, Beatty said, the plans had little incentive to speed up the process since care was being delivered while costs got kicked down the road.

Signed into law by Gov. Haslam this past May, the law doesn’t go into effect until Jan. 1, 2016.

Reimbursement During the Credentialing Process

Yarnell Beatty

Page 8: Nashville Medical News September 2015

8 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m


On Aug. 20, more than 600 health-care leaders and entrepreneurs gathered at the Omni Nashville Hotel for the inau-gural Health:Further conference.

Sponsored by Parallon, the meeting of medical minds was the brainchild of Nashville-based Jumpstart Foundry – a healthcare-focused, mentor-driven ac-celerator challenging entrepreneurs to ‘Make Something Better™.’ To date, 47 companies have graduated from Jump-start Foundry’s 14-week program and gone on to raise over $26 million in fol-low-on capital.

Smart People, Smart Ideas“Our goal was to bring great indi-

vidual minds together and showcase in-

novation across the marketplace,” said Vic Gatto, Jumpstart Foundry CEO and founder. “We wanted to get established players talking to entrepreneurs so our industry can solve problems and deliver

better care for patients, taxpayers and in-dividuals.”

Keynote speakers included U.S. Con-gressman Jim Cooper, FoxFuel Creative CEO Colton Mulligan, Saint Thomas Health’s Chief Experience Officer Dawn Rudolph, Amedisys, Inc. President and CEO Paul Kusserow, HCA Healthcare’s Chief Medical Officer Jonathan Perlin, MD, and Healthways’ Chief Digital Offi-cer Chris Dancy. The event also featured business model and technology breakouts, as well as a friendly debate about ACOs and value-based payments (see separate article.)

A Diverse IndustryCooper spoke about health policy

and innovation and reducing down-side risks in a target-rich environment,

while Kusserow discussed evolution of the traditional hospital-centric model in favor of home care. A Nashville new-comer, Kusserow praised Gatto and the Health:Further team for producing the sold-out conference.

“If you’re running a corporation, you need to be challenged and see what’s out there on a consistent basis,” said Kusse-row.

The nation’s second largest home health provider, Amedisys will move its executive headquarters from Louisiana to Nashville’s Cummins Station in Oc-tober. “Big providers are dominant here, and it gives smaller players the chance to be a real innovator with you. That’s how it should be in a vibrant economy: the big players nurture the little players … and everyone gets better.”

Community Health TV was among Health:Further’s smaller players hoping to make it big. The Jumpstart Foundry company produces multi-cultural, multi-platform videos including blackhealthtv.com. And on Aug. 20, the company launched latinohealthtv.com.

“Diverse populations are at the high-est rate for poor health across the popula-tion,” explained Community Health TV President Cary Wheelous. “We produce programs with engaging content that are culturally relevant to a diverse market-place.”

Health:Further also provided Jump-start Foundry entrepreneurs like Whee-lous an opportunity to pitch their startups to potential long-term investors. While most Jumpstart Foundry companies are just taking root, others are utilizing Gat-to’s leadership and mentoring services to take their business to the next level. Such is the case for Life-Links, a Nashville-based company providing care to aging adults and their families. The company has provided consultation services for 13 years but wanted to expand, said CEO Gretchen Napier.

“We wanted to add more technology including virtual consultations for fami-lies, and to grow the business across the country,” Napier said. Through Jump-start, Napier was paired with mentor Stephanie Forsberg, director of marketing and training for Childcare Network. Each week, mentors and participants meet to discuss business challenges and opportu-nities. “Being a mentor allows me to take the experience in my own career and help someone who’s just starting out,” Fors-berg said. “Since I was new to the area, it also helped me make connections and validated my knowledge about what I can bring to others.”

Health:Further is expected to move to the Music City Center for 2016. For more information visit healthfurther.com.

Healthcare Leaders, Entrepreneurs Merge at Health:FurtherJumpstart Foundry Conference Draws more than 600 to Downtown Nashville


Middle Tennessee nonprofit Alive Hospice has been selected to participate in the Medicare Care Choices Model, which allows eligible beneficiaries the option to elect to receive supportive care services typically provided by hospice while con-tinuing to receive curative services at the same time.

Under current payment rules, Medi-care and dually eligible beneficiaries are required to forgo curative care in order to receive services under the Medicare or Medicaid Hospice Benefit. Health and Human Services Secretary Sylvia M. Bur-well recently announced this new program, which is part of a larger effort at HHS to transform the U.S. healthcare system to de-liver better care more efficiently and to put patients at the center of that care.

Beginning in January 2016, eligible beneficiaries will receive comfort care measures and support from Alive Hos-pice, while receiving curative treatments from Tennessee Oncology. Initially, this new model of care will begin as a small pilot program. However, officials with Alive Hospice noted this could lead to a significant change in the delivery of care at the end of life should the pilot project be expanded to a larger pool of patients in the years to come.

“Before now, terminally ill patients have had to choose between comfort and cure. The Medicare Care Choices Model will give eligible patients the benefit of both rather than a choice of one or the

other,” said Alive Hos-pice President and CEO Anna-Gene O’Neal. “Alive Hospice com-mends the Centers for Medicare and Medicaid Services for exploring this new model of care, and we are honored to have been chosen as a participating provider.”

Tennessee Oncology CEO Jeff Pat-ton, MD, added, “Tennessee Oncology understands the benefits of simultaneous curative and palliative care for cancer survivors. Survivorship begins the mo-ment you are diagnosed with cancer.” He added that Tennessee Oncology was one of the first in the country to include hospice services as part of their treatment program.

All eligible hospices across the country were invited to apply to par-ticipate in the model. Due to robust inter-est, CMS expanded the model from an originally anticipated 30 Medicare-certified hospices to more than 140 participants and extended the duration of the model from three to five years. This is expected to enable as many as 150,000 eligible ben-eficiaries with advanced cancers, COPD, congestive heart failure, HIV/AIDS who receive services from participating hos-pices to experience new flexibility. Alive Hospice was the only Middle Tennessee hospice provider to be selected for the Medicare Care Choices Model during the recent announcement.

Alive Hospice, Tennessee Oncology Selected for Unique Medicare Care Choices Model

Anna-Gene O’Neal

Eligibility CriteriaIndividuals who wish to receive services under the model must fall into

certain categories:• Must be diagnosed with certain terminal illnesses such as advanced

cancers, COPD, congestive heart failure and HIV/AIDS;• Must meet hospice eligibility requirements under the Medicare or Medicaid

Hospice Benefit;• Must not have elected the Medicare or Medicaid Hospice Benefit within

the last 30 days prior to their participation in the Medicare Care Choices Model;• Must receive services from a hospice that is participating in the model; and• Must have satisfied model’s other eligibility criteria.

