Nashville Medical News May 2015

FOCUS TOPICS WOMEN’S HEALTH HEALTH INFORMATION TECHNOLOGY

May 2015 >> $5

Middle Tennessee’s Primary Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 2

Shantell Ceaser, MD ON ROUNDS

PHiiT: Statewide Initiative Addresses Pressing Pediatric Issues In the fall of 2013, the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) launched a bold new initiative to address pediatric quality issues in primary care through the formation of the Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT). ... 4

TMA Wraps MedTenn15 Dr. John Hale Inducted as President ILast month, physician leaders, practice managers and other healthcare professionals from across the state gathered in Nashville for MedTenn15, the annual convention of the Tennessee Medical Association ... 13

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Please see our special section honoring nine outstanding healthcare leaders in Middle Tennessee

Security Risk

Data-Rich Healthcare a Major Target for Cyber Thieves

By CINDy SANDERS

You are a security risk.

It might sound harsh, yet the sentiment is true for almost every practice, hospital, insurer, healthcare company, or business associate in the world. Size doesn’t really matter … small is often easier to attack and large offers a bigger payday. Sophisticated systems help, but you are only as secure as your weakest link.

In fact, most security and risk experts echo the same sentiment when it comes to data breaches – it’s not a matter of if but when. Adding fuel to the fire, a number of experts have dubbed 2015 the “Year of the Healthcare Hack.” On that happy note, what can be done to minimize risk and damage?

Be Aware & Prepared There are no simple solutions, but there are certainly safeguards and best practices that can be adopted.

Mark Fulford, CISA, CISSP, ABCP, a partner in LBMC Secu-

rity & Risk Services, said there are many resources and tools available from the Office of the National Coordinator (ONC), Office of Civil Rights (OCR), HealthIT.gov, Healthcare Information & Management Systems Society (HIMSS) and others. In addition, private consulting companies and many technology vendors are also available to help assess and address risks.

One of the first steps, Fulford said, “Is just knowing where all your protected health information (PHI) is. It sounds easy, but it’s not. It could be on your smart phone text messages, emails, voice mails, in files sent to your business partners. If you don’t know where it is, you can’t protect it.”

Fulford continued, “Next, you need to understand what the threats are to the confidentiality or availability or integrity of those assets.” Those vulnerabilities range from a data breach to a virus attacking information to data loss because of poor backup systems.

“Once you understand the threats to your data, then you can begin to evaluate to determine if the safeguards in place are adequate,” Fulford said. Finally, he noted, weaknesses must (CONTINUED ON PAGE 10)

BRCA Mutations & the Challenges of Genetic Testing

By MELANIE KILGORE-HILL

Advancements in BRCA research are revolutionizing women’s health.

The genetic test has even gained notoriety outside the healthcare community, as celebrities like Angelina Jolie openly discuss preemptive mastectomy and hysterectomy after testing positive for BRCA mutations. Just how much will this blood test change the face of healthcare, and what should general practitioners know about BRCA testing?

Identifying Those at Risk First, the facts: According to the National Institutes of Health, 12 percent (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Following her Dream: Meharry Graduate Shantell Ceaser, MD, Defies Odds

By MELANIE KILGORE-HILL

pany his mom to class, where he would form friendships among students and professors. Ceaser also credits God and the support of her family for getting her through those long rotations.

“It’s been the most amazing experience,” Ceaser said. “When I applied and interviewed for the postbach program, I could see that everyone is family here, and I knew it would be best for me and my son.”

Shantell Ceaser knows about hard work. The single mom will proudly add ‘MD’ to her title as she graduates from Meharry Medical College this month. The young doctor has come full circle as she prepares to return to her home state of Louisiana for an internal medicine residency. But for Ceaser, the road to medicine hasn’t always been an easy one.

