Nashville Medical News February 2016

FOCUS TOPICS CARDIOLOGY • HEALTHCARE LAW & REGULATIONS

February 2016 >> $5

PHYSICIAN SPOTLIGHT PAGE 10

Mark P. Freeman, MD ON ROUNDS

Clinical Importance of Haptoglobin in Diabetes, Cardiovascular Complications Diabetes affects nearly 400 million people worldwide and is expected to increase to nearly 600 million people by 2035. Patients with diabetes mellitus are often more susceptible to a host of multiorgan complications that arise as a result of microvascular and macrovascular dysfunction ... 8

Practice Makes Perfect

Patient Satisfaction Means Changing a Company’s Culture Starting at the Top Interested in changing the culture of your practice?

Most leaders know that starts from the top, but understanding how to get there can seem like going down a rabbit hole.

Last month, nationally known speaker and healthcare advisor Dotty Bollinger, RN, JD, CMPE addressed more than 60 members of the Nashville Medical Group Management Association about how to surpass patient care expectations. The registered nurse-turnedattorney serves as CEO of Integrity Healthcare Advisors in Gatlinburg, Tenn., and uses her extensive experience growing and leading multi-facility operations to foster an environment focused on the patient experience first.

“If you can convince leaders culture matters, everything else

Become a Customer A mistake Bollinger said she commonly sees is leaders who focus solely on CAHPS survey results – the Consumer Assessment of Healthcare Providers and Systems reports collected and publicly posted by CMS. She encourages management to take a few steps back and look at the practice from the perspective of the customer – the patient. “Every practice manager needs to be a consumer of his or her own service,” she said.

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Priorities for the 109th General Assembly State Associations Outline Legislative Wish List

March of Dimes Honors Outstanding Middle Tennessee Nurses at Annual Gala

By CINDY SANDERS

The second legislative session of the 109th Tennessee General Assembly officially convened on Jan. 12, 2016. With lawmakers back in Nashville, the leadership teams representing the state’s physicians, nurses and hospitals are ready to share key priorities and make a case for a list of wants, needs and concerns impacting the delivery of care to Tennesseans.

Now in it’s sixth year, the annual March of Dimes Nurse of the Year Awards drew a record crowd on Dec. 8, 2015 to honor outstanding Middle Tennessee nurses ... 12

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they desire will come from a mindset of a culture of care,” Bollinger said in an interview with Nashville Medical News.

“My goal is to get folks to think about quality from the perspective of service. If we give great service start to finish, what results is consumers who walk away with ‘Wow!’ experiences.”

By MELANIE KILGORE-HILL

TMA Last month Nashville Medical News shared the top priorities of the Tennessee Medical Association, which included reimbursement stability, clarifying malpractice caps, and codifying the doctor as the team leader.

(CONTINUED ON PAGE 4)

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HEALTHCARE ENTERPRISE

At the Crossroads of Business and Law DW Franklin Brings Comprehensive Consulting to Healthcare Clients

By MELANIE KILGORE-HILL

A promising new Nashville corporate healthcare venture is merging the worlds of business and legal consulting – services traditionally offered by separate professionals at separate firms.

DW Franklin Consulting Group is a full-service healthcare firm providing comprehensive consulting in the areas of government relations and general business guidance, strategic planning and more. Launched C. Timothy Gary Kerry Hart recently by international law firm Dickinson Wright PLLC, DW Franklin Consulting Group is led edented legal and business model shifts.

by Chief Executive Officer C. Timothy DW Franklin’s non-proprietary approach Gary and Consulting Leader Kerry Hart. allows for candid, open conversations Both are healthcare veterans with unique where each player brings a vastly unique perspectives into a constantly evolving inperspective to the table. dustry.

“In-house staff have a very deep knowledge of processes within their busiA Different Approach ness, and we’re not ever going to know as An MBA and attorney with 24 years much about their specific business as they of experience, Gary often advised execudo,” Gary said. “We bring a much broader tives on business issues, as well as legal focus and have seen many times somematters. “I couldn’t figure out where the thing that is a unique situation to them. lines were between giving strategic and It’s an opportunity to peer over walls in financial advice and legal advice in my a way that they can’t; and when you put law practice,” he said. “Along the way, it those two dimensions together, you start occurred to me it was a fairly unique apgetting well-calculated solutions.” proach to provide services different than Clients also have access to Dickinjust law.” son Wright’s 400-plus lawyers. But unlike That idea morphed into a business traditional law offices, DW Franklin also plan that eventually caught the attention recruits expert business and government of Dickinson Wright. Gary soon brought relation consultants, offering flexibility on Hart, a business acquaintance and forand integrative solutions that often aren’t mer healthcare CEO who had founded a available in the more conventional law healthcare consulting company specializfirm structure. They also pride themselves ing in large-scale performance improvein recruiting seasoned, successful consulment. tants with ‘real-world’ experience.

“As a CEO and C-suite advisor, it “We’ll be looking for folks who have was very easy to see that the more regurun companies or worked for private eqlated healthcare became, the more disuity, who have had quarterly expectations jointed it seemed management input was breathing down their necks and performed getting,” Kerry said. “When you’re trying well,” Gary said. “We’re not the type that to figure out how to take the company to will unload a busload of new MBAs at a the next level, you have your strategist doorstop to tell a 30-year veteran how to coming up with one point, your attorney run a business. We’re about respect, aptelling you something different and your preciation, and knowledge sharing, and compliance people pulling their hair out.

It’s very complicated, but we can now bring a truly integrative set of perspectives in a very simultaneously engineered solution.”

“They’re Bringing in Consultants?”

While DW Franklin’s clients are predominately small- to medium-size healthcare companies, they are also working with two Fortune 100 companies – proof that the market might be bigger than what the executives originally thought. While clients typically have in-house legal and strategic advisors, they’re increasingly overwhelmed by the industry’s unprecnashvillemedicalnews

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we want to model that in the way we work with people.”

New Rules for a New Game Much of their work has been spent navigating waters stirred up by the Affordable Care Act, bundled payments and cost sharing initiatives. While such initiatives make sense from a business standpoint, Gary said laws often haven’t kept up.

“We still have Stark Law, the False Claims Act and other preACA regulatory systems in place,” Gary said. “While CMS is pushing folks to be innovative and rewarding providers for higher quality care, the Department of Justice is having record years on the enforcement side. It’s a very interesting dynamic.”

Hart said while market factors, competition and capital were driving forces in developing healthcare strategy and operational imperatives several years ago, legal and regulatory drivers are primary agents today.

“Navigating the healthcare marketplace today is both complex and arduous,” Hart explained. “In partnering with

Dickinson Wright, we bridge legal and regulatory compliance guidance with operational consultancy, which is very timely for today’s market – if not overdue.”

Hart added clients also are looking for help on strategic repositioning. “As lines are getting moved by regulatory changes, healthcare has become one big, complex set of relationships really,” he said. That’s because payers are dealing with providers, patients and suppliers … with a lot of intermediaries in between.

That movement causes everyone to have to reposition for optimal performance, Hart said. He guides his team through efficient processes to reposition companies strategically and operationally. They also address changes to the reimbursement environment, streamlining payment issues that help drive operational efficiency.

“We’re very experienced and valueadded at helping architect and innovate operational models to meet customer obligations in a more efficient way,” Hart said. “We see that management priority cycle through every three to four years, and we’re coming strongly into that in 2016.”

An apple a day may keep doctors away but ICD-10 could make them bananas.

We have the remedy.

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Priorities for the 109th General Assembly, continued from page 1 The Healthcare Provider Stability Act, sponsored by Sen. Bo Watson (R-Hixson) and Rep. Jon Lundberg (RBristol), would limit how often insurance companies could change fee schedules and payment policies and require adequate notice of those changes to make the process more transparent.

TMA President John W. Hale, Jr., MD, said another priority for TMA in the upcoming session is to work toward a constitutional amendment clarifying the General Assembly has the authority to set the caps on noneconomic damages in cases including medical liability actions Dr. John W. Hale that passed in 2011 but is now being threatened by lawsuits. In order to make it to the ballot for a vote in 2018, the proposed amendment must pass two separate General Assemblies, which makes this session critical for TMA. One of the key pieces of legislation on TMA’s list of priorities is the Tennessee Healthcare Improvement Act, which outlines a team-based healthcare delivery model with doctors as the team leader in patient care coordination. The TMAbacked bill is being offered as an alternative to the Nurse Independent Practice/ Full Practice Authority Bill. The Tennessee Nurses Association has long advocated for legislation to remove scope-of-practice barriers, which has put the two major provider organizations at odds on this issue.

“Having the proper collaboration from a physician in diagnosing and treating a patient ensures the highest quality of care and patient safety,” stated Hale.

“The Healthcare Improvement Act will allow advanced practice nurses to use the full extent of their training but make sure that a physician is involved in the care of every patient. It’s in the best interest of all Tennesseans.”

TNA The Tennessee Nurses Association disagrees with that assessment. For TNA Executive Director Sharon Adkins, MSN, RN, it comes down to improving access to care while decreasing costs to the system and individual patients.

“We certainly unSharon derstand there are major Adkins changes going on in healthcare; and in Tennessee, we are consistently at the bottom of healthcare rankings,” Adkins said. “In order to address that, we’re concerned about providing access to quality, affordable care. Advanced practice registered nurses are positioned to provide that care, and so we will oppose any efforts to restrict their ability to practice to the full extent of their education, training, experience and certification.”

She continued, “Though the Tennessee Medical Association has introduced legislation to ‘improve healthcare,’ it es4

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sentially will restrict the existing practice of advanced practice registered nurses.

Their bill would increase cost and decrease access.”

Adkins noted that while scope-ofpractice issues are a major focus, there are a number of other bills that have been filed that could potentially impact the state’s healthcare landscape. To that end, TNA leadership is reviewing proposed legislation and will weigh in as necessary.

“We will support any legislation that is beneficial to the healthcare of the citizens of our state,” Adkins concluded.

THA Although TMA and TNA might have to agree to disagree over practice authority, both organizations are united, along with the Tennessee Hospital Association, in supporting continued efforts to pass Insure Tennessee.

While hopeful the General Assembly once again will consider the proposal to extend healthcare coverage to more than 200,000 Tennesseans, THA Chief Executive Officer Craig Becker recognizes it will be difficult to gain traction on coverage Craig Becker expansion during a presidential election year.