Dr. Jeff Patton

Page 9: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 9

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Jordan added, “There are complex tools like operations research, simulation, mathematical modeling and statistical analysis that engineers can bring to help optimize processes that people in healthcare typically have not tradi-tionally used.”

Since arriving at MD Anderson Cancer Center eight years ago, Jordan and colleagues have built a quality engineering group to support efforts to maximize efficiency and quality, while minimizing waste. Although some of that work was already underway, Jordan said it wasn’t nearly at the level of expertise, focus or acceptance that is found today.

“We’ve raised awareness from the clin-ical staff how these tools and techniques can help.” She added, “When they ask what in-dustrial engineers do, I always tell people we make things better, safer, faster, cheaper … that’s the mantra for the industrial engineer-ing profession. In healthcare, that translates to safe, timely, effective, efficient, equitable and patient centered.”

Value Stream MappingOne of those tools, value stream map-

ping, helps a team break down a process step-by-step. “It’s more valuable if you have everybody that’s involved in the process sit around the table and discuss it because what you find often is that people are doing it dif-

ferently,” Jordan noted. After searching for consensus on the

general process, she said you begin to look at each step along the way to see if it added value to the finished product or deliverable service. “If it didn’t add value, why are we doing it?” she questioned, adding the an-swer could be because there is a regulatory requirement in play. “But either there’s a reason we’re doing it or not … if not, it’s waste. So we start to identify how we can streamline the process and make it more ef-ficient.”

Fabel added there is also a quality el-ement to value stream mapping. Is there is a safety concern or lapse in quality? In what part of the process does it typically occur? After identifying the issue and adding a corrective step, the hope is to eliminate the concern.

Fabel and Jordan said these types of exercises are particularly eye opening in hospital settings that are often siloed. When bringing to-gether various groups that touch a process at different points along the way, duplica-tion and extraneous steps can come to light.

Fabel said groups are often surprised to find out how their process impacts an-other department downstream. The key to changing behaviors, he added, is to let the group collaboratively come up with solu-tions. “When people come together and actually talk and generate ideas together,

Trust the Process, continued from page 1

Victoria Jordan

Nashville Gets INFORMedThe Institute for Operations Research and Management Sciences

(INFORMS®), an international association for professionals in analytics and operations research, held its third Healthcare Conference in Nashville at the end of July.

INFORMS Healthcare 2015 featured 450 papers delivered in more than 100 sessions to help decision makers better understand the value of analytics as a competitive driver of healthcare. HCA President of Clinical Services and CMO Jonathan Perlin, MD, PhD, and Emdeon Executive Vice President Kris Joshi, PhD, led plenary presentations on the intersection of analytics and healthcare during the three-day event.

The conference – which was chaired by Robert Dittus, MD, MPH, associate vice chancellor for Public Health and Health Care, director of the Institute for Medicine and Public Health, and senior associate dean for Population Health Sciences at Vanderbilt University School of Medicine, and M. Eric Johnson, PhD, dean of the Owen Graduate School of Management at Vanderbilt – attracted more than 500 attendees from across the nation. In addition, Vikram Tiwari, PhD, an assistant professor of Anesthesiology and Biomedical Informatics at Vanderbilt’s School of Medicine and director of Surgical Analytics for Vanderbilt University, served as the program chair.

In their welcome to attendees, the three chairs stated, “The focus on delivering the highest value has never been greater for healthcare organizations. Accelerated downward pressures on reimbursements are causing organizations to reinvent service delivery across the entire continuum of care.” The trio added there is a unique opportunity for the operations research community to develop innovative techniques to address emerging challenges at all levels of healthcare delivery.

The recent meeting gave stakeholders a chance to come together to share knowledge, insights and best practices in applying analytics and process improvement measures in the healthcare arena as the industry’s focus shifts away from volume and towards individual and population health.

For additional information, access the videos, podcasts and articles that are part of ‘Healthcare in the Age of Analytics’ by going online to pubsonline.informs.org/editorscut/healthcareanalytics.

Dr. Vikram Tiwari

they can understand how their actions af-fect others later, and they’re much more willing to buy in (to the change).”

Jordan agreed cross-functional teams are critical to reengineering the process but added leadership and communication are equally important when rolling a pro-gram out. “Every project, to work, has to have an implementation plan,” she said.

Access to Engineering ToolsWhile Fabel and Jordan are part of

large, prestigious institutions, they said the types of tools they bring to the table aren’t out of reach for community hospitals or physician practices. Fabel noted the Mayo Clinic, like many other large health sys-tems, makes their resources available to affiliates in their network.

“We try to create almost a grass-roots effort as far as quality improvement using some of these industrial engineer-ing tools. We have at Mayo what’s called the Quality Academy, which is really our own educational institute,” Fabel explained, adding many of the engineers use the platform to teach the basics – such as value stream mapping and PDSA (plan, do, study, act) – so that individuals can take these tools back to their facilities

and begin to put them in play with qual-ity efforts.

Even without access to an educa-tional offering like the Quality Academy, Jordan said almost every community has resources to assist with quality and effi-ciency. In addition to private consultants, she said there are opportunities to partner with the local community college or closest university. Additionally, she continued, “There are professional organizations like American Society for Quality and the In-stitute for Industrial Engineers that have courses online so there are places where they can find affordable training and edu-cation in some of the basic tools.”

For more advanced tools or projects, Jordan suggested partnering with a college or university on a capstone project, which is a graduation requirement for industrial engineering students. “Schools are always looking for people who are willing to spon-sor those projects.”

Some are free; others require a mini-mal cash outlay, but the return on invest-ment can be significant. “You get the benefit of four or five students who have been through four years of industrial engi-neering and their faculty advisor all work-ing on your project,” she concluded.

Dr. M. Eric Johnson

Dr. Robert Dittus

Mike Fabel

Page 11: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 11

PARTNERS. advancing health together.


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These are exciting times in healthcare - Advanced Health Partners remains committed, not only to furthering our mission by providing exceptional care to our patients, but also partnering with our colleagues to improve the overall quality of care for our community.


Page 12: Nashville Medical News September 2015

12 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

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some patients. Now they can often prevent those patients from going blind, and many patients actually experience improvements in vision when they undergo drug therapy.

“You really can call anti-VEGFs miracle drugs,” Awh said. “Drug therapy remains the gold standard of care for mac-ular degeneration and diabetic retinopathy and diabetic edema. But every tool in our toolbox is important, and we use them as needed to provide the best outcome for each patient. Of course, we’re always look-ing for new ways to improve care.”