One of four siblings, she watched helplessly as her sister Continuing became ill and later was diagMeharry’s Mission nosed with Crohn’s Disease. “I Ceaser also is passionwas young, and my family didn’t ate about Meharry’s mission: have insurance,” she explained. Soon-to-be Dr. Shantell Ceaser celebrates matching in her hometown of Shreveport “Worship of God through ser“We had to travel back and with son Elijah. vice to mankind.” While she forth to Shreveport (three hours anticipates a return to Louisieach way) to get a diagnosis. It was tough ana, she hopes to one day return to the policy and could just tell if I was having a because I wanted my sister to get the help college that gave her a chance. good or bad day. He or the others in the she needed, but that meant our family had “I feel that because of what Meharry office would always encourage me. ‘How to be apart.” has done for me – by not judging me or are you today? How is Elijah?’ They knew At age six, Ceaser’s parents gave her treating me like a burden – and letting me I was a med student but also a mom. It’s so a gift that would change her life: a doctor’s know that as long as I can do the work simple, but when I had a rough day they kit. “Ever since then I knew I wanted to be I’m accepted, one day I’d like to return to recognized that.” a physician,” she said. “After my sister got teach here. I want to be a part of Meharry That grace extended to the occasick, I knew I’d go back to my community again.” sional days young Elijah would accomand treat patients.”

Going Home On Meharry’s Match Day, Ceaser got her wish. This summer she and her son Elijah, 6, will return to her hometown of Lafayette for a three-year residency. It was one of four programs to which she applied.

“I didn’t know what I would get, but I knew I wanted to go home,” said Ceaser, whose family and close friends still reside in the area. She hopes to eventually specialize in geriatrics – a passion she developed while working in VA nursing homes – and also work with low-income populations.

“During college, I didn’t have insurance so it’s very important to me to take care of the community,” she said. “Every person deserves a chance to see a doctor.

It will be very special to take care of the underserved because that’s the type of community I came from. It’s important for me to be in a community like that.”

A Balancing Act So how does a single mom successfully navigate med school while raising a young child? With ample grace, love and prayer, she said.

“Meharry is a different program,” said Ceaser, who arrived in Nashville with her then 11-month old son in 2010.

“They’re understanding. They didn’t give me an excuse but moral support. My dean (Millard Collins, MD) had an open door 2

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Her advice to other nontraditional students is to determine what your ultimate dream is and pursue it. “Find out what’s really important,” she said. “I wanted to do better, and it was always my dream not only to be a doctor but to be in a better position to take care of my son.

You’ll have good days and bad days, but if you continue to believe in yourself, pray and have faith in God, you can do it.”

While being a single parent in med school is no easy feat, Ceaser said being very intentional with her time as a mom made it work. “I didn’t have a lot of time off so for me what little time I got off, I made special,” she said. “I know it’s tough for moms who work all the time and feel guilty. When I left school, it was just Elijah and me for the next few hours. I tell other single parents to be encouraged. You can always make time for your child. It’s the special time together that matters.”

That commitment has made a big impression on a special little boy – now a rising first grader with plans to save lives as a firefighter.

“Elijah’s excited,” Ceaser said. “He knows what a doctor does and brags on me. On Match Day, he told me, ‘Congratulations Mom, I’m very proud of you.’”

Perfect Matches: Meharry & Vanderbilt Celebrate as Students Move to the Next Phase of Training At the end of March, fourth-year medical students from around the country nervously waited to learn where they would begin their next phase of training as resident physicians. Match Day is the crowning moment of the National Resident Match Program (NRMP), which matches thousands of medical students with residency programs at medical centers and teaching hospitals across the country.

Each year, medical school students submit their top three choices for residency programs to the NRMP, which uses computerized mathematical algorithms to align preferences of more than 30,000 students with the residency programs available at U.S. teaching hospitals.

On Match Day, a day filled with anticipation and emotion, students receive a sealed envelope containing information about where they will spend the next few years of their lives. Each student is in the spotlight — often surrounded by family, friends, and mentors — as envelopes are eagerly opened to reveal the future.