Becker said there is work to be done even if legislators don’t formally take a look at Insure Tennessee this year. “We’re going to use this as an opportunity to provide more education to the Legislature

and more public education, as well,” he said, adding there are lingering misconceptions about program.

Of key concern to THA is maintaining Tennessee’s Certificate of Need program. Becker said there have been discussions about eliminating the CON program with free market proponents opposed to government intervention in controlling healthcare supply.

“Those in favor of a free market say it controls costs, which would be true if there was a level playing field … but there’s not,” Becker stated. “We have to take all comers.”

Becker added the CON program helps control ‘cherry picking’ so that an ambulatory surgery center or imaging center doesn’t siphon off commercial pay patients without taking charity care patients.

Becker said not having a program in place “definitely poses a threat to hospitals in communities.” In addition to endangering access to care, Becker said eliminating

the CON process would actually increase cost to the system.

Another area of emphasis this year is on telehealth reimbursement. “In 2014, we passed legislation that required insurers to pay for telehealth/telemedicine,” Becker said. However, he continued, the insurance industry “has come up with some loopholes so that they don’t have to pay in certain circumstances, which really guts the intent of the bill. In our opinion, it subverts the legislative intent.” Becker said THA is working with lawmakers to clarify the legislation with the strong support of hospitals and providers.

Also garnering broad support is the creation of a statewide stroke system.

THA is working with TMA and TNA to replicate the success of the trauma system to ensure stroke patients receive the right level of care at the right time in the right setting. Launching a coordinated statewide stroke response system might even be feasible without requiring formal legislation, Becker noted.

Getting Involved in the Process The Doctor’s Day on the Hill is slated for March 1. Approximately 300 physicians from across the state are expected to convene at Legislative Plaza in Nashville to share opinions and expertise with state lawmakers. To register or for more information, go online to tnmed.org/dayonthehill.

The TNA Legislative Summit is set for April 6. More than 1,000 student nurses, registered nurses and faculty are expected to attend the annual event, which includes presentations on hot topics and the opportunity to meet with legislators. Information is available at tnaonline.org under the Events section.

Practice Makes Perfect, continued from page 1 While most CEOs can’t replicate the reality television show Undercover Boss type of investigating, they can throw on jeans and a t-shirt and sit in the waiting room as a casual observer. “Does it look like a bad day at the bus station?”

Bollinger asked. Is it welcoming? Does it feel dirty, although it’s technically clean? Are magazines wrinkled? How are patients greeted, and what are processes like?

Dotty Small things start Bollinger the experience as patients come through the door so Bollinger encourages all leaders to regularly schedule time to experience the office from a patient’s point of view – something, she said, a surprisingly few managers take the time to do.

Look Beyond Healthcare As healthcare continues its evolution into a consumer-driven industry, Bollinger said she also encourages leaders to look to great service providers in highly regulated industries outside healthcare.

“Our providers and clinicians know what the efficiency fixes are in any practice, and often times we’re taking steps that aren’t really helping anybody,” she said of making administrative changes

without truly consulting those impacted on the front lines. Bollinger encouraged employers to set up work groups where they focus on culture and identifying inefficiencies. “The concept is prevalent in business, but we’ve been a ‘top down’ industry in healthcare for 30-plus years,” she said. “Culturally we need to borrow practices from our business counterparts.”

For example, ask any physician assistant or medical tech what they do in a day that’s rework to them, and they’ll tell you things that will make employees’ lives easier – changes that will ultimately impact the patient experience, as well. Often times a fix is as simple as moving an inconveniently stored piece of equipment, which could save hundreds of steps a day for a staff member.

“You can’t change regulations and forms, but often times you can change what’s sucking the life out of their day,” she said. “If you’re allowing bad behavior or experiences, you’re never going to inspire staff. Leadership sets the bar.”

Differentiate Yourself Employers also should take a step back and think about the service model they want to give consumers. How would great service differentiate their practice?

How would it help from a marketing perspective?

Ultimately great service means better financial results as patients pursue followup appointments, the best employees are more easily retained, and the office is set apart as a great place to work. And, Bollinger pointed out, as every leader knows, it’s easier to take care of customers who are happy than to constantly be in recruitment and service recovery mode.

Linda ClenDening, FACMPE, recently named CEO of Premier Orthopaedics and president of the Nashville MGMA, said the talk was motivation to create stronger relationships with staff, and to lead by example.

“Dotty has a real in-depth knowledge of industry issues in regards to customers service, satisfaction and key indicator areas, but at the same Linda time she gave us practical ClenDening takeaways we could go back with and really think about how to improve customer services,” said ClenDening, who now hopes to implement patient focus groups at her own office. “It was a reminder to keep up the effort and to establish a rapport and collaborate with patients across a broader demographic reach.”

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RAC is Back

After a Short Respite, RAC Audits are Back with a Few New Rules

By CINDY SANDERS

They’re baaaaaaack.

After hitting the pause button on the much despised recovery audit contractor (RAC) program, the Centers for Medicare & Medicaid Services (CMS) pushed play again at the end of last year, albeit with some changes in place.

Red Light, Green Light Like the popular childhood game, CMS has called red light, green light on the program for the past 24 months. In February 2014, CMS issued an edict to hold additional documentation requests (ADRs) until new RAC contracts were put in place. However, the federal agency reminded providers that automated reviews could continue.

In June 2014, CMS established a provider relations coordinator to act as a conduit to ‘more efficient resolutions.’ By late August of that year, CMS initiated contract modifications to allow the current auditors to restart some reviews when it became apparent the contract procurement process wasn’t going to happen quickly. In a statement, CMS officials noted, “Most reviews will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS.” In late 2014, CMS noted a further delay in awarding contracts for several regions because of pre-award protests. Although Connolly, LLC was awarded the Region 5 contract, that decision became the subject of a post-award protest filed by the Government Accountability Office in January 2015. Throughout the spring and summer of 2015, CMS tweaked the program and requirements for contractors to address several complaints, as well as the internal issue of recovering money from the contractor if an overpayment decision was overturned on appeal.

On Nov. 6, 2015, CMS submitted requests for proposals for the next round of recovery auditor contractors but extended existing contracts, with modifications, to current auditors to allow the continuation of activities through July 31, 2016. CMS then announced that effective Nov. 13, 2015 all recovery auditors had agreed to the modifications and could continue auditing activities, including sending out new ADRs. Flag on the Play Donna K. Thiel, a shareholder in the Washington, D.C. office of Baker Donelson, said providers have expressed numerous complaints about the RAC program since its inception. One of the biggest issues has been the sheer volume of requested records.

Donna Theil “A RAC audit would overwhelm the provider with requests for information,” she said. “Even electronic health records take time to access, review and duplicate. RAC audits are time and resource demanding.”

Thiel said the demands were also overnashvillemedicalnews

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whelming because RACs are not alone in their audit activities. Similar information was being requested by ZPIC and CERT auditors. “So in addition to being overwhelmed, there was a sense of ‘piling on,’” she continued.

Providers also were frustrated that CMS seemed not to be holding its auditors to the same standards that were applied to providers, Thiel noted. After jumping through hoops to provide reams of information within strict time limits under the threat of stiff consequences, providers then experienced delays and extended audit periods with no apparent consequences for the auditors.

And, not surprisingly, the biggest provider complaint has been with the inherent program design. With auditors receiving a percentage of funds recovered when overpayments are discovered, Thiel said the provider community has long felt RACs have no real incentive to pay claims and a very lucrative incentive not to pay claims on review.

She added, CMS spent $454.1 million to operate the Medicare FFS Recovery Audit Program, of which $301.7 million was paid to recovery auditors in the form of contingency fees. Providers have pointed out their high success rate on appeal of RAC findings is evidence the auditors have been taking too hard a line on medical necessity.

Additionally, Thiel explained, as the denials increased and recoupment levels rose, the appeals process became overwhelmed to the point where hearings to challenge RAC determinations became harder and harder to schedule.

Compare & Contrast After members of the U.S. Congress heard these complaints from angry providers , the RAC process came under increased fire, and CMS was persuaded to review the program and institute several reforms.

“In the changes that were brought about at the end of last year, some of these provider issues were addressed,” Thiel said of the RAC program modifications.

“Last year, CMS limited the number of claims that can be requested by RACs,” she said, adding there is a formula as to how many document requests could be made of hospitals. “There’s been a limit on physician requests since 2011 and DMEs since 2013 so this new one is for facilities … hospitals, skilled nursing facilities, rehabilitation centers,” Thiel explained.

She continued, “CMS is also going to evaluate RAC auditors based on a stricter set of criteria with consequences to the RAC if they make decisions that are consistently reversed on appeal.”

Although the exact penalties for the RACs have not been spelled out, the CMS website did indicate limits also would be put on the number of ADRs that could be requested if auditors have a high rate of overturn on appeal. “The fewer claims they review, the fewer may be denied and so RACs start to lose revenue,” Thiel said.

She also noted CMS has announced auditors won’t receive contingency fees until after the second level of appeal is ex-

hausted under the new RAC contracts that will be awarded later this year. Auditors must maintain an overturn rate of less than 10 percent at the first level of appeal under the new plan. “Failure to do so may land a RAC auditor on a corrective action plan,” Thiel said.

“CMS has also said, as of January of this year, the ADR limits are going to be indexed to denial rates,” Thiel continued. “therefore a provider with a low rate of denials, should be getting fewer ADRs.” Another key change is how far back auditors are allowed to go in reviewing claims.

Previously, claims could be reopened for four years. Now, RAC auditors must limit their look-back period to six months.

“By limiting that review window for hospitals, in particular, you will have RAC auditors looking at claims under current coverage rules, as opposed to trying to evaluate older claims under older coverage policies,” she said.

However, Thiel stressed this new lookback timeframe is only for RAC contractors so providers should be prepared to go back further for other government audits.

TBD “There are also a couple of ‘to be determined’ items that will probably be addressed with new RAC contracts,” noted Thiel.

The first is that auditors will have 30 days to complete complex reviews. Previ-

ously, they had 60 days … but realistically it often took much longer with seemingly little consequence if the contractor missed the deadline.