Anti-VEGF drugs are injected directly into the eye, and monthly injections are often required. Awh and Purohit acknowl-

edge that easing the bur-den on patients would be ideal. Purohit added, “Any injection carries some risk of infection.”

He detailed the fi-nancial burdens, as well. “Anti-VEGFs are not inexpensive,” he said. “A cost of $2000 per injection is not untypical. The trend toward higher insurance deductibles means that more of that expense is borne by patients.”

Purohit is enthusiastic about the re-sults he is achieving with laser treatment. While lasers have been in widespread use

for decades, Purohit said ongoing advances in laser technology and techniques have created outcomes that rival those achieved with anti-VEGF medications.

At the Toyos Clinic, the Iridex® IQ577™ Laser System is one of the tools Purohit uses to treat retinal disorders. The manufacturer’s materials describe the IQ577 as “a true yellow wavelength laser that incorporates proprietary MicroPulse™ technology” to deliver “tissue-sparing therapy.” Purohit said that the IQ577 has proven effective in the treatment of central serous retinal disorder, diabetic retinopathy and diabetic edema.

However, care plans are individual-

ized. Toyos Clinic physicians might treat a patient with injections, the IQ577 Laser System, or a combination of both. Purohit said laser treatment regimens also vary. In mild cases, a single treatment might pro-vide lasting results. In more advanced cases, three, four or more treatments a year could be necessary.

“Patients are treated at the clinic, and each treatment usually takes less than five minutes,” Purohit noted. “The current cost is $1000 per laser treat-ment, and that treatment carries lower risks of in-fection and retinal de-tachment than injections. The IQ577 can provide outstanding results while significantly reducing the patient’s burden of care.”

Purohit mentioned one case involving a patient with central serous retinopathy who came to him for a second opinion. She had been told her treatment options were exhausted. “I was able to treat her with the laser, and she has experienced significant im-provement in her condition,” Purohit said.

According to Purohit, the Toyos Clinic is the only private practice in the area cur-rently using the IQ577 laser. “I am sur-prised this model and the techniques we use are not in far more widespread use,” Puro-hit remarked. Though the Iridex IQ577 is not currently used to treat macular degen-eration, Purohit said he has begun “looking into developing a clinical trial for macular degeneration applications.”

At Tennessee Retina, Awh is well aware of the advances in laser treatment devices and techniques. However, he be-lieves refinements and advances in drug therapies offer the most promising oppor-tunities in the fight against retinal diseases. “I’m a surgeon, and I love what I do,” Awh explained, “but at this particular moment, I feel the most compelling, immediate break-throughs will involve pharmaceuticals.”

This summer, Tennessee Retina will be one of the few practices in the country involved in sponsored Phase II clinical tri-als for new retina drug therapies. Awh is understandably excited about the practice’s participation.

He touched on three different ap-proaches that are being put to the test. The first involves the placing of an implant in the cell wall of the eye. The implant is actu-ally a tiny reservoir designed to store and dispense a special formulation of LUCEN-TIS® (ranibizumab), an anti-VEGF drug with a history of success. The implant of-fers tremendous potential to reduce or even eliminate the need for monthly injections. Two other trials focus on the use of topical and oral medications, again with the goal of reducing or eliminating the need for monthly injections.

The efforts of Awh and Purohit could not be timelier. America’s type 2 diabetes epidemic has brought significant increases in co-morbid retina disorders. Retina spe-cialists now find themselves on the front lines of a healthcare crisis. The use of new devices, techniques and medications that improve outcomes while reducing the bur-den of care will become increasingly impor-tant in the coming years.

Advancing the Revolution in Retina Care, continued from page 1

Dr. Carl Awh

Amish Purohit

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This summer, the Tennessee Depart-ment of Health (TDH) issued a public health advisory in the wake of a nation-wide increase in the rate of Hepatitis C in-fection. The alert called for Tennesseans to learn more about the life-threatening disease and to consider being tested for chronic Hep C infection.

A Centers for Disease Control and Prevention report issued in May showed Hepatitis C as the most common blood-borne infection in the United States with approximately 3 million people living with Hep C. While the increase in disease is na-tionwide, the largest increases have been in the Appalachian region. The rate of acute Hepatitis C cases in Tennessee has more than tripled in the last seven years.

When announcing the public health advisory, TDH Commissioner John Dreyzehner, MD, MPH, said, “In addi-tion to reported cases of acute Hepatitis C, it is estimated that more than 100,000 Tennesseans may be living with chronic Hepatitis C and not know it.”

Tim Jones, MD, who has served as the state epidemiologist since 2007, noted, “The state of Tennessee is number four in the country for the amount of Hepatitis C that we see. We have three times the na-

tional average of rates of disease.” Look-ing at the map of Tennessee, Jones said there are a particularly high number of cases along the eastern border and northeastern part of the state.

The good news, Jones added, is that along with increased rates of disease are improved treatment options. “One of the reasons it’s getting more attention now is that there are better treatments available, and they are relatively new to

the market.”In the past, he continued, the treat-

ment regimen was difficult, not terribly effective and included a lot of side effects for many individuals. “Now there are much more rapid and effective treatments so there is more enthusiasm for getting people tested and into treatment,” said Jones, who has been with the TDH for 18 years and previously worked for the CDC. “You can now treat it in 12 weeks … and these drugs cure it.”

However, he continued, the problem is the cost of the three-month regimen, with a price tag coming in at $60,000-

$90,000. He added it’s an issue public health officials, providers and insurers are all struggling to address. Time, he contin-ued, could provide at least a partial solu-tion. “It’s likely as more medications come on the market, and there are several in the pipeline, those costs will be driven down.”

And, Jones pointed out, the slow pro-gression of the disease gives those infected time to get into appropriate care. “About 20 percent of people will get rid of it on their own. For the other 80 percent, the disease progresses very slowly. If people catch it early, it can take 20-30 years be-fore getting to the end stages,” he said.

Although price is an issue, another consideration is the cost not to treat. “As (Hepatitis C) progresses, it can lead to fibrosis of your liver up to liver failure. It’s the number one cause for liver trans-plants,” Jones noted. He added, Hep C is also the main cause for cirrhosis of the liver. If the disease progresses to one of these conditions, the price of caring for individuals with Hep C could far outstrip the cost of the drugs to cure it.

A blood-borne pathogen, Jones said the nation’s blood supply up until the late ‘80s/early ‘90s helped spread the disease. Today, however, the biggest risk factor is IV drug use.