By Vanderbilt tradition, the Associate Dean for Students randomly selects names, and as each person receives the envelope, he or she places one dollar in a fishbowl. The last person called gets to keep all the money as a reward for patience in the face of high anxiety. This year, 117 fourthAs dean, Dr. Jeff Balser kicks off an annual Vanderbilt Match Day tradition by dropping year VUSM students are graduating, and 91 were on hand to his dollar in the fishbowl. participate in the annual tradition. Fayrisa Greenwald, who matched in psychiatry at NYU School of Medicine, was this year’s fishbowl winner.

At Meharry Medical College, 76 students were matched with residencies at locations including the Mayo Clinic and Washington University in St. Louis. This year, 51 percent of Meharry students were matched with residencies in the primary care fields of internal medicine, pediatrics, family medicine and obstetrics and gynecology. Others matched in specialty fields including orthopaedic surgery and neurology.

Historically, Meharry has exceeded the national averages for students matched to primary care. The matches directly addresses the current shortage of approximately 9,000 primary care doctors and expected shortfall of up to 31,100 primary care doctors by the year 2025, according to a March 2015 study by the Association of American Medical Colleges. nashvillemedicalnews

.com

The doctors’ doctor:

Dr. Ming Wang Harvard & MIT (MD, magna cum laude); PhD (laser physics) Performed surgeries on over 4,000 doctors Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doctorate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”).

Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s first laser-assisted artificial cornea implantation. He has received an achievement award from the American Academy of Ophthalmology, and a Lifetime Achievement Award from the American Chinese Physician Association.

Dr. Wang founded a 501c(3) nonprofit charity, the Wang Foundation for Sight Restoration (www.Wangfoundation.com), which to date has helped patients from over 40 states in the U.S. and 55 countries worldwide, with all sight restoration surgeries performed free-of-charge.

Amniotic membrane is obtained after the baby’s birth

Inventions & Patents 1. LASERACT: All-laser cataract surgery U.S. patent filed.

2. Phacoplasty U.S. patent filed.

3. Amniotic membrane contact lens for photoablated corneal tissue U.S. Patent Serial No 5,932,205.

4. Amniotic membrane contact lens for injured corneal tissue U.S. Patent Serial No 6,143,315.

5. Adaptive infrared retinoscopic device for detecting ocular aberrations U.S. Utility Patent Application Serial No. 11/642,226.

6. Digital eye bank for virtual clinical trial U.S. Utility Patent Application Serial No. 11/585,522.

7. Pulsed electromagnetic field therapy for nonhealing corneal ulcer U.S.patent filed.

8. A whole-genome method of assaying in vivo DNA protein interaction and gene expression regulation U.S. patent filed

AMNIOTIC MEMBRANE CONTACT LENS

Dr. Wang’s invention U.S. patents: 5,932,205 & 6,143,315

Used by over 1,000 eye doctors to restore sight.

Wang Vision 3D Cataract & LASIK Center 615.321.8881 | WangCataractLASIK.com nashvillemedicalnews

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MAY 2015

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PHiiT: Statewide Initiative Addresses Pressing Pediatric Issues

By CINDY SANDERS

In the fall of 2013, the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) launched a bold new initiative to address pediatric quality issues in primary care through the formation of the Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT). Following a successful first pilot program in East Tennessee, PHiiT is now expanding its education and quality improvement efforts across the state.

The collaborative – which is inclusive of all Tennessee parties utilizing pediatric care, delivering pediatric care, measuring outcomes or structuring payment systems – came about as a result of conversations with key stakeholders over the course of several years. Allen Coffman, Jr., MD, FAAP, who Dr. Allen serves as medical direc- Coffman, Jr. tor of PHiiT, said many practices were struggling in the wake of the recession. At the same time, practices were being asked to revamp many of their processes.

“All of this was coming at one time,” said Coffman, a practicing pediatrician with Highland Pediatrics in Chattanooga and past president of TNAPP. “Providers were overwhelmed with the financial changes, care delivery changes, and changes on how our board certification processes were happening … so we asked, ‘How can we do this better?’”