Perhaps one of the most significant modifications is the addition of a ‘real’ discussion period between the time a RAC auditor presents results to a provider and forwards those findings to Medicare Administrative Contractors (MACs).

“The RAC auditor, in the new contract, will be required to wait 30 days to send the results of their audit to the MAC,” Thiel said, noting that currently reports are sent almost simultaneously to the provider and MAC for recovery overpayments.

Since the clock begins ticking on the appeal process as soon as the MAC sends a demand, providers realistically have had little or no window for rebuttal with the RAC to stop recoupment before they needed to appeal.

“The whole rebuttal period was, in my view, an ineffective process for providers to attempt to correct errors or misinterpretations by the RAC,” Thiel said. “There was a good chance a provider would have had to file an appeal before the RAC even responded to a rebuttal,” she added.

By pumping the brakes a bit, Thiel continued, the rebuttal period should become more meaningful and potentially relieve some downstream pressure on ALJ hearings by clarifying disputed information before money changes hands.

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Prevent, Protect, Improve

Healthways Continues Expansion of Ornish Heart Disease Reversal Program

By CINDY SANDERS

When two wellness giants joined forces in 2013, the hope was that millions of people would benefit. Nearly three years later, the partnership between Dean Ornish, MD, and global well-being improvement company Healthways continues to expand, bringing evidence-based lifestyle programming to ever-increasing numbers of individuals across the nation.

Based in Franklin, Tenn., Healthways is a provider of well-being and health improvement solutions to nearly 68 million people on four continents. The company entered into an exclusive agreement with Ornish in July 2013 to operate and license his Lifestyle Management Programs, which included interventions addressing early-stage prostate cancer, type 2 diabetes, and heart disease.

A cornerstone of the partnership is Dr. Ornish’s Program for Reversing Heart Disease™ (Ornish Reversal Program), which is scientifically proven to not only treat … but also to reverse … the progression of heart disease through comprehensive lifestyle changes.

“What’s different about it is recognizing lifestyle is a viable treatment alternative for cardiac disease that can actually reverse the disease at its root cause,” said Robert Porter, managing director of the Ornish Reversal Program Robert Porter for Healthways.

He added integral parts of the program focus on diet and nutrition, exercise, stress management and group support. “One of the unique things about the program is that it is offered to people in cohorts of eight to 15,” Porter said. “The reality is we are social animals. We’ve discovered the power of that group support and community in helping individuals make and sustain a behavior change.”

Each small group participates in 18 four-hour interactive sessions. In addition to learning new strategies and techniques from a staff leader, participants also use group time to share suggestions and practical solutions to incorporating new habits into daily ‘real’ life. During a session, the group might share a meal, practice yoga together, work on stress reduction exercises and learn how to choose wisely from restaurant menus. “They don’t just learn what they should do … they actually do it,” Porter said. “They’re actually living the program during those 18 sessions.”

He pointed out the support system functions in much the same way as having a workout buddy, mixing social interaction with a degree of accountability. “It’s a really powerful way to provide support, a bond and a covenant among the group that helps them build (program elements) 6

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into their new lifestyle,” he explained.

Porter added the bond is so strong that participants formed alumni groups to continue to foster encouragement and maintain interaction. The Ornish Reversal Program website (ornishspectrum. com) states 87.9 percent of participants continue to get together regularly after finishing the 72 hours of active programming. In fact, Porter noted, some of the participants from the early research studies, which go back decades, continue to keep in contact.

“Dr. Ornish, over 30 years, has done the most rigorous research you can imagine,” Porter said of the science behind the program. Starting with the notion that it’s easer to turn off the faucet than to mop up the floor, Ornish began formulating ideas about how to improve health while he was still in medical school. By 1978, Ornish and colleagues at the University of California, San Francisco showed heart disease could be reversed after only 30 days, as demonstrated by improved blood flow to the heart, in a pilot study that utilized the tenets of the Ornish program.

Based on nearly four decades of ongoing research, which has been widely published in peer-reviewed journals, the program was approved for Medicare reimbursement under the category of ‘Intensive Cardiac Rehabilitation’ beginning in 2011. In addition to nationwide reimbursement through Medicare, commercial payers in 17 states also cover the program for heart disease.

“As the evidence grows, as we gain experience, the science would seem to predict there is the possibility for this program to expand to a larger number of chronic diseases,” said Porter. He added a few payers have extended the criteria for coverage to include those with diabetes and early-stage prostate cancer.

The core program, however, is currently focused on heart disease. With the exception of congestive heart failure, which Porter said he hopes will be added in the near future, the program is approved under Medicare for the same diagnoses as traditional cardiac rehabilitation. The six qualifying conditions are: • Acute myocardial infarction in the preceding 12 months, • Coronary Artery bypass surgery, • Current stable angina pectoris,

• Heart valve repair or replacement, • Percutaneous transluminal coronary angioplasty or coronary stenting, and • Heart or heart-lung transplant.

A focus on lifestyle modification and prevention has increasingly become more mainstream in healthcare, but transforming the delivery system remains an ongoing challenge.

Phil Newbold, CEO of Beacon Health System in Indiana, which launched the program in August 2015, noted, “If you look at the mission and vision statements of most hospitals and health systems, the word ‘health’ is all over them … but if you look at where we spend our resources, about 99 percent goes to the medical side of things and very little actually focuses on health. When we looked at the Ornish Reversal Program, we saw that it was the best way for us to really embrace health in a scientific way and better align ourselves with our mission of creating a healthier community.”

Echoing the sentiment, Porter said, “I think our whole healthcare system was built around passively waiting to treat people when they presented with a

problem. We’ve found that is unsustainable. It’s unsustainable financially, and we’re not optimizing the health status and qualify of life for people.” He continued, “The best way for us to promote health is to adopt a healthy lifestyle that prevents the onset of chronic disease.”

The Ornish Reversal Program is rapidly gaining a foothold in the medical community since rolling out nationally about 18 months ago. At the end of 2015, four new partner sites were announced in Texas, Florida, North Carolina and Virginia. At press time, Healthways had implemented the program in 22 sites across 14 states with two more programs in the process of being launched and numerous others in the discussion phase.

While Porter said it was too early to have hard financial figures in terms of savings to the health system, he noted early indicators have been impressive. “We’re certainly seeing incredibly solid clinical results,” he said. “Based on those clinical results, the predictive variables would indicate we expect to see solid results in other outcomes like readmissions and costs.”

Physician groups and hospitals interested in learning more about the program and research behind it should go online to ornishspectrum.com or call Healthways at 877-888-3091.

Using Rhythmia to Treat Arrhythmias TriStar Summit Debuts Mapping Technology

By CINDY SANDERS

In the fourth quarter of last year, TriStar Summit Medical Center debuted a new system by Boston Scientific to enhance mapping and navigation in treating arrhythmias. The hospital was the first in Middle Tennessee and one of the first in the nation to use the state-of-the-art, high-resolution, 3D Rhythmia Mapping System to perform a cardiac ablation procedure.

Thomas Williams, MD, the electrophysiologist with Centennial Heart at TriStar Summit who first used the new system on Oct. 1, 2015, noted there are certainly other mapping systems commercially available and widely used for such procedures. “Rhythmia is not novel in the end product,” he said. “It’s how it goes about it.”

Williams continued, “Instead of half an hour to an hour to create Dr. Thomas a functional map, it takes literally just a few minutes. That results in Williams less procedural time and less exposure to fluoroscopy.”

He added the amount of data points the system collects far exceeds other mapping systems and provides a more accurate view of the arrhythmias. “It makes for a more precise map with less error involved due to more data being collected,” Williams noted.

Williams said it isn’t unusual to re-map a patient at the end of the procedure to ensure ablation targets were met and no further course of action would be necessary so the speed of Rhythmia once again factors into decreasing overall procedure time and radiation exposure.

“The system’s fast and detailed highresolution maps made a tremendous difference in enabling me to quickly diagnose and treat the source of the patient’s arrhythmias, as well as efficiently confirm the success of the procedure,” Williams recalled of using the new system for the first time.

Since then, Williams said he has used Rhythmia more than 15 times with successful results and has been very pleased with the accuracy and clarity of the technology. nashvillemedicalnews

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Taken in Context: Study Raises Questions about Sharing vs. Scaring

By CINDY SANDERS

A little knowledge goes a long way … but could it go too far if taken out of context? With genomic data becoming increasingly available to clinicians, providers are having to learn to navigate the line between sharing important information and needlessly scaring a patient.

A new study led by investigators at Vanderbilt University Medical Center found a genetic test suggesting a patient might be at increased risk for potentially fatal arrhythmias very often wasn’t as ominous as it first appeared. Out of the group of 2,022 patients, 63 were identified who had genetic variations considered to be “potentially pathogenic.”

However, the electrocardiograms of the individuals in this group were no different than those without the genetic variances.

Sara Van Driest, MD, PhD, an assistant professor of Pediatrics and Medicine at VUMC and the paper’s first author, said the results “warn us to be very careful about returning genetic results, particularly to people who have no signs or symptoms of heart disease.”

The researchers fully expected to find genomic variants when sequencing healthy people. Van Driest said everyone has some variations that could potentially

Dr. Sara Van Driest and Dr. Dan Roden

cause disease. Yet, those ‘red herrings’ are often just that – harmless anomalies that don’t progress to disease. Van Driest noted, “We were interested in learning what the potential implications were for incidental findings in these genes.”

She explained the study came about as part of the eMERGE (Electronic Medical Records & Genomics) Network.

Funded by the National Human Genome Research Institute, Vanderbilt is actively involved in this national, multicenter research project and serves as the network’s coordinating center. According to the

website, eMERGE combines DNA repositories with EMR systems for large scale, high-throughput genetic research in support of implementing genomic medicine.

As the field of genomic medicine continues to grow, the list of gene variants linked to different diseases also grows.

However, Van Driest pointed out, “The difficulty is so far nearly all the data we have to base our decisions on comes only from people or families with the disease … people who have already been diagnosed or with very high risk.”

She continued, “It’s only when we take a step back and look at both people with and without the disease that we can determine how accurate the variant is in actually predicting the disease.” Simply having a variant, even one that does increase risk, doesn’t necessarily mean the disease will manifest, she stated.