Tennessee’s Hep C EpidemicRecent TDH Advisory Draws Attention to Disease, New Treatments


Dr. Tim Jones

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Page 14: Nashville Medical News September 2015

14 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

On Aug. 18, the Nashville Health Care Council released an economic impact study in partnership with the Business and Economic Research Center (BERC) at Middle Tennessee State University that found the healthcare industry contributed $38.8 billion to the region’s economy in 2014.

A follow-up to a similar study commissioner in 2010, this latest report shows significant growth in terms of the financial scope and geographic reach of Nashville’s healthcare industry over the past five years. The nearly $40 billion local impact includes direct, indirect and induced business revenues and represents a 32.9 percent increase from the 2010 study. On the jobs front, the healthcare industry is Nashville’s largest employer and accounted for 249,345 local jobs in 2014, which is up 18.14 percent from the previous study.

The industry’s impact, however, reaches far beyond Middle Tennessee. The report reflects information collected from the 15 publicly traded companies that were headquartered in the Nashville MSA in 2014. Those firms employ more than 500,000 people globally and have combined revenue of $73 billion annually. The area is now home to 16 publicly traded healthcare companies so those figures are anticipated to increase.

“Nashville’s role as the center of our nation’s healthcare industry is most apparent when looking at the sheer number of jobs across the country that are created by this community,” said Bill Gracey, chairman of the Council board and recently retired CEO of BlueCross BlueShield of Tennessee, who added the city serves as the international healthcare epicenter.

“Looking beyond these staggering figures, you simply cannot quantify the entrepreneurial spirit and collaborative mindset that propel Nashville’s dynamic healthcare network,” said Council President Hayley Hovious.

In addition to analyzing the economic data, the study included a survey of CEOs from Council member organizations. Hovious noted, “Ninety-five percent of Nashville Health Care Council member CEOs surveyed reported that a headquarters in Nashville is important to their company’s positive performance. They also indicated a confidence index of 71 out of 100 for Nashville’s economy, significantly higher than the national outlook.”

Other key findings include:• Nearly 400 healthcare companies have operations in

Nashville. Additionally, Nashville MSA is home to more than 400 professional service firms that provide expertise in the healthcare industry, according to Council data.

• The Nashville healthcare industry cluster accounts for an estimated $1.5 billion in state and local taxes.

• In 2014, the Nashville healthcare cluster occupied 34.7 million square feet of office space.

• The healthcare industry cluster accounted for nearly 9 percent of Tennessee’s and 25.6 percent of the Nashville MSA’s nonfarm employment in 2014.

The 2015 report was authored by Murat Arik, PhD, director of the BERC at the Jones College of Business at MTSU. The full report is accessible online through our website at NashvilleMedicalNews.com.


‘Not all money is created equal’ was an ongoing theme during last month’s Nashville Health Care Council and Nash-ville Capital Network event focused on early stage investing.

The annual Developing Health Care Ventures program was moderated by Nancy Everitt, president and CEO of HEOPS, and featured a panel of health-care entrepreneurs and investors. Curt Thorne, former president and CEO of MedSolutions, and Walker Poole, partner at Ridgemont Equity Partners, discussed their working relationship. Similarly, Qual-Derm CEO Bill Southwick and Chairman Gene Fleming, who also worked together at The Rehab Documentation Company (ReDoc), shared their strategies for grow-ing an idea into a profitable company.

Ridgemont was a partial funder of benefits management company MedSo-lutions, and Poole was closely involved in the merger with CareCore to form what is now called eviCore healthcare in a December 2014 transaction valued at ap-proximately $1 billion.

“Since 1993, I’ve been through a lot of mergers of like-minded, like-sized companies where integration was frankly a nightmare,” Poole said, adding that wasn’t the case with MedSolutions and CareCore. “I’ve never seen a merger go

more smoothly.” Thorne, who said MedSolutions

had looked at acquiring CareCore for years before the script flipped, noted, “CareCore had strengths we didn’t. We had strengths they didn’t. It was a classic case of 1+1=3.”

However, he continued, not every scenario turns out so well. “It’s important to find investors who view not all capital as the same, who know how to handle it when things don’t go well, where there’s alignment at a values, ethics level, and that are competitive … not all money is the same.”

Southwick led ReDoc – a provider

of integrated clinical electronic medical record and management solutions for physical, occupational, and speech therapy markets – through the company’s acquisi-tion by Net Health in 2014. Like Thorne, he recognized some investors brought more value to the table than others.

“When I took the helm at ReDoc, I knew I wanted to put good people around me to help lead the strategic direction of the company. The investors we brought together had significant experience in healthcare and building a fast moving en-terprise,” he said. “We were able to tap into that experience to make several im-

portant strategic decisions that lead to a great outcome for ReDoc’s investors.”

Fleming added bringing in investors with relevant experience to help make tough decisions resulted in ReDoc expe-riencing significant growth and a positive exit. “You always begin with the end in mind,” he said.

When he and Southwick looked at ReDoc, they agreed the solution was ‘best in breed,’ but they also saw the company wasn’t growing and was losing money. They looked at a number of changes … from the way the product was marketed to the technology platform to building a sustainable revenue stream … and put together a strategic plan. “All those things led it to a point where it was a very de-sirable product for Net Health,” Fleming said. “We actually had a five-year plan, but we attracted suitors within two to two-and-a-half years.”

He continued, “We weren’t looking to be acquired. We were very pleased with the progress we were making.” However, after being courted pretty hard by Net Health, the investors had a decision to make. “We ultimately put a number out there that we didn’t think they would take … and they did.”

Southwick said the deal was well aligned. In fact, he laughingly said that he was the only misalignment. “As CEO, I wanted to go, go, go and had to be re-minded of our fiduciary responsibility to shareholders.”

Thorne agreed that it could be hard to sell a business that is succeeding. However, he noted, “If you are honest with yourself and your investors, you know where your inflection points are and when to take a bow.”

For ReDoc, it happened faster than planned. For MedSolutions, it took a little longer than expected for the right deal to present itself. “Businesses never go in a straight line up,” said Fleming. “The more experience you get, the more you know how to handle stuff. I think all of you who aspire to be CEOs or senior management should align yourself with someone a little further along in their career.”

Thorne agreed, saying money isn’t the only investment that should be con-sidered when looking to take a company to the next level. “I think the best results come from building relationships over a long time.”

Fleming added, “Healthcare investing really is different. My advice would always be to only talk to private equity groups who know what they’re getting into.”

Poole concurred. “The guys who dabble in healthcare and only do one deal every three years … I don’t like to com-pete against them because they don’t know what they don’t know.” When it comes to healthcare investing, he continued, “It’s not for the faint of heart, and you need to live it every single day.”