As discussions became more formalized, Coffman said TNAPP realized it would take a broad coalition to address the changes providers faced and drive quality to improve the health of the state’s youngest citizens. PHiiT’s main goals are: to educate providers about high value process changes for practices to impact serious population health concerns, to bring together stakeholders to organize and prioritize what those population health priorities are and develop measures to assess outcomes, and to ensure providers and patients have the tools they need to be successful.

“We’re really focusing on that patient-provider space and making sure the patient and provider have the tools they need to make that a better working relationship,” Coffman said. After all, he continued, “The only ones who can really change healthcare delivery are providers in concert with patients.”

Working with the National Improvement Partnership Network out of the University of Vermont, PHiiT set about to develop and implement quality improvement projects around pediatric health concerns that are high cost, consistent with 4

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state and federal priorities, have poor outcomes, are difficult for patients, and/or cause frustration for practitioners.

Coffman said each quality improvement project also includes a Continuing Medical Education component and standardization of metrics and outcomes reporting so the collaborative could analyze data and broadly share information and best practices.

The first initiative – Breastfeeding Sustainment and Smoking Cessation Project – was piloted through practices in Chattanooga, Knoxville and Oak Ridge with funding from the Tennessee Department of Health and data support from the Tennessee Initiative for Perinatal Quality Care (TIPQC). Coffman said the project kicked off in the summer of 2014 and winds up this month. An educational program was hosted over two weekends to get providers – which included physicians, nurses, nurse practitioners, and medical students – up to speed on ways to extend breastfeeding and discourage tobacco use around infants, and preliminary data has been very encouraging.

“When you look at breastfeeding, one-third will breastfeed no matter what you do, one-third won’t no matter what, and one-third in the middle are undecided, ambivalent,” Coffman said.

“There is a high value window during the newborn period. We know the sooner you get them (mothers) in and the better you engage them that first two weeks, you maximize the chance they will continue to breastfeed,” he explained, adding this newborn period is also the most motivated time for caregivers to quit smoking.

“We have been able to improve the frequency of patients seen within 72 hours of hospital discharge from 76 percent at baseline to 85 percent at our first followup,” Coffman said. “Our two-month breastfeeding rate has increased from 56 percent at baseline, which was better than anyone expected, to 62 percent at our first follow-up,” he continued. Coffman did note the higher-than-normal baseline breastfeeding rate could be attributed to the type of practices that participated in in the pilot, which were already working to engage parents around the importance of breastfeeding.

As for the second part of the project, Coffman noted, “Only 60 percent of newborns were being screened for tobacco exposure at baseline. We were able to increase that to three-quarters, 76 percent, at our first follow-up.” He added that in-

stead of just asking if the child was exposed to tobacco, which Coffman said could feel judgmental and garner a biased response, PHiiT trained providers to reframe the conversation. “What we tried to teach was to positively engage the family around their care network and then go back and ask if each of those persons used tobacco.”

Ultimately, Coffman noted, providers need effective tools they can use to engage with patients. “We know there is a finite amount of time that the provider

and patient have so we look for the high value propositions … what really works.”

He continued, “We really push our education faculty to choose what are high value changes and then communicate that to providers and patients in a way that is useful.”

Coffman said an important part of the equation that has been missing is feedback as to what is sustainable and then using that feedback to help develop payment structures that incentivize continued process improvement. While the information is critical to inform practice and impact (CONTINUED ON PAGE 6)

TPCA, United Health Foundation Connect for Quality Last month United Health Foundation awarded $900,000 to the Tennessee Primary Care Association to help support “Tennessee Quality Connect,” a clinical initiative connecting healthcare professionals and patients through Community Health Centers (CHCs) in person or by utilizing telehealth technology.

CHCs, which are often located in communities where primary healthcare providers and hospitals are not easily accessible, serve as a primary source of care for one in 17 Tennesseans. However, when a patient’s condition requires the attention of a physician not on staff at a CHC, a range of barriers from a lack of transportation to not having adequate childcare to not being able to take time off work can stand in the way of seeing the specialist. The United Health Foundation grant is focused specifically on providing access to behavioral health and nutritional counseling services for individuals with hypertension, diabetes and depression to help combat these chronic issues.