Dan Roden, MD, senior author and professor of Medicine and Pharmacology at VUMC, added there has been a big push to return every genetic result back to patients. “This is one way of saying, ‘Hold on. Let’s make sure we’re doing this the right way,’” he noted of the study’s findings.

The team found that relying solely on genetic testing without consideration of the ECG and other data found in an indi-

vidual’s EMR might needlessly alarm the patient and could also lead to expensive and unnecessary treatments – in this case, an implantable defibrillator.

“I think we need to educate clinicians, as well as patients, that with these variants, we’re still learning what the real clinical implications are,” Van Driest said. “A genetic variant doesn’t determine their fate.”

She added there are a couple of downstream outcomes that would ideally develop from this study: “1) We need to have large sequencing efforts in extremely large cohorts of patients so we can determine how impactful the variants are, and 2) we should never look at a variant in isolation.”

The good news is that by studying the genomic data of a large mix of patients with and without disease and using other tools at hand including family history, medical records, and prior test and lab results, researchers should begin to get a handle on how much weight each genetic variation carries over time.

Indeed, some variants have already been well characterized (see pg. 8), but many others have not. “We just have a lot more to learn,” Van Driest concluded.

For more information, results of the study were published last month in the Journal of the American Medical Association.

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Clinical Importance of Haptoglobin in Diabetes, Cardiovascular Complications

By MARY TAYLOR HYDE, RD, LD & DAVID VIGERUST, MS, PHD Diabetes affects nearly 400 million people worldwide and is expected to increase to nearly 600 million people by 2035. Patients with diabetes mellitus are often more susceptible to a host of multiorgan complications that arise as a result of microvascular and macrovascular dysfunction. These complications equate to the leading cause of morbidity and mortality in the form of accelerated atherosclerotic disease.

There are a variety of contributing factors leading to both diabetes and cardiovascular disease including genetics, environment, and lifestyle. However, those with diabetes should be aware of recent research that could significantly affect heart health. In fact, the October 2015 issue of the Journal of American College of Cardiology reports that genetic testing for a specific blood protein might identify individuals with diabetes who are at a greater risk for coronary heart disease. Moreover, those with diabetes and carrying one specific variant might be 1000 percent more likely to suffer a heart attack.

Haptoglobin (Hp) is an acute phase plasma protein with hemoglobin-binding

Dr. David Vigerust and Mary Taylor Hyde at the lab.

properties that is expressed as either Hp1 or Hp2 alleles. Haptoglobin has the primary task of capturing and eliminating free heme circulating in the blood and tissues. For this reason, Hp is considered a key antioxidant molecule in the prevention of hemoglobin-induced oxidative tissue damage. Each of us carries two copies of the Hp molecule. These are expressed as three potential genotypes: Hp1-1, Hp1-2, and Hp2-2 representing 16, 37 and 47 percent of the U.S. population respectively.

One of the key blood values for any diabetic patient is the hemoglobin A1C value, which represents a person’s approximate blood sugar levels over the

past three months. Recent evidence from several groups around the world indicates that if a person carries the Hp1-2 or Hp2-2 gene and has an A1C above 6.5, they have a significantly increased risk for a cardiovascular event.

Diabetes is well established as a risk factor for heart disease. Clinical evidence suggests that 65 percent of diabetic patients will suffer a heart attack, and a significant portion will perish from cardiovascular complications.

Greater than 70 percent of the population carries at least one form of the Hp2 gene. Those with diabetes and the Hp1-2 gene are three times more likely to have a cardiovascular event, while diabetics

with the Hp2-2 gene are five times more likely to suffer a cardiovascular event.

Therefore, Hp1-2 and Hp2-2 are directly predictive of heart disease in those with diabetes.

The testing for Hp genotype is facilitated by a simple, non-invasive oral rinse that can be administered within minutes, and the assay is both affordable and actionable. The clinical objective with any patient with diabetes is to minimize the risk for a cardiovascular event. The treatment for those with Hp2 is supplemental vitamin E therapy. For those with a single copy of Hp2, the treatment suggestion is 200IU of a high quality vitamin E and 400IU for those with two copies of Hp2.

Therapy should not be implemented, however, until a genotype has been determined. In a multiyear study, long-term vitamin E has been shown to increase the risk of a heart attack for those without Hp2 alleles.

Additionally, there are many cases when Hp gene-carriers are found to be vitamin C deficient because vitamin C is utilized as an antioxidant surrogate in place of Hp. Therefore, supplementation of vitamin C might also be beneficial for this group. Excellent sources of vitamin C include oranges, grapefruits, strawber(CONTINUED ON PAGE 9)

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Heart Monitor Mark Your Calendar

Focus on the Heart: Annual Cardiovascular Symposium Feb. 26, 2016 • Music City Center, Davidson Ballroom Designed to meet the educational needs of primary care physicians, emergency room physicians, hospitalists, registered nurses and other healthcare professionals involved in the care and management of patients with cardiovascular disease. The symposium includes information and presentations that will allow participants to: • Describe the evidence-based and emerging strategies to manage structural heart disease, • Discuss the role of advanced cardiac imaging in the diagnosis and treatment of cardiovascular disease, • List indications of novel pharmaceutical therapy to manage hyperlidemia and heart failure, • Explain the clinical advantages to complex interventional cardiology and recent advances in coronary stents, and • Describe the multi-disciplinary approach in cardio-oncology.

Those interested in more information or registering, should go online to TriStarHealth.com/focusonheart or call 615.342.1919.

New Recs for Diagnosing Chest Pain in the ER New recommendations from the American College of Cardiology and American College of Radiology have established appropriate use of diagnostic imaging for patients with chest pain, one of the most common reasons for emergency department visits.

The document addresses 20 fundamental clinical scenarios for emergency imaging for chest pain and assesses when imaging is useful in each case, and if so, what information is provided by the speci-

fied imaging procedure. The clinical scenarios are broken down into leading critical diagnoses: acute coronary syndrome, pulmonary embolism and acute aortic syndrome. There is a fourth category, triple rule out computerized tomography (CT), for the minority of patients for whom a leading diagnosis is not possible.

Using the well-established modified Rand methodology, an expert panel rated each of the diagnostic procedures for the 20 clinical scenarios on a scale from 1 to 9. Each procedure has a corresponding rating of “rarely appropriate,” “may be appropriate” or “appropriate.”

The paper published Jan. 22 in the Journal of the American College of Cardiology and the Journal of the American College of Radiology.

Broken UV Light Leads to Key Heart Muscle Cell Discovery For a team of Vanderbilt investigators trying to generate heart muscle cells from stem cells, a piece of broken equipment turned out to be a good thing.

The faulty equipment pushed the researchers to try a different approach.

They recently reported their new method — using a “Matrigel mattress” to rapidly generate cardiac cells suitable for heart disease studies and drug discovery — in the journal Circulation Research.

The new method addresses a problem researchers have had with cardiac muscle cells derived from human induced pluripotent stem cells. The stem cellderived cardiac cells did not exhibit contractile properties similar to normal adult cardiac muscle cells, said Charles Hong, MD, PhD, and Björn Knollmann, MD, PhD, who collaborated to develop the new method.

The researchers believed the problem was that growing the cells on the usual glass or plastic surfaces didn’t allow them to mature into beating cardiac cells. Instead, they aimed to grow the cells on “a flexible substrate, to hopefully allow the cells to mature and contract, so that we could make measurements at the single-cell level,” said Hong, associate professor of Medicine.

The team had achieved some success toward this goal using synthetic substrates such as polyacrylamide, which requires exposure to ultraviolet light to form a gel substrate. Then the ultraviolet light was broken.

T.K. Feaster, PhD, who was a graduate student in the lab, decided to try a different type of gel — a natural matrix product called Matrigel. Matrigel is commonly used to culture cells, but it is usually diluted. Feaster decided to use undiluted Matrigel to create a cushiony “mattress” — his term — for the cells.

It worked. The stem cell-derived cardiac muscle cells grew on the Matrigel mattress with shape and contractile parameters that matched freshly isolated cardiac muscle cells, and they responded to drugs that increase the force of contraction.

The simplicity of the method makes it very attractive. “Now we can quickly and inexpensively generate these human cardiac myocytes and quantify contractile responses in single cells,” said Knollmann, professor of Medicine.

Nashville Hospitals Lead the Way on WATCHMAN™ Middle Tennessee cardiology programs have been early adopters of an implantable alternative to long-term warfarin medication for those with atrial fibrillation.

The WATCHMAN™ left atrial appendage closure device offers a stroke risk reduction option by closing off the left atrial appendage (LAA), limiting the passing of harmful blood clots from the LAA into the blood stream and potentially causing a stroke. By closing off the LAA, the risk of stroke is reduced and, over time, patients may be able to stop taking warfarin.

In early April 2015, Saint Thomas Heart cardiologist Drew Pickett, MD, performed the first WATCHMAN implant in Tennessee. When cardiologists at TriStar Centennial Heart & Vascular Center and at Vanderbilt Heart and Vascular Institute began implanting the device a couple of months later, they joined only about 50 other programs in the nation to offer the treatment option, which received FDA approval on March 13, 2015.

Clinical Importance, continued from page 8 ries, bananas, broccoli, spinach, potatoes and tomatoes.

Heart disease is the currently number one and diabetes the number seven cause of death in the United States. According to 2012 data from the American Diabetes Association, there are nearly 30 million Americans suffering from diabetes and more than 85 million with prediabetes. Moreover, Hp2 carriers face risk of developing increased cholesterol levels, increased risk for aneurysms, as well as elevated arterial inflammation — a known contributing factor to having a stroke.

With one simple, non-invasive test, diabetic patients can find out if they are at increased risk of cardiovascular events, and clinicians can take preventive measures to minimize those risks.

If an event does occur, patients who carry the Hp2 gene will require more treatment support and follow-up once out of the hospital than normal patients.

In the grand scheme of things, a heart atnashvillemedicalnews

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tack could cost insurance companies and patients anywhere from $700,000 to $1 million, according to insurance providers such as Assurant Employee Benefits.

Therefore, allocating a few dollars on a genetic test to determine a patient’s risk and possible need for vitamin E supplementation could be considered a very prudent expenditure.