Of Investors and EntrepreneursHealth Care Council, NCN Program Lends Insight into Successful Partnerships

Panelists (L-R) Gene Fleming, Bill Southwick, Curt Thorne, and Walker Poole shared their investment and entrepreneurial observations with a crowd of 250 at the recent Developing Health Care Ventures program.

Healthcare Industry Annually Contributes $39 Billion Locally, $73 Billion Globally

Bill Gracey

Hayley Hovious

© 2







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Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprec-edented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“Perhaps we shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services, a 4,000-member group with physicians in all 50 states. “High speed in-ternet connections are now the norm. Services like Facetime and Skype are more popu-lar than ever. Under continued pressure to cut costs and cope with declining re-imbursements, administrators believe telemedicine offers a tool for increasing ef-ficiency. Patients also like the convenience and increased options that flow from tele-medicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compli-ance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

LicensureMedical providers “must be licensed

by, or under the jurisdiction of, the Medi-cal Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so the medical provider does not accidentally practice in a state without a license.”

Professional LiabilityMost professional liability insurance

policies provide state-specific coverage, meaning that if a provider accidentally practices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested. “Another consideration relates to cyber issues. Traditional medical malpractice

policies provide little to no coverage for electronic breaches. The nature of a tele-medicine generates exposures to a variety of cyber risks. Any practice moving for-ward with offering telemedicine should have a comprehensive cyber insurance policy.”

Standard of Care It’s imperative to note that telemedi-

cine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stat-ing: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physician-to-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological condition? If the condition is normally photographed when a patient is in the of-fice, then the practice should be ready to capture the same quality of image via tele-medicine. Each step of the consultation should be planned in advance to ensure it is equal in quality to an in-office evalu-ation.”

Patient PrivacySacopulos said it’s also important to

note that any form of electronic communi-cation with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text mes-saging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines spe-cifically state: “Physicians should meet or exceed applicable federal and state requirements of medical/health informa-tion privacy, including compliance with HIPAA and state privacy, confidentiality, security, and medical retention rules,” said Sacopulos, adding that FSMB Guidelines suggest maintaining written policies to ad-dress:

• Privacy; • Healthcare personnel who will be

processing messages and patient communications;

• Hours of operations; • Types of transactions that will be

permitted electronically; • Required patient information to

be included in the communication, such as patient’s name, identifica-tion number and type of transac-tion;

• Archival and retrieval; and • Quality oversight mechanisms. “Finally, telemedicine practitioners

are cautioned to periodically evaluate their policies and procedures to insure they re-main current and readily accessible,” he said. “FSMB informs us that electronic communications received from patients must be maintained within secured tech-nology password-protected encrypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to as-sume that additional patient privacy re-quirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem Insurance experienced earlier this year,” he said. “Studies show that medical identity theft grew at an alarming rate in 2014. Govern-ment officials, including the FBI and Cali-fornia Attorney General, have specifically cautioned medical providers that their patients’ electronic data is at risk for hack-ing and theft. All of this should serve as a warning to telemedicine providers to com-ply with existing state and federal regula-tions. Telemedicine providers should also anticipate increasing privacy standards.”

Informed ConsentBefore practicing telemedicine, a

medical provider should obtain appro-priate patient informed consent. The in-formed consent document should:

Clearly state the patient’s identity; Clearly state the physician’s identity

and qualifications; Specify the scope of activities the

practice will be using telemedicine tech-nologies to fulfill, such as patient educa-tion, prescription refills, and scheduling appointments;

The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/or treat the patient;

The patient should acknowledge the possibility of, and hold harmless the medi-cal provider for, any technology failures and/or interruptions;

The practice should, as part of the informed consent process, provide infor-mation on the telemedicine technologies

privacy and security standards, such as the inscription of data and firewalls; and

The informed consent document should specify express patient consent to forward patient information to a third party if necessary.

Referrals for Emergency Service

“The FSMB suggests that telemedi-cine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos. “This emergency protocol should cover possible scenarios when patients require acute care. How and where referrals are to be made should be covered in this pro-tocol.”

State-Specific RequirementsThe scope of permissible telemedicine

varies significantly by state. Some states specifically require a physician/patient re-lationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much at-tention at the moment,” said Sacopulos. “The American Medical Association is in the process of adopting a Code of Ethics for physicians who provide clinical services through telemedicine. Texas has recently issued new telemedicine guidelines to its practitioners. All of this should serve as a warning to those interested in telemedi-cine to consult with their State Board of Medicine before engaging in telemedicine activities.”

Telemedicine: A Virtual Compliance Jigsaw PuzzleA Closer Look at the New Wave in Healthcare Delivery

Michael Sacopulos

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Tennessee. All nominations must be submitted by September 30.

Page 16: Nashville Medical News September 2015

16 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

Additional information for healthcare providers and patients is available through the Tennessee Department of Health website. Go to tn.gov/health/article/health-advisories for Hepatitis C statistics, answers to frequently asked questions, and prevention messages. There is also a direct link to the information from our website at NashvilleMedicalNews.com.

Tennessee’s Hep C Epidemic, continued from page 12

Liver Damage in Hep C Significantly Underestimated, Underreported

The number of Hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a new study led by researchers at Henry Ford Health System and the Centers for Disease Control and Prevention.

The findings, which were published in The American Journal of Gastroenterology (110, 1169-1177, August 2015), were the result of a study of nearly 10,000 patients suffering from Hepatitis C.

“Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of Hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling,” said lead researcher Stuart Gordon, MD, director of Hepatology at Henry Ford Hospital in Deroit.

The Chronic Hepatitis Cohort Study is an analysis of records from a large, geographically and racially diverse group of 9,783 patients receiving care at four large U.S. health systems. The records analyzed by researchers indicated evidence of cirrhosis in 29 percent, or 2,788, of the Hepatitis C patients included in the study. Surprisingly, however, 1,727 of those 2,788 patients, or 62 percent, had no formal documentation in their medical records that they had cirrhosis.

Gordon said the results suggest cirrhosis may be underdiagnosed in a large segment of the population. Clinicians, he continued, typically rely on liver biopsies to diagnose cirrhosis, but in the Hepatitis C patients studied, only 661 patients were diagnosed with cirrhosis through a liver biopsy.

“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” said Gordon.The researchers discovered highly likely signs of liver damage by calculating the patients’ liver enzymes, platelet counts

and age in a previously validated test called a FIB-4 score.“It’s an underappreciated, easily obtained, and widely available test done through lab work that can point out there’s a

problem,” noted Gordon. “It’s a simple test not routinely used by clinicians. A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. In addition, electronic medical record reports may not be a reliable indicator of just how many Hepatitis C patients may be suffering from cirrhosis.”