The ability to leverage telehealth technology extends the reach of urban-based specialty care providers, improving access to critical health services in remote and underserved areas. More than 10 million people nationwide directly benefited from using telemedicine last year, according to the American Telemedicine Association.

“The Tennessee Primary Care Association’s work in the community has shown significant success in connecting people with quality healthcare services, and we are grateful for the opportunity to support its efforts to bring new, innovative approaches to healthcare,” said Rita Johnson-Mills, CEO of UnitedHealthcare Community Plan of Tennessee.

Announced at Neighborhood Health in Nashville, the grant is part of United Health Foundation’s “Helping Build Healthier Communities.” The funds will be awarded over three years and will support the Tennessee Quality Connect initiative at 17 CHCs, which collectively represent 104 health center sites serving more than 300,000 residents across 44 counties.

Officials gathered to celebrate the United Health Foundation grant to the Tennessee Primary Care Association last month. Pictured (L-R): UnitedHealthcare Community Plan of Tennessee COO Richard Reeves, Tennessee Primary Care Association CEO Kathy Wood-Dobbins, State Rep. Harold Love, State Rep. John Ray Clemmons, Neighborhood Health CEO Mary Bufwack, and UnitedHealthcare Community Plan of Tennessee CEO Rita Johnson-Mills.

nashvillemedicalnews

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Women’s Sexual Dysfunction & the Little Pink Pill magic pill, even if something were to be approved,” Faught said.

By MELANIE KILGORE-HILL

“Little Blue Pill” It’s the three-word phrase that revolutionized erectile dysfunction and generated worldwide awareness of a condition affecting some 30 percent of men. Nearly two decades after the FDA approved sildenafil for E.D., there’s another little pill making waves in the field of sexual dysfunction … only this time, it’s pink.

Flibanserin & HSDD Manufactured by Sprout Pharmaceuticals to treat Hypoactive Sexual Desire Disorder, or HSDD, flibanserin failed to receive FDA approval in 2010 and again in 2014. In February, Sprout filed a new application for use in pre-menopausal women. Originally created by German pharmaceutical company Boehringer Ingelheim to treat depression, flibanserin switched gears when trial participants reported an increase in sexual desire.

In 2014 the drug was sold to Raleigh-based Sprout, which touts the nonhormonal treatment as the first-in-class, first-in-disease treatment for HSDD – a lacking libido in an otherwise healthy person. And while the “little pink pill” has failed to receive FDA approval, it’s succeeded in sparking a heated debate about women’s sexual dysfunction.

“Women’s sexual health is really misunderstood,” said Brooke Faught, MSN, WHNP-BC, IF, clinical director of the Women’s Institute for Sexual Health. WISH, a division of Urology Associates, treats women struggling with decreased desire, diminished arousal and Brooke orgasmic potential, and Faught pain with intercourse, among other sexual and pelvic floor conditions.

“People still believe sexual dysfunction in women isn’t a medical entity because women with a low libido can still have intercourse, where men with erectile dysfunction can’t,” Faught said. “They don’t understand how debilitating it can be.”

Increasing Awareness Faught, who trained at a similar clinic in Philadelphia, was brought on to enhance women’s health services at WISH 10 years ago. She now treats patients from across the U.S. and internationally from her Nashville practice. And while the concept of women’s sexual dysfunction was once a blush-inducing novelty in the American South, Faught said the Nashville community has embraced the condition as a real problem affecting a reported 43 percent of women.

That’s thanks, in part, to awareness campaigns like “Even the Score,” which work to promote women’s sexual health nashvillemedicalnews

.com

equity. “If you’re a man with sexuality issues, you can take a ‘magic pill,’” Faught said. “But for those women who’ve become accustomed to not having sex, many experience changes in vaginal tissue and then are suddenly expected to jump on the bandwagon again. Many are suffering in silence.”

Like men, women go through various stages in their sexual lives, with no age limit as to when they’ll quit having sex. Faught treats patients in their 90s still eager to make the most of their love lives.