Of course, some of the best ways to prevent the costs associated with cardiovascular disease is to maintain a healthy lifestyle; eat a diet low in sodium, fat and cholesterol; exercise regularly; avoid smoking; avoid drinking in excess; and keep weight, blood pressure, cholesterol and stress levels at manageable level.

Mary Taylor Hyde is a Registered and Licensed Dietitian specializing in research and Dr. Dave Vigerust is the Chief Science Officer at MyGenetx Laboratory. Currently, MyGenetx is the only laboratory in the region offering a rapid, cost-effective molecular test for Hp genotyping. MyGenetx is a CLIA certified molecular laboratory that offers molecular testing to physicians.

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PHYSICIAN SPOTLIGHT

Mark P. Freeman, MD: Radiology from the Top Down

By KELLY PRICE

Mark P. Freeman, MD, likes to take the 10,000-foot view and then dive deep into the cracks and crevices … both at work and for fun.

Specializing in diagnostic and interventional radiology, Freeman is in practice with Radiology Alliance and also serves as the medical director of Diagnostic Imaging at TriStar Summit Medical Center. His areas of special interests and expertise include neuroradiology, MRI and angio/interventional radiology.

The Memphis native is also an avid mountain climber and hiker. Freeman is the youngest of four boys, and he attributes his sense of adventure, strong work ethic and desire to explore to his amazing mother who retired at the age of 100 and is still driving at 103.

After high school, Freeman headed east to Nashville and received his undergraduate degree in mathematics from Vanderbilt University, where he graduated magna cum laude. He then returned home to Memphis to continue his educa-

tion at the University of Tennessee School of Medicine. After graduating from med school in 1982, Freeman completed a diagnostic radiology residency at the Medical College of Virginia, where he served as chief resident of Radiology from 1985-1986. Following board certification, Freeman performed a neuroradiology fellowship at Vanderbilt University Medical Center and earned a Certificate of Added

Qualifications in the subspecialty from the American Board of Radiology in 1995.

He was named to his current role at TriStar Summit in 2011 and also has staff affiliation for a number of other hospitals in Middle Tennessee, including facilities in Ashland City, Dickson, Erin, Linden, Smyrna and Nashville, as well as Bowling Green, Ky. On May 15, Freeman will be inducted

Women 20 16 TO W AT C H

Our annual Women to Watch issue is coming in May 2016, and we want your input on women in Middle Tennessee impacting healthcare at home and beyond.

Help us honor clinicians, researchers, administrators, policy makers, and other industry experts by nominating these outstanding professionals.

CALL FOR NOMINATIONS

To nominate, please visit nashvillemedicalnews.com and click the Women to Watch icon.

Nomination Deadline: Feb. 15, 2016

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as a Fellow in the American College of Radiology (FACR) at a formal convocation ceremony during the annual meeting in Washington, D.C. “I’m looking forward to this distinction,” Freeman commented, “I am very grateful to be able to do what I do.”

One of the highest honors bestowed by the ACR, only about 10 percent of the membership ever achieves this distinction. Of course, Freeman is used to scaling the mountains most never attempt … literally. It is only fitting that he spends much of his workday at Summit since that’s where he likes to spend his off hours, as well.

When he isn’t practicing, Freeman relishes hiking and mountain climbing and recently reached the summit of a 14,000-foot mountain in Colorado with his family. Prior to setting off to climb, Freeman said his children are quick to remind him of what he has always told them when they study an ascent, “That ain’t no hill for a stepper!”

He is equally fascinated with going in the other direction, down into the Slot Canyons that pockmark the Southwestern landscape with ethereal light beams, golden hues and corkscrewing rock walls that seem to defy gravity.

Perhaps it shouldn’t be surprising that with his love of structures spanning the centuries – and a mother who has eclipsed the 100-year mark – that Freeman also enjoys studying genealogy to trace the history of his family. He said he has interviewed members of generations of his family, visited cemeteries across the country, and studied aging family records and Bibles. Freeman also noted he appreciates that the study of family histories has become much easier with the support of modern DNA discoveries. However, he said he worries that the Internet often offers up suspicious or inaccurate entries that should not be taken at face value.

Freeman enjoys traveling to far-flung places with his wife, a former cardiac nurse who has found a second career building spec houses. They especially enjoyed a recent river cruise along the Danube and are currently planning more visits abroad.

And he’ll certainly be heading back to those awe-inspiring depths and heights of those luminous canyons and majestic mountains a few more times.

Whether this adventurous physician is scaling mountains, sliding into caverns or unraveling the mysteries of the human body, there is always something new to explore.

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In Remembrance of Healthcare Industry Pioneer Clayton McWhorter

By CINDY SANDERS

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projects at Belmont University including McWhorter Hall and the establishment of the McWhorter Society, which provides a funding mechanism to further the uni-

pertise to numerous leaders in the healthcare industry. He leaves a legacy that not only shaped the business of healthcare in Nashville but also served as a gracious example of how that business should be conducted.

Upon learning of his death, U.S. Senator Bob Corker (R-Tenn.) said, “Clayton’s impact on the business, civic and political landscape of Nashville and Tennessee will be felt for decades. I first met Clayton in the ‘90s when I was commissioner of finance, and through his personal perseverance, he worked to ensure Hospital Corporation of America’s headquarters would remain in Nashville.

While his professional impact was large, his personal encouragement to so many will be what those who knew him well will miss the most. He was a true friend and mentor to so many people. I will miss him greatly, and my heart and prayers go out to Michelle and his entire family as they celebrate his life.”

Council Hosts Annual Wall Street Panel With markets off to a bumpy start, more than 600 executives gathered at the Omni Nashville Hotel to hear top investment analysts discuss 2016 predictions for the healthcare industry.

Wayne T. Smith, chairman and CEO of Community Health Systems, moderated the Nashville Health Care Council’s annual “Wall Street’s View on Prospects for the Health Care Industry” program.

Panelists included Frank Morgan, managing director, RBC Capital; Chris Rigg, senior managed care and healthcare services research analyst, Susquehanna International Group; Andy Schenker, executive director, Morgan Stanley; and Brian Tanquilut, senior vice president, healthcare services equity research, Jefferies & Company.

The group offered perspectives on a variety of sectors, including healthcare facilities, behavioral health, outpatient services, managed care, dialysis, senior living, long-term care and others. The panel identified behavioral health, post-acute care and ambulatory surgery centers as top sectors for growth in 2016.

“The 16 publicly traded healthcare companies headquartered in Nashville have a great deal of influence on healthcare throughout the nation,” Smith said.

“Wall Street continually looks to Nashville-based companies to see where the healthcare industry is headed.”

The panel discussed the effects of industry trends on the market, including M&A activity, exchange enrollment rates, value-based purchasing and innovative care models.

DONN JONES PHOTOGRAPHY

Nashville lost one of its revered city leaders and a pioneer in the healthcare industry when R. Clayton McWhorter passed away Saturday, Jan. 23, 2016 at the age of 82.

The founder and chairman emeritus of Clayton Associates, McWhorter was the former founder, chairman and CEO of HealthTrust and an integral part of the executive leadership of Hospital Corporation of America. He retired from HCA in 1996 as chairman but didn’t step away from the industry he loved. Instead, McWhorter brought his wealth of healthcare expertise to bear on a new firm, Clayton Associates, to fill the need of investing in innovative healthcare ventures and advising the entrepreneurs seeking to improve the industry.

McWhorter began his healthcare career as a pharmacist after taking prepharmacy courses at the University of Tennessee and earning his bachelor’s degree from Samford University. Recognizing he could broaden his impact on patients by moving into the business side of the industry, McWhorter became a hospital administrator. Working his way through the ranks at HCA, he rose to president and chief operating officer of the hospital giant. He then formed HealthTrust Inc., where he served as chairman, president and chief executive officer until the company merged with Columbia/ HCA in 1995. After his stint as HCA chairman, McWhorter continued to serve on the corporate board until 2000.

After the formation of Clayton Associates, McWhorter went on to found PharmMD a decade later to honor the vision of his late brother, Fred, who spent more than 50 years as a pharmacist. McWhorter served on the board of PharmMD and as a member of the Harpeth Capital Advisory board until the time of his death.

In the spirit of helping others bring innovative healthcare ideas to life, McWhorter was instrumental in the launch of the Nashville Entrepreneur Center and served as the organization’s first chairman. His son, Stuart, was named CEO of the EC when founding president and CEO Michael Burcham left to launch a new healthcare firm last year.

McWhorter was as noted for his philanthropic spirit as his business acumen.

He and his family have greatly contributed to education with the creation of the McWhorter School of Pharmacy at Samford University and by funding of a number of

versity’s health science programs.

His community involvement also extended to work with organizations including the American Cancer Society, YWCA, United Way, the Nashville Area Chamber of Commerce, and the Middle Tennessee Council of the Boy Scouts of America.

A founding member of the Nashville Health Care Council, McWhorter’s impact on the national healthcare landscape was recognized this past October as one of eight inaugural inductees into the Tennessee Health Care Hall of Fame. McWhorter was a passionate mentor and lent his ex-

(L-R) Frank Morgan, Chris Rigg, Andy Schenker, & Brian Tanquilut

“As more CMS incentives are put in place, we’re seeing volumes shift to homebased care and an increased pressure on skilled nursing facilities. At the end of the day, I think home health will see the biggest increase in volumes. We’re bullish on home health,” said Tanquilut.

“The ACA achieved its aims of having more people with health coverage, but it didn’t address issues like costs. The market is ripe for innovation, and I think some healthcare startups have potential to have a huge impact,” said Schenker.

“People on Wall Street are excited about the opportunities surrounding bundled payments. Incentives outlined by CMS are driving adoption and momentum, so I think there’s room for growth there,” added Morgan.

“At the end of the day, I don’t see any significant coverage disruptions from major insurers pulling out of the ACA marketplace,” noted Rigg. “We may see one or two get out after this year, but moving through 2016 and onto 2017, I expect things to stabilize across the board.”

In addition to discussing the upcoming presidential election’s impact on the market, the speakers offered insights on the recent market volatility and factors that will determine if it will continue.

“The Council’s member companies are leading the way in implementing innovative solutions to improve healthcare across the nation and the world,” said Council President Hayley Hovious. “We are pleased to provide them with access to the vital information provided today.”