The results of such testing and reporting could have wide impact on the treatment of those with Hepatitis C, which is now curable in many cases with oral antivirals.

“People with Hepatitis C need to find out the severity of their underlying liver disease because they may not realize that they have cirrhosis,” said Gordon. “Obviously, treatment can slow down the progression.”

“There are pretty negative connota-tions when a disease is associated with IV drug use, but even one indiscretion de-cades ago can lead to these problems years later,” he pointed out.

Ideally, Jones said the following peo-ple should be tested:

• All baby boomers (anyone born 1945-1965),

• Anyone who has ever injected drugs (even once),

• Anyone who received a blood trans-fusion or organ transplant before 1992,

• Any healthcare worker who might have had a needle stick injury,

• Anyone who has gotten an illegal tattoo or unsanitary piercing (from an unlicensed provider),

• Anyone with HIV or AIDS,• Those with abnormal liver tests or

other liver disease, and • Anyone on dialysis.While healthcare providers might be

able to rule out some of the risk factors for their patients, Jones said the only way to really determine if an individual should be tested is to broach the topic and ask ques-tions.

Of course, he continued, the best defense is a good offense … namely pre-vention. With no vaccine for the disease, efforts to avoid exposure are the best weapon in stopping the spread of Hep C. Don’t share needles is the key message, and that includes the ‘diabetes curious’ … the person who wants to see what their blood sugar is so they try out a diabetic friend’s testing equipment.

“Don’t share needles … period,” Jones stated firmly.

GrandRoundsMark Your Calendar:

Sept. 16-17 • Transvisional Forum: Transforming the Health of Consumers through Engagement • Music City Center

YourCareUniverse™ is hosting this two-day, highly interactive conference bringing together hospital strategic mar-keting and engagement executives to discuss intuitive and analytical approach-es to placing the healthcare consumer at the epicenter of their strategies. For pric-ing, registration and more information, go online to transvisionalforum.com.

Sept. 21-23 • Policy Immersion Trip to D.C.

The University of Tennessee’s Haslam College of Business faculty and Executive MBA in Healthcare Leadership program is hosting an intensive three-day immersion on healthcare policy, business and government with insights from current and former legislators and regulators, corporate and industry pub-lic affairs officials and government rela-tions executives. The trip is certified for 19 CME credits or 1.9 CEUs. For informa-tion on availability, contact Kitty Cornett at [email protected] or (865) 974-1705.

Oct. 12 • Tennessee Health Care Hall of Fame Induction Ceremony • Curb Event Center, Belmont University

Celebrate the eight illustrious healthcare leaders being honored in the inaugural class of the Tennessee Health Care Hall of Fame at a special luncheon event. Registration begins at 10:30 fol-lowed by the induction luncheon at 11:30 am. Tickets are available for pur-chase online at tnhealthcarehall.com/induction-ceremony.

Carpenter Cancer Center Announced

HighPoint Health System and Sum-ner Regional Medical Center recently celebrated groundbreaking on the Carpenter Cancer Center at Sumner Station in Gallatin. Named in honor of LifePoint Health Chairman and CEO Bill Carpenter, the $18 million, state-of-the-art treatment facility will feature com-prehensive cancer care in 17,000 square feet of new construction, including the addition of Varian TrueBEAM, PET/CT scanner, and a CT simulator, along with centralized services, support groups and nurse navigation all under one roof.  

The Carpenter Cancer Center, which will replace Sumner Regional’s current cancer care services at the hos-pital, will feature a skilled oncology team of 10 full-time employees led by medical oncologist Dianna Shipley, MD, and radiation oncologist Robert Mc-Clure, MD. The facility is expected to open in the first quarter of 2016.

 Rathmell to Lead Vanderbilt Hematology and Oncology

W. Kimryn Rathmell, MD, PhD, has been named director of Vander-bilt University Medical Center’s  Division of He-matology and Oncology. Rathmell is a physician-scientist whose research focuses on the genetic and molecular signals that drive renal cell carci-nomas and who specializ-es in the treatment of patients with rare and complex kidney cancers, as well as prostate, bladder and testicular cancer.

She comes to Vanderbilt from the University of North Carolina, Chapel Hill, where she held leadership roles with the Lineberger Comprehensive

Cancer Center. Rathmell earned under-graduate degrees in biology and chem-istry at the University of Northern Iowa in Cedar Falls, and then continued her education with a PhD in biophysics and her medical degree from Stanford Uni-versity. Following an internship at the University of Chicago, she completed residency and fellowship at the Univer-sity of Pennsylvania.

She assumed her new position as division director at Vanderbilt on Sept. 1.

NextGxDx Adds CorrectChemo to Platforms

DiaTech Oncology, provider of the drug response-profiling test Cor-rectChemo®, is now available through NextGxDx’s online genetic testing mar-ketplace, GeneSourceTM and GeneCon-nect™. Adding the assay to its platforms continues NextGxDx’s efforts to broad-en the scope of cancer diagnostics in its GeneSource catalog with emerging cell-based assays. CorrectChemo is a diagnostic test that delivers a ranking of the ability of chemotherapeutic agents to kill tumor cells in an individual patient sample within 72 hours.

Dr. Kimryn Rathmell

Page 17: Nashville Medical News September 2015

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GrandRoundsLet’s Give Them Something to Talk About!

Awards, Honors, AchievementsAmy George, EA, CHBC, of

Nashville-based Mahan & Associates has earned the National Society of Certified Healthcare Business Consul-tants  (NSCHBC) prestigious Certified Healthcare Business Consultant (CHBC) credential, the highest level of certifica-tion within the industry.

The American Heart Association re-cently named the members of the 2015-16 Greater Nashville board of directors. Ken Harms, president of UPS Mid-South District has been named chair, and A. Brian Wilcox, MD, chief phy-sician executive of the Cardiovascular Service Line for Saint Thomas Health, will serve as board president.

Tracy Q. Callister, MD, FSCCT, founder of Tennessee Heart & Vascular Institute, PC in Hender-sonville, was one of eight physicians to receive the Arthur S. Agatston car-diovascular disease pre-vention award at the So-ciety of Cardiovascular Computed Tomography (SCCT) annual scientific meeting in Las Vegas. Callister is an internationally rec-ognized leader in the field of comput-ed tomography and a Diplomat of the American Board of Internal Medicine/Cardiovascular Disease. 

Vanderbilt University Medical Center has received the Mission: Life-line® Silver Receiving Quality Achieve-ment Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks. VUMC has also recently been recognized by the Ameri-can College of Cardiology for cardiac care.