And clinics like WISH are often the sole place women feel comfortable discussing such intimate concerns.

“I have patients in my office in tears, all day, every day,” said Faught. “Women in general are just super complicated when it comes to addressing and dealing with sexual dysfunction, as so many things play a role when it comes to arousal and libido.

The pathway is complicated.” That’s because – unlike men – the woman’s primary sexual organ is the brain.

Diagnosis & Treatment Hormones clearly play a large role in sexual health, but while testosterone patches and gels have helped women in Europe, they’ve yet to be approved in the United States. Faught said many sexual health providers turn to compounded test products but admits that keeping testosterone levels in normal ranges long-term can be tricky. Menopause, breastfeeding, diabetes or thyroid problems, prescription medications and long-term use of birth control pills also can cause dysfunction.

“Treatment is really individualized, and there’s no ‘one size fits all’ protocol,” explained Faught, who said a solution is rarely as simple as low testosterone. ”I most often see biological causes, although there are still many women in crummy relationships or with a history of sexual abuse.”

Recommended treatment can range from general counseling or sex therapy to a change in depression, cholesterol or blood pressure medications, which can decrease sexual sensation. Patients often need encouragement to simply lay a healthier foundation: drink more water, eat healthier and exercise. “There’s no

The Future of Flibanserin Critics of flibanserin say HSDD is a made-up condition to benefit big pharma … essentially, the emotional connection women typically need to enjoy sex can’t be replaced by a pill. Similarly, some worry men might pressure or force their partners to take such a pill to increase their own sexual fulfillment. Regardless of the reasons, the FDA still needs more convincing.

“The FDA says we need more data, more proof that it’s needed,” Faught said.

“They want to see an overwhelming efficacy with the medication.”

In an emailed statement to Nashville Medical News from the FDA, the agency said they “cannot discuss any drug application that is still under regulatory consideration. Currently, the FDA continues to work with the company to determine whether the drug’s benefits could outweigh its risks.” Side effects of flibanserin, which works on neurotransmitters, include nausea, anxiety, insomnia and dizziness.

The missive went on to say, “The FDA’s regulatory decision-making on any drug product is a science-based process that carefully weighs each drug in terms of

its risks and benefits. The agency evaluates drugs based on science and strongly rejects claims of gender bias. The FDA strives to protect and advance all important areas of women’s health, including disorders of female sexual function.”

In June, Faught will head to D.C. to help advocate for women’s sexual health.

While the topic might be slow moving, it is moving thanks to voices like Faught’s.

In 2012, the FDA identified female sexual dysfunction as one of 20 disease areas of high priority and focused attention. The agency subsequently held a twoday meeting last October to advance their understanding of female sexual dysfunction.

“We are committed to working with companies to develop safe and effective treatments for female sexual dysfunction, as we do for all areas of unmet medical needs,” said the FDA in a statement.

Faught is crossing her fingers for a 2015 approval on flibanserin. “The concern is if it doesn’t go through, pharmaceutical companies will give up on the issue altogether, as so much money has already gone into marketing and awareness for this issue with no financial return,” she said.

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BRCA Mutations & the Challenges of Genetic Testing, continued from page 1 of women in the general population will develop breast cancer sometime during their lives, and 1.3 percent will develop ovarian cancer. By contrast, 55 to 65 percent of women who inherit a harmful BRCA1 mutation and around 45 percent of women who inherit a BRCA2 mutation will develop breast cancer by age 70.

In addition, 39 percent of women with BRCA1 mutation and 11 to 17 percent of women with BRCA2 mutation will develop ovarian cancer by age 70.

BRCA & Ovarian Cancer Marta Ann Crispens, MD, associate professor and gynecological oncologist at Vanderbilt-Ingram Cancer Center, said BRCA testing is recommended for all women diagnosed with ovarian cancer – the disease that killed Jolie’s mother. “We’ve been testing these patients for Dr. Marta Ann BRCA 1 and 2 for sevCrispens eral years, as breast cancer is very common among patients with ovarian cancer,” Crispens said.