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including an upbeat attitude, respect for patients and colleagues, problemsolving abilities, initiative and recognition of teamwork as the foundation for providing quality care. These attributes have positively impacted patients and families during a difficult time.

EMERGENCY Sponsored by CEP America Kimberly Butler, RN Sumner Regional Medical Center

More than 140 Middle Tennessee nurses were nominated for the annual March of Dimes Nurse of the Year awards. Honorees were chosen in 15 categories.

Photos Provided by Brentwood Photography Group.

March of Dimes Honors Outstanding Middle Tennessee Nurses at Annual Gala

By CINDY SANDERS

Editor’s Note: Nashville Medical News is honored to serve as media sponsor for the annual March of Dimes Nurse of the Year Awards. We salute the winners and all the nominees for their dedication, compassion and clinical expertise in caring for our community.

Now in it’s sixth year, the annual March of Dimes Nurse of the Year Awards drew a record crowd on Dec. 8, 2015 to honor outstanding Middle Tennessee nurses.

Rita Mitchell, executive vice president and manager of Private Client Services for First Tennessee Bank, chaired the gala event. Calling nurses the ‘heart’ of both March of Dimes and the entire healthcare industry, Mitchell said, “The awards process showcases the positive impact nurses have every day on so many lives and celebrates their accomplishments.”

Catherine Ivory, PhD, RN-BC, an assistant professor and nurse researcher at Vanderbilt University School of Nursing, served as honorary chair and keynote speaker. Ivory, who represented more than 300,000 nurses nationwide as the 2014 president of the Association of Women’s Health, OB and Neonatal Nurses, noted, “At a time when the United States is in the throes of healthcare reform, nursing is on the frontlines as the largest segment of the healthcare system, and we’re considered by many to be not only the most trusted profession – as you heard earlier from Dan (emcee Dan Thomas of WSMV), – but to be essential to the health of the U.S. population by providing direct patient care, health promotion, patient education and care coordination.”

Referencing the fifth anniversary of the 2010 IOM Future of Nursing

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Report, Ivory added that events such as the Nurse of the Year Awards help raise the profile of nursing. “The more we promote our practice among colleagues in healthcare and colleagues in the community, the better our image becomes and the greater our chances to influence health policy and to influence health systems.”

Top honors were awarded to 17 nurses in 15 categories from more than 140 highly accomplished nominees who live out the mission of the March of Dimes to lead efforts that support children and families. In addition, one nurse was recognized for her outstanding volunteer work on behalf of the organization.

First Tennessee served as the event’s presenting sponsor and Lipscomb University School of Nursing as the gold sponsor. More than a dozen other organizations, including Nashville Medical News, also helped sponsor the awards and evening event.

ADVANCED PRACTICE Sponsored by Vanderbilt University Medical Center Jane Kershaw, RN, IBCLC, RLC, BA TriStar Centennial Women’s and Children’s Hospital Kershaw has dedicated her practice to helping moms and babies succeed at breastfeeding. Early on in her nursing career, she pioneered the development of lactation services at her hospital and also helped negotiate the coverage of those services by insurance companies. Additionally, she has advocated not only for patient policies, but employer policies designed to protect, promote and support breastfeeding freedoms for staff.

As Kershaw begins a new adventure … retirement … this latest award fittingly comes in recognition of a career that has spanned more than four decades and impacted thousands of lives.

BEHAVIORAL HEALTH Christina Cannon, RN Mental Health Cooperative Colleagues hail Cannon as an extraordinary psychiatric nurse who models to students, the healthcare team, patients, and families what it means to address the holistic needs of individuals who struggle with severe mental health issues in a trusting, non judgmental environment. Throughout her eight years in practice, Cannon’s efforts on behalf of her patients have resulted in improved medication adherence and better engagement with the healthcare system. Her strength as a provider comes from viewing each interaction, intervention, and collaboration as an opportunity to learn and grow both as a nurse and a person.

CRITICAL CARE Sponsored by HighPoint Health System Marcus Thompson, RN Sumner Regional Medical Center Although he has only been practicing for three years, Thompson has already established a sound work philosophy and skill set that has been noticed by others. The extra effort and perseverance it took to excel as both a nursing student and college athlete laid the foundation for the leadership traits he demonstrates in his career

The 2015 Emergency Nurse of the Year is described as the “embodiment of nursing – bright, efficient, unflappable.” Fearless when it comes to protecting her patients, Butler pushes for excellence but also offers plenty of praise along the way. Butler’s staff knows her expectations are high for everyone on the team … including herself. With 21 years of nursing experience and six years in the emergency department, Butler is most proud of helping further education and loves seeing patients benefit from lessons shared with colleagues.

GENERAL MEDICINE Sponsored by NorthCrest Medical Center Deidra Tidwell, RN-BC TriStar Ashland City Medical Center Over a 26-year career, the words ‘outstanding’ and ‘compassionate’ have often been used to describe this nursing leader with a heart for service. Her dedication to her staff and passion for those in her care have resulted in successful patient outcomes and enhanced employee engagement.

Tidwell’s quest for excellence has been demonstrated not only in her achievement of a 4.0 GPA while caring for her family and working 12-hour shifts, but is also illustrated in her encouragement of others to hold steadfast to their career goals and her support in helping make those dreams come true.

HOSPICE & PALLIATIVE CARE Tammy Stokes, RN, BSN Maury Regional Medical Center Described as a tireless worker with a tender heart, Stokes goes ‘above and beyond’ when it comes to helping patients achieve end-of-life wishes.

Through her leadership in palliative care, she has been able to promote a culture of change within the medical community and has been proactive in her outreach to underserved rural communities. Stokes encourages individuals to make end-of-life decisions before a crisis situation and helps families find peace in accepting and respecting those choices. Although her specialty field can be draining, Stokes finds great fulfillment in helping empower patients and families at the end of life.

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MANAGED CARE

PEDIATRIC

Sponsored by Cigna HealthSpring

Sponsored by Monroe Carell Jr. Children’s Hospital at Vanderbilt

Melinda McMeans, RN Amerigroup Within her managed care organization, McMeans works with pregnant women who have substance abuse disorders, engaging the women through education and connecting them to local resources to improve outcomes for both the mother and child. Throughout her 25-year career, McMeans has been steadfast in her philosophy: “Never give up on what you believe to be the right thing to do and adjust to change without compromising your beliefs.”

This cornerstone of her practice has led to healthier, brighter futures for those she serves.

NURSING ADMINISTRATION Kim Parham, RN, SBN, CN-BN Saint Thomas Health Although her role as a nurse has changed during her three decades of practice, Parham’s passion for giving patients and staff members the hope and positive mindset needed to navigate the healthcare journey has remained constant. Today she uses that experience and desire to hire compassionate, flexible team members. With a detailed orientation and ongoing mentorship, Parham allows staff to work independently but encourages input from every member of the team to improve outcomes. Living her organization’s motto, Parham tells her team that ‘nothing shall be impossible’ for patients throughout the continuum of care.

NURSING EDUCATION Sponsored by Belmont University College of Health Sciences & Nursing Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT Tennessee State University Taking community and social responsibility has been part of Wilson’s nursing platform for more than 40 years and is a tenet the beloved professor passes along to her students. For the past seven years, Wilson has been widely recognized as a faculty member who makes a difference in the lives of nursing students by imparting wisdom and offering hands-on opportunities that showcase the importance of community service to the nursing profession. Wilson noted that she is a nurse first and with that in mind tries to lead by example, modeling her life in service to others.

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QUALITY & RISK MANAGEMENT

STUDENT NURSE OF THE YEAR: GRADUATE

Sponsored by Hylant Group

Sponsored by Lipscomb University School of Nursing

Cheryl Major, RNC-NIC, BSN Monroe Carell Jr. Children’s Hospital at Vanderbilt

Mary Lee Lemley, RN, MSN Monroe Carell Jr. Children’s Hospital at Vanderbilt

With a wealth of nursing experience, Major continually seeks opportunities to provide education and to advocate for programming and services that prevent and address issues impacting the incidence and disparity in outcomes for babies. Her 42 years of practice have influenced the care of thousands of infants in Tennessee and around the globe through her work in Haiti and Kenya. As she embarks on retirement, the selection committee has chosen Major as the first repeat recipient in this category in honor of her work and legacy. She was initially honored in 2010, the inaugural year of the awards program.

Lemley has been affecting positive change in the healthcare system for 20 years. Approachable and nonjudgmental, she brings pertinent scenarios to providers and facilities to improve the care of various patient populations and encourages team members to develop new skills, test systems, understand team roles, create solutions for the unexpected, and hone clinical reasoning in the environments where these critical skill sets will be put into practice. While recognizing that change isn’t always easy, Lemley knows transformation is both inevitable and exciting when coupled with the proper training.

PUBLIC & COMMUNITY HEALTH 1:

RESEARCH

WOMEN’S HEALTH

Sponsored by Vanderbilt University School of Nursing

Sponsored by HCA/TriStar Health

Sponsored by Amerigroup Sharon Hendrix, RN, DNP, FNP-BC Vanderbilt University School of Nursing Hendrix has more than 40 years of nursing experience with 24 years in advanced practice.

She addresses key public health issues by conducting workplace wellness programming to reduce the risk of obesity, hypertension, and diabetes in adult clients. Additionally, she teaches community health nursing and mentors students to address self-care in elderly adults living in lower income residential facilities. Hendrix is also developing a partnership with a food truck to expand services to a population that currently does not have ready access to healthy food options. Her multi-faceted efforts impact both the community and the nursing profession.

PUBLIC & COMMUNITY HEALTH 2: Sponsored by Amerigroup Jacque Cundall, RN, BSN Tennessee Department of Health Cundall has spent 43 of her 44 years in nursing addressing public health concerns.

Tennessee’s newborn hearing screening and follow-up program wouldn’t exist today if Cundall had not taken the initiative and worked closely with hospitals, providers, parents and advocates to encourage screening at birth. To support her passion, Cundall developed new procedures, linkages for early intervention, referral networks, quality improvement projects, task forces, and grant funding. Under her leadership, more than 98 percent of Tennessee newborns receive a hearing screening in their first month, and 66 percent of infants with hearing loss are enrolled in early intervention programs by six months.

Todd Monroe, PhD, RN-BC, FNAP, FAAN Vanderbilt University School of Nursing Monroe’s research focuses on the critical need to improve pain management and detection in the cognitively impaired older adult.