Three Saint Thomas Medical Part-ners locations – Saint Thomas Medical Partners Lenox Village (Nolensville Pike), Nashville (20th Ave. N.) and West (Harding Pike) – have received NCQA Patient Centered Medical Home rec-ognition for using evidence-based, pa-tient-centered processes that focus on highly coordinated care and long-term relationships.

National law firm Polsinelli, which opened an office in Nashville earlier this year, has claimed the top spot on Mod-ern Healthcare’s 2015 Healthcare Law Firms Survey. The designation acknowl-edges that Polsinelli has built the larg-est healthcare practice in the nation.

Nashville-based Guidant Partners recently ranked No. 199 on the 2015 MSPmentor 501, an annual list showcas-ing the world’s top managed services providers. Rankings for the MSPmentor 501 are determined by multiple factors including annual recurring revenue, to-tal devices managed and growth rates.

Cumberland Consulting Group has been recognized for the seventh

consecutive year as one of the nation’s “Fastest-Growing Private Companies” by  Inc. Magazine. A strategic business advisory, information technology imple-mentation and support services firm serving the healthcare industry, Cumber-land appears at 3,842 on this year’s list.

Centerstone, CRI Announce New Directors

Centerstone and Centerstone Research Institute (CRI) recently an-nounced the appointment of two new senior managers.

Carol Bean, who joined the com-munity-based behavioral health pro-vider in 2014 as assistant corporate controller, has been promoted to di-rector of Finance. In her new role, she will serve as the finance officer for Centerstone’s national operations, including its provider locations in Florida, Illinois, In-diana and Tennessee. Previously, Bean served as finance manager for Deloitte Services LP. She received her under-graduate degree from East Tennessee State University and her MBA from the University of Phoenix.

Larry Croney has been named di-rector of Analytics for CRI. In this posi-tion he will lead, manage and coordi-nate all business intelli-gence, data analytics and data warehousing proj-ects for the not-for-profit research and information technology organization. He comes to CRI after spending 10 years with HCA/Parallon where he held a number of positions and was responsible for business intel-ligence and reporting for more than 200 client hospitals and 700 physician prac-tices. He received his undergraduate degree from Auburn and his MBA from Tennessee Tech.

InfoWorks Adds Healthcare Strategist Alan Taylor

Nashville-based management consulting firm InfoWorks recently an-nounced that Alan D. Taylor has joined its team as a business consultant. Taylor, a seasoned pro-fessional with 30 years of experience, will help promote the healthcare services practice of the company and engage with clients to optimize value delivery. 

Previously, Taylor held both senior leadership and consulting positions at other healthcare, financial and insur-ance companies, including stints with MassMutual, Aetna, Associates Finan-cial Services and Vanguard. Taylor is a certified Lean and Six Sigma profes-sional and has his Project Management Professional (PMP) certification from the Project Management Institute. He received his undergraduate degree at

Purdue and his master’s from BayPath University in Massachusetts.

Neighborhood Health Adds Parish as CMO

Neighborhood Health has recently added Samuel Keith Parish, MD, as chief medical officer. In his new role, Parish will be responsible for the clini-cal program of Neighbor-hood Health and its 12 clinics serving more than 25,000 clients each year. Parish has 24 years of ex-perience in family medicine and spent the past six years with Physicians Re-gional Healthcare System (PRHS) in Na-ples, Fla. A graduate of the University of Kentucky College of Medicine, Parish received his medical degree with dis-tinction in 1988. Parish completed his residency at Trover Family Clinic Foun-dation in Madisonville, Ky.

Weinstein Joins Specialty Care as CMO, EVP

Noted cardiothoracic surgeon Samuel Weinstein, MD, MBA, recently joined the executive team of Nashville-based clinical services provider Special-ty Care. In his new role, he will serve as chief medical officer and executive vice president.

His past experience includes serving as direc-tor of Pediatric Cardiothoracic Surgery and surgical director of Cardiac Trans-plantation and Mechanical Assistance at The Children’s Hospital at Montefiore. He also held leadership roles with the adult cardiothoracic program at Monte-

fiore Medical Center. He received his un-dergraduate degree from the University of Pennsylvania, his MBA from Fordham University, and his medical degree from The State University of New York at Stony Brook, and did postdoctoral training at Columbia Presbyterian Medical Center in New York and The Children’s Hospital of Philadelphia.

Kitko to lead Vanderbilt Pediatric Stem Cell Transplant Program

Carrie Kitko, MD, has joined Mon-roe Carell Jr. Children’s Hospital at Vanderbilt as associate professor of Pediatrics and director of the Pediatric Stem Cell Transplant Program in the Di-vision of Hematology/Oncology.

After undergrad at Denison Univer-sity, she earned her medical degree from Ohio State and was a resident and chief resident at Duke University Medical Cen-ter. Kitko went on to a fellowship at the University of Michigan Medical Center and was then recruited to the faculty.

Healthways Appoints Tramuto as President & CEO

Healthways, Inc., the largest inde-pendent global provider of well-being improvement solutions, announced last month that Board Chairman Donato J. Tramuto would take the helm of the company as president and CEO effec-tive Nov. 1, 2015.  

Alfred Lumsdaine, executive vice president & chief financial officer, who has been interim CEO since May 2015, will continue to serve as EVP and CFO. Current Director Kevin G. Wills has been elected to serve as the company’s inde-pendent chairman of the board once Tramuto begins his new role.

Dr. Tracy Callister

NHC Breaks Ground in Maury CountyNational HealthCare Corporation has broken ground on NHC-Maury Regional

Transitional Care Center, a joint venture between NHC and Maury Regional Medical Center.

The $18.3 million skilled nursing and transitional care center is a single-story cen-ter totaling more than 73,500 square feet and will include 104 skilled nursing beds, of which 98 will be private patient rooms. When completed in he fall of 2016, the new center will replace the existing 92-bed NHC Healthcare-Hillview. Patients in the existing 20-bed Maury Regional Medical Center’s Skilled Nursing Unit, which NHC has managed, will be transferred to other area NHC centers.

Carol Bean

Larry Croney

Alan D. Taylor

Dr. Samuel Keith Parish

Dr. Samuel Weinstein

Page 18: Nashville Medical News September 2015

18 > SEPTEMBER 2015 n a s h v i l l e m e d i c a l n e w s . c o m

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GrandRoundsMacdonald Joins EndoGastric Solutions Executive Team

Nashville-based healthcare execu-tive Philip Macdonald has joined Endo-Gastric Solutions, a leader in incision-less procedural therapy for gastroesophageal reflux disease located in Redmond, Wash., as vice president of Healthcare Economics, Policy & Reim-bursement.