Recent accomplishments include publication of numerous articles in refereed journals, presentations at national meetings, and leadership of a team that has garnered national recognition on the topic of nursing care of the elderly. Calling on his 17 years of experience, Monroe is also active in mentoring undergraduate students and nurses to help them pursue graduate education and research activities.

STUDENT NURSE OF THE YEAR: UNDERGRADUATE Sponsored by Lipscomb University School of Nursing Dereldia Clendening Lipscomb University School of Nursing Clendening was nominated for her compassion, as well as for displaying the strong leadership characteristics that are a vital component of the nursing profession. An outstanding student, she is busy honing her clinical skills. However, Clendening also believes many health issues can be better addressed in the community.

As a result, she also is actively involved as a volunteer with a number of community education programs aimed at helping alleviate negative health outcomes and decrease disparities.

Jennifer Barut, PhD(c), MSN, RN-BC Vanderbilt University School of Nursing Barut is passionate about the mentally ill and has been recognized for her work by the American Psychiatric Nurses Association.

Throughout her 15-year nursing career, she has also been an outstanding scholar.

Beginning in 1999 with an associate’s degree, Barut successfully became a doctoral candidate in 2015. Thrilled to reach this personal goal, she said she is extremely grateful for the varied experiences in nursing – from the bedside, to the community, to various roles in nursing education – which she has enjoyed along the way.

Jessica Woods, RN, BSN TriStar Hendersonville Medical Center Woods has displayed leadership qualities throughout her five years of practice. The women’s health specialist is continually looking for ways to improve work processes to improve quality of care and optimize the team environment. Recently, Woods created a discharge checklist to help new employees ensure the correct documentation was completed prior to a patient leaving the medical center. The checklist has also helped normalize education to prepare new mothers to safely care for themselves and their new infants upon discharge. This is just one example of how Woods is positively impacting her patients and colleagues.

DISTINGUISHED SERVICE TO THE MARCH OF DIMES Cheryl Major, RNC-NIC, BSN In addition to being named Pediatric Nurse of the Year, Cheryl Major was also honored for her tireless work on behalf of March of Dimes and living the organization’s mission.

Having started her career in an era when preterm babies almost certainly died, Major quickly became involved with a new unit at Vanderbilt that was working to revolutionize the way fragile infants were cared for – one of the very first NICUs in the nation. Over the ensuing decades, Major has been at the forefront of revolutionizing neonatal care across the state and in creating models that other states have adopted.

She helped pioneer NICU regionalization and addressed transportation issues to ensure high-risk newborns could receive the best care in the right facility.

Thanks to her dedication, countless babies have been given a fighting chance.

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GrandRounds Capella Names National Advisory Board Capella Healthcare’s new National Advisory Board of Directors has been appointed, with founder Dan Slipkovich named as chair, according to Michael Wiechart, president and CEO. The board includes representatives from communities served by Capella, including hos- Dan Slipkovich pital board chairs, physicians and hospital leaders, as well as other prominent industry leaders.

In addition to Slipkovich and Wiechart, the 10-person inaugural board includes several with strong ties to Tennessee. Robert Z. Hensley previously served on Capella’s board and is a director for several companies, including Diversicare, Inc., Athletico Inc., and Community Healthcare Trust. Donald E. Lighter, MD, MBA, FAAP, FACHE, serves as professor and core faculty for the Physicians’ Executive MBA program at the University of Tennessee and as director of The Institute for Healthcare Quality Research and Education. Mark Medley is president of Hospital Operations for Capella Healthcare and also serves as an executive vice president of the company. The full list of members is available in the Grand Rounds section of NashvilleMedicalNews.com.

Zoghbi Receives 2015 Vanderbilt Prize in Biomedical Science Huda Y. Zoghbi, MD, a physicianscientist known internationally for her extraordinary range of discoveries in neurology and neuroscience, is the recipient of the 2015 Vanderbilt Prize in Biomedical Science.

Zoghbi is a profesDr. Huda sor in the Departments of Zoghbi Pediatrics, Molecular and Human Genetics, Neurology and Neuroscience at Baylor College of Medicine, a Howard Hughes Medical Institute investigator and director of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital in Houston.

She is the 10th recipient of the Vanderbilt Prize in Biomedical Science, established by Vanderbilt University School of Medicine in 2006. Zoghbi will receive her award on April 21, 2016 when she delivers a Flexner Discovery Lecture.

A native of Lebanon, she began medical school in Beirut but transferred to Meharry Medical College because of civil war in her homeland. Much of her research has focused on Rhett syndrome and spinocerebellar ataxia type 1 (SCA1). After joining the Baylor faculty in 1988, and in collaboration with Harry Orr, PhD, at the University of Minnesota, Zoghbi helped identify the mutant gene responsible for SCA1. Their work shed light on the role that abnormal proteins and protein misfolding play in neurode-

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FEBRUARY 2016

generative diseases like Parkinson’s and Alzheimer’s. Another line of inquiry led to the discovery of a gene that is essential for the generation of inner ear hair cells. The discovery encouraged development of potential gene therapy approaches for deafness.

Lovell Expands Team, Opens New Office Nashville-based strategic communications firm Lovell Communications recently announced expansion of the agency’s footprint with the opening of an office in Baton Rouge, La., which will be led by veteran healthcare marketing and public relations strategist Nicole Kleinpeter. The agency now has operations in three states with another office being located in Louisville, Ky. Additionally, three new team members also have joined join the firm’s headquarters’ office in Nashville. Melissa Wyllie, senior account supervisor, brings 15 years experience in marketing and media communications with strong knowledge of the wellness, disease management, prevention, behavioral health and mobile health sectors. Sam Prichard, has come on board as a senior account executive managing public relations and marketing efforts for agency healthcare clients, specializing in the areas of media relations, thought leadership, content creation and event planning. Kristy Lucero joins the agency as an account executive with experience as a content creator and marketing and PR specialist with expertise in the consumer, healthcare, nonprofit, hospitality and tourism industries.

Bass Named CEO of InVivoLink John Bass has been named CEO of InVivoLink. The healthcare technology company, a HealthTrust affiliate since November 2014, provides expertise in bundled payments and value-based medicine.

Bass has served as the company’s COO since its Bradford Vieira creation in 2009. Previously, he was COO of Titan Management Group and was on the startup team for empactHealth.com. A Nashville native, Bass earned a bachelor’s degree in chemistry from the University of North Carolina at Chapel Hill.

TriStar Centennial Welcomes Garwood TriStar Centennial Medical Center recently welcomed Susan Garwood, MD, a pulmonary/critical care and lung cancer specialist, to its medical staff.

Garwood completed her undergraduate degree in biomedical science at Texas A&M University and Dr. Susan Garwood her medical degree at the University of Texas at Houston Medical School. She completed her residency

in Internal Medicine at Vanderbilt University and completed her internship in Pulmonary and Critical Care at the Medical University of South Carolina.

She is board-certified in pulmonary and critical care medicine.

Garwood’s new practice, Centennial Thoracic Surgical Associates, focuses on interventional pulmonary with a special emphasis on the diagnosis of lung cancer.

Melvin Joins TriStar StoneCrest Staff Willie V. Melvin, III, MD, FACS, a board-certified general surgeon, recently joined the medical staff of TriStar StoneCrest Medical Center. Melvin also joined The Surgical Clinic, which is located on the campus of TriStar StoneCrest in the PhysiDr. Willie V. Melving, III cian’s Building.

A graduate of Texas Southern University in Houston with a bachelor’s degree in biology, Melvin received his medical degree from Meharry Medical College and completed his residency at St. Joseph Hospital in Houston. Prior to joining The Surgical Clinic, Melvin served as assistant professor of Laparoscopic and Endoscopic Surgery at Vanderbilt University Medical Center and at Nashville VA Medical Center.

MHC Adds Internal Medicine Physician Patricia Arns, MD, has been named Integrated Health Cooperative’s new medical director. The primary care clinic is an LLC of Mental Health Cooperative. As an internal medicine physician, Arns provides medical and preventive care, as well Dr. Patricia Arns as educating psychiatric providers, nurses and care managers about physical health issues within MHC’s Integrated Health Cooperative clinic.

Prior to joining MHC, Arns spent 22 years in private practice and 19 years with Nashville Medical Group (now known as Saint Thomas Medical Partners). She completed her studies at Mount Holyoke College, Harvard Graduate School of Education and Mount Sinai School of Medicine. Arns also completed a fellowship in Clinical Pharmacology at Vanderbilt School of Medicine, an internship at University of Oklahoma Medical Center and internal medicine residency at University of Tennessee at Baptist Hospital.

Diatherix, VUMC Establish Multi-Year Clinical Study Agreement Recently, officials with Diatherix Laboratories, LLC, a provider of multiplex

diagnostic services and solutions, announced the company has established a multi-year research agreement with Vanderbilt University Medical Center and the Vanderbilt Vaccine Research Program. Diatherix will provide clinical laboratory services using its proprietary multiplex molecular diagnostic platform for the detection of infectious diseases.

Diatherix and the Vanderbilt Vaccine Research Program will collaborate on high-impact research programs to enhance and expand both organizations’ capabilities related to the detection of bacterial and viral infections in both pediatric and adult patient populations.

The alliance was designed to advance scientific and medical knowledge, with a due regard for patient safety and improvement of patient outcomes, particularly in children.

Colombo Tapped to Lead Vanderbilt Stallworth

Armando Colombo has been named chief executive officer of Vanderbilt Stallworth Rehabilitation Hospital, a joint venture between Vanderbilt University and Vanderbilt Health Services, LLC, and HealthSouth. He comes to Vanderbilt Stallworth after serving as president and CEO of InterMedical Hospital of South Carolina in Columbia.

Colombo has more than 20 years of healthcare experience, including three years as CEO and CFO of HealthSouth Rehabilitation Hospital of Sarasota and HealthSouth Rehabilitation Hospital of Tallahassee. He received his bachelor’s degree in accounting from St. Louis University.

LifePoint Promotion, Acquisitions LifePoint Health has appointed J.L. Osei Mevs to the role of chief of staff.