Macdonald has more than two decades experi-ence in the field and previously served as vice president of Healthcare Economics, Policy & Reimbursement at Given Imag-ing (now Medtronic). Past experience also includes work with Siemens, St. Jude Medical, Bayer and HCA corporate. He holds a doctorate in Healthcare Manage-ment & Economics from the University of La Verne. Macdonald earned his under-graduate degree and master’s degree in Hospital Administration from the Univer-sity of Memphis.

News from LifePoint HealthIt’s been a busy few months for

LifePoint Health. In July, the company announced the Duke LifePoint Quality Affiliate, a new quality designation pro-gram in conjunction with Duke University Health System. That same month, offi-cials with LifePoint and Providence Hos-pital in Columbia, S.C., signed a letter of intent.

In August, the addition of Fleming

County Hospital in Flemingsburg, Ky., expanded the company’s footprint. Ad-ditionally, Regional Health Network of Kentucky and Southern Indiana – a joint venture between Norton Healthcare and LifePoint Health – finalized the acquisi-tion of Clark Memorial Hospital in Jeffer-sonville, Ind.

The company also announced two promotions. Ken Gagnon has been named vice president of Pharmacy Services for LifePoint facili-ties nationwide, and Mi-chelle Augusty has been named senior director of Communications. Ga-gnon previously served in a similar role for two Life-Point hospitals in Utah. He earned his doctor of phar-macy degree from Idaho State University College of Pharmacy. Augusty, who has been part of Life-Point’s communications team since 2012, was previously with DVL Seigenthaler. She earned both her un-dergraduate and master’s degrees from the University of Georgia.

Wishes GrantedThe Centers for Disease Control

and Prevention has awarded Nashville CARES, Street Works and Neighbor-hood Health a multi-million dollar grant to be rolled out over the next five years. This funding will be used to develop My-

House, a first-of-its-kind, comprehensive LGBTQI community health services cen-ter with a goal to reduce new HIV infec-tions, increase access to care and opti-mize health outcomes for people living with or at risk for HIV/AIDS.

Vanderbilt University, Meharry Medical College and the Tennessee De-partment of Health have received a five-year grant from the National Institutes of Health (NIH) to establish the Tennessee Center for AIDS Research. Simon Mallal, MBBS, the Major E.B. Stahlman Profes-sor of Infectious Diseases and Inflamma-tion at Vanderbilt, is principal investigator. Co-directors of the new center are David Haas, MD, professor of Medicine, Pathol-ogy, Microbiology & Immunology and Pharmacology at Vanderbilt, and Duane Smoot, MD, professor and chair of the Department of Internal Medicine at Me-harry.

Twenty-two Middle Tennessee non-profit agencies will receive a collective $1.2 million in grants from Baptist Heal-ing Trust in the third quarter. The grants support health-related services for the most vulnerable people in Middle Ten-nessee. BHT awards similar grants quar-terly, with an annual award of $5 million.

Vanderbilt University Medical Cen-ter has received a five-year, $12.8 million grant from the federal government to de-velop better ways to predict how patients will respond to the drugs they’re given. Vanderbilt’s is one of three “P50” grants awarded by the National Institute of Gen-eral Medical Sciences (NIGMS), part of the National Institutes of Health (NIH), to establish specialized research centers for pharmacogenomics in precision medicine.

Lovell Communications Expands Nashville-based Lovell Communica-

tions, a national strategic public relations and crisis communications firm, recently announced expansion with three new hires and a half dozen new healthcare cli-ents.

Susanne Powelson, who has more than 20 years experience working with all segments of the healthcare industry, has joined the firm as vice president. She has particular expertise in media rela-tions, crisis communications and public policy strategies. Previously, Powelson held leadership positions at UnitedHealth Group, BlueCross BlueShield of North Carolina, Emdeon, the State of Tennessee and Trone Brand Energy. She received her bachelor’s degree from the University of North Carolina at Chapel Hill.

Alli Finkelston has joined the group as assistant account executive. A recent graduate of the University of South Car-olina (USC), she earned a bachelor’s de-gree in public relations and held a num-ber of communications internships.

Lovell also added Lory Cantrell, who holds a bachelor’s degree in hospitality management from Southern Utah Uni-versity, as administrative assistant. In ad-dition, the firm has welcomed a number of new clients in recent months including national home health provider American HomePatient, ARIS Radiology, national hospice company Compassus, Dickson Medical Associates, Montee & Montee Dental Co., and behavioral health pro-vider Oceans Healthcare, which is head-quartered in Plano, Texas.

Philip Macdonald

Ken Gagnon

Michelle Augusty

Page 19: Nashville Medical News September 2015

n a s h v i l l e m e d i c a l n e w s . c o m SEPTEMBER 2015 > 19


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Page 20: Nashville Medical News September 2015

In the last decade, the most common cancer types have been lung, breast, colon and prostate. Looking forward to the next couple of years, they will likely remain the same. Notable is multiple myeloma, a rare blood cancer, increasing regionally.

Traditionally, chemotherapy and hormone therapy have been the standard approaches taken in the treatment of cancer patients. However, the paradigm is shifting. Impressive discoveries have and will continue to change cancer care for the better.

For instance, molecular profiling and targeting are huge breakthroughs in cancer care. For most cancers, a piece of a malignant tumor can be taken and evaluated for certain mutations through molecular profiling. Once those abnormalities are identified, molecular targeting agents can be prescribed to pinpoint them, blocking their ability to grow and spread and stopping cancer in its tracks. Molecular targeting agents are often times less toxic to patients than traditional therapies. Overall, molecular profiling and targeting are growing substantially in oncology, and they will continue to play a major role advancing cancer care in the future.

Likewise, immunotherapy developments are very promising in cancer care. The ability to harness the immune system to strip cancer’s camouflage and identify it and kill it is an incredible feat. Immunotherapy works very well in patients and is more tolerable than traditional therapies. While the current list of cancers approved to be treated with immunotherapy is small, immunotherapy is a big push in oncology, and more cancers will likely be treatable with it in the near term.

As cancer rates are expected to increase with the aging baby boomer population, efforts to identify, test and release new therapies will intensify. Oncology professionals know more about cancer now than ever before. At Tennessee Oncology, we are very excited about new therapies being studied and released. Better therapies are producing more cancer survivors. We are and remain committed to recognizing, acquiring and utilizing the latest, cutting-edge therapies in the treatment of our patients’ cancers. Caring for cancer patients is a privilege.

Trending in the next 3-5 years in Cancer Care TENNESSEE ONCOLOGY’S Victor Gian, M.D.


1.877.TENNONC | www.tnoncology.com