Previously, he served as director of Government Relations. In his new role, Mevs will work closely with Bill Carpenter, LifePoint’s chairman and CEO. Mevs has more than J.L. Osei Mevs 15 years of experience in public policy and legislative strategy, regulatory research and analysis, government relations, business development and community outreach. Prior to joining LifePoint, Mevs served as vice president of external affairs and business development at Meharry Medical College.

He earned his undergraduate degree in psychology from New York University and his master’s in public health/health policy and management from Columbia University’s Mailman School of Public Health in New York. Mevs is a Fellow of the Nashville Health Care Council.

In other news, LifePoint completed the acquisition of St. Francis Hospital in Columbus, Ga. at the beginning of the

Read More Grand Rounds online.

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year. Also last month, Duke LifePoint Healthcare announced the acquisition of Central Carolina Hospital and Frye Regional Medical Center from Tenet Healthcare Corporation. Central Carolina is a 137-bed hospital in Sanford and Frye Regional a 335-bed hospital in Hickory. The acquisition also included 19 regional physician practices.

News from NextGxDx

solution that enables healthcare institutions to create genetic testing formularies that can lower the costs and address the workflow inefficiencies associated with genetic test ordering, at the children’s hospital.

Cheryl Hess has joined the company as an account manager. She is a board-certified genetic counselor with deep expertise in patient care and a background leading local and national utilization management initiatives. Hess joined Cheryl Hess NextGxDx from Detroit Medical Center University Laboratories.

She holds a master’s in genetics from Case Western Reserve University and is certified by the American Board of Genetic Counseling. She will report to Dan Kauke, former NextGxDx marketing director, who has been promoted to the newly created role of director of customer operations.

Nick Tazik has been tapped as director of marketing. Previously, he was with the strategic marketing department at Vanderbilt University Medical Center. While at Vanderbilt, Tazik supported the launch and growth of new clinical initiatives, Nick Tazik including the Vanderbilt Health Affiliated Network. Tazik completed his graduate management education at the Owen Graduate School of Management at Vanderbilt University.

Recently, NextGxDx Inc., which provides an online genetic testing marketplace for healthcare professionals and hospitals, announced the addition of two team members promotion of one and a new agreement with Cincinnati Children’s Hospital Medical Center.

NextGxDx will deliver GeneConnect™, the genetic test utilization management

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements

Jennifer Pietenpol, PhD, will be honored at the T.J. Martell Foundation 8th Annual Nashville Honors Gala on Feb. 29. She is one of six honorees and has been selected for the Medical Research Advancement Award. Pietenpol is director of the Vanderbilt-Ingram Cancer Center.

Leadership Health Care recently announced the organization’s 2015 awards. Baxter Lee, CFO at Entrada, received the Dr. Jennifer Health Care Emerging Leader of Pietenpol the Year award. Wes Pass, vice president of Bank of America Merrill Lynch’s national for-profit healthcare group, was named Ambassador of the Year, and Bradley Arant Boult Cummings was named Supporting Organization of the Year.

Acadia President Brent Turner has been LHC award-winners (L-R) Baxter Lee, Wes Pass, and Kevin Campbell, partner at Bradley Arant named to the board of Surgery Partners. He is Boult Cummings the fifth director named for the company, which went public last year.

Gina Pruitt, the member in charge of the risk assurance and advisory services practice of Nashville-based KraftCPAs PLLC, was recently selected to serve on the American Institute of Certified Public Accountants (AICPA) National Service Organization Control (SOC) Task Force.

The group is responsible for determining updates and changes to the SOC standards, audit guides, and the peer review questionnaire.

Gina Pruitt Trudie Goers, MD, FACS of The Surgical Clinic PLLC in Nashville became a Fellow of the American College of Surgeons during 2015 annual Clinical Congress in Chicago. Goers, who received her medical doctorate from the Medical College of Wisconsin, has a strong professional interest in esophageal surgery.

Three employees at TriSDr. Trudie Goers tar StoneCrest Medical Center earned a Certificate in Healthcare Leadership from Union University – Center for Excellence in Health Care Practice. Ashley Fleming, RN, surgical services manager, Heather Bratcher, RN, emergency services director, and Paul Hartley, patient access director, recently completed the 2015 TriStar Health Leadership Academy to earn the (L-R) Ashley Fleming, Heather Bratchera and Paul Hartley distinction.

Wishes Granted Anton Reiner, PhD, a professor in the Department of Anatomy and Neurobiology in the College of Medicine at the University of Tennessee Health Science Center has received a $617,000 grant from the Cure for Huntington’s Disease to study the hereditary, degenerative brain disease that usually becomes apparent around 40 years of age and ultimately results in the destruction of the cerebral cortex and basal ganglia.

Researchers at Vanderbilt University Medical Center have received more than $11 million in new grant support aimed at slowing the growing burden of diabetes. The central theme and unifying focus of two grants from the National Institutes of Health (NIH) and one from the Juvenile Diabetes Research (L-R) With the help of more than $11 million in new Foundation (JDRF) is to improve understandgrant support Jeremy Norris, PhD, Christopher Wright, DPhil, Marcela Brissova, PhD, and colleagues ing of changes that occur in the human panat Vanderbilt are exploring new ways to help slow the creatic islet in type 1 and type 2 diabetes. growing burden of diabetes.

Alive Hospice Announces Three Executive Appointments

PHOTO BY SUSAN URMY

PUBLISHED BY: SouthComm Business Media, Inc.

Middle Tennessee nonprofit Alive Hospice recently announced three additions to its executive leadership team.

Robert Berkompas, MD, a veteran physician who has practiced in Middle Tennessee with Saint Thomas Medical Group for the last 25 years, has been named Alive Hospice’s chief medical officer. He is board-certified in internal medicine and served as an Alive Hospice team physician for seven years before his appointment as the agency’s chief medical officer.

Kathi Lindstrom, PhD, FNP-BC, ACHPN, HSMI, has been named executive director of the Alive Institute, Alive Hospice’s center for outreach, innovation and advocacy. Lindstrom will continue to serve on the faculty of the Vanderbilt University School of Nursing.

Kira Hilley has joined the agency as vice president of community development. In that role, Hilley is responsible for the development and management of a comprehensive fund development program, as well as marketing. After executive positions in finance and marketing, she most recently served as senior director of development and advancement for Nashville Opera. Prior to that post, Hilley served as executive director of Leadership Music.

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Divorce?

The Rices wrote the book on divorce.

Anything else?

Larry Rice Family Law Specialist, NBTA Mid-South Super Lawyer Family Law 2008-2015 Avvo Rated Superb 10 of 10 in Divorce and Family Law Top 50 Attorney in all areas of law in Memphis, Thomson Reuters Top 100 Attorney in all areas of law in Tennessee, Thomson Reuters Nationally Ranked Top 10 Attorney in Tennessee National Advocates Top 100 Matrimonial and Family Lawyers Top 10 in Client Satisfaction, American Institute of Family Law Attorneys National Advocates Top 100 Matrimonial and Family Lawyers Co-founder of the Tennessee Bar Association Divorce & Family Law Section Founder of the Memphis Bar Association Divorce & Family Law Section Tennessee Supreme Court Child Support Guideline Commission Family Law Revision Commission Exceptional Mentorship, Rhodes College Over 200 CLE Lectures, including 12 American Bar Association Conventions Matrimonial Strategist Board of Editors Author: The Complete Guide to Divorce Practice, First, Second, Third Edition Divorce: What You Need to Know When It Happens to You Divorce Practice in Tennessee Tactics in Divorce Practice Alternate Dispute Resolution The Joy of Cross Examination Family Law, “How to Win For Your Client” Rice’s Divorce Practice Manual Trends and Issues in Family Law The Effective, Ethical Lawyer

Divorce Practice A to Z Divorce Lawyer’s Handbook Hot Topics in Family Law Divorce Trial, Tribulations, Tactics, and Triumphs Tennessee Evidence Workshop Handbook National Divorce Skills Institute Manual Using ‘Divorce Worksheets’ to Keep Track of Cases Child Custody in Tennessee Alimony- What it is, What it was, and What it shall be.

How to Run an Efficient and Effective Divorce Practice and Improve Client Satisfaction Antenuptial Contracts-Alimony, Attorney Fees, & Property Division Nick Rice Rising Star 2010-2015 for Family Law, Super Lawyers Honored Professionals Top 5% for 2014, American Registry Top Attorney in the Memphis area Outstanding Young Lawyer, American Registry Finest Young Professionals, Cystic Fibrosis Foundation Top 10 in Client Satisfaction 20142016, American Institute of Family Law Attorneys Rule 31 Mediator Family Law Section Executive Council member of the Tennessee Bar Association Nick and Larry Rice Authors of “The Complete Guide to Divorce Practice – Forms and Procedures for Attorneys” 25th Anniversary Edition Face of Divorce Law, Memphis Magazine 2013-2016 Jennifer Bellott Goodin Super Lawyer Rising Star National Best Oral Advocate, 2008 ABA NAA Competition

Memphis Magazine “Women to Watch” 2014-2015 Top Attorney in the Memphis area Outstanding Young Lawyer, American Registry Top 10 Client Satisfaction, American Institute of Family Law Attorneys Jessica Farmer Academic Achievements Award Trust Law, ADR/Mediation, and Decedent’s Estates Joseph Henry Shepherd Scholarship Association of Women Attorneys Scholarship Tracy Eaton Academic Achievements Award Law Practicum, Non-profit Organizations, and Problems in Bankruptcy Andrea Schultz Certified Paralegal Advanced Certified Paralegal in Family Law – Dissolution Case Management, NALA Past President Greater Memphis Paralegal Association Memphis Magazine “Women to Watch” 2014-2015 Susan Woodard Certified Paralegal Advanced Certified Paralegal in Family Law – Division of Property & Spousal Support, Alternative Dispute Resolution, Trial Practice, & Discovery, NALA Stacey Pipkin President of the Greater Memphis Paralegal Alliance National Association of Legal Assistance Honor Society Rice Amundsen Caperton PLLC Memphis Finest Law Firm, Commercial Appeal 2014, 2015 Top 10 Law Firm, American Institute of Family Law Attorney

Rice Divorce Team 6 1 5 . 8 1 3 . 11 0 0 f i r m @ r i c e l aw . c o m • w w w . a b o u t d i v o r c e . c o m