Michael Milam, MD, a board-certified gynecologic oncologist with Saint Thomas Health, said the absence of a screening test for ovarian cancer means most cases are found in an advanced stage. “The interesting thing about ovarian cancer is that its risk of having a genetic Dr. Michael mutation is approxiMilam mately 20 percent, which is a lot higher and a separate topic than breast cancer,” Milam said. “The idea of identifying people at risk before they develop the disease is the Holy Grail.”

BRCA & Breast Cancer Mutations affect both men and women and often are associated with breast, pancreatic, ovarian and prostate cancers. BRCA mutational status also becomes important for those with an early stage cancer such as breast cancer, where knowledge of their status and high risk of subsequent cancers might influence surgical decisions.

Misconceptions about BRCA still exist, even in the medical community.

“Many people believe that if someone in their family has breast cancer, they must have BRCA,” said Erika Hamilton, MD, associate director of the Breast Cancer and Gynecologic Cancer Research Program at Sarah Cannon Research Institute. “But statistics tell us that only Dr. Erika 5-10 percent of cases are Hamilton due to BRCA 1 or 2. The rest of the cases are because breast cancer is just so common, and we need to educate people about that.”

Genetic Testing: What Providers Need to Know Knowing who - and how - to screen 6

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What are BRCA1 and BRCA2?

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product either is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

Specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer. A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50 percent chance of inheriting the mutation. The effects of mutations in BRCA1 and BRCA2 are seen even when a person’s second copy of the gene is normal.

Source: National Institutes of Health

is the biggest struggle surrounding BRCA testing. The screening process starts with a thorough family history, often gathered by a general practitioner. Milam said patients could be their own best advocates by providing a thorough family history up front, especially since today’s office visits are often rushed. Patients with a diagnosis of ovarian cancer are always screened.

Those under the age of 50 with a history of cancer, or those with multiple family members with breast or ovarian cancer also are strong candidates for BRCA testing.

The next step, said all three specialists, is often marred by the medical community at large. While any provider can order the blood test (which typically is covered by insurance for those at-risk patients), patients often don’t receive adequate genetic counseling to help them grasp the potential emotional, physical and familial impact of BRCA testing. “It’s not just, ‘Here’s a blood test,’ but practitioners need to really understand how it impacts patients and potentially their families,” Milam cautioned. “One of the biggest changes over the last few years is that we used to just test for certain mutations, but today’s expanded testing can add to the confusion. That part’s complicated to patients, and we need to emphasize the need for more support with genetic counseling.”

Crispens also cautioned that genetic testing should never be done outside of genetic counseling. Counselors help patients understand implications, know how to talk to families, obtain medical records, clarify risks and interpret tests.

“Get counseling first and then get testing,” Crispens stressed. “A positive test is fairly straightforward, but a negative test may mean there’s no established gene in the family and may not be truly negative. Genetic testing isn’t definitive in that sense. If there’s no established gene but a strong family history and you test negative, there may be a gene you didn’t inherit, or a gene we don’t know how to test for.”

A third possibility is a variant of an insignificant gene appearing on a test. “Polymorphism is normally no big deal, but if it results in a protein that doesn’t function,

that’s a mutation,” Crispens said. “These genes can have mutations in multiple sites.

Sometimes there’s not enough people with a gene at that site to know whether a change there is associated with cancer or not, and we can’t know whether it’s a mutation or a variant of uncertain insignificance.” Over time, researchers can track these changes and reclassify them as benign or mutations depending on how many patients demonstrate that pattern.

“Interpreting these tests is relatively complex, and genetic testing isn’t just a ‘yes’ or ‘no’ answer,” said Crispens, who often sees referrals who lack a real understanding of what their tests mean. “Testing has changed so much, and it really is hard to keep up with. There are a lot of subtleties, but if you don’t fully understand it or know how to manage it, that’s a problem.

If you’re a generalist, will you follow-up every year about a genetic insignificance?

Those are important things to think about when ordering BRCA testing.”

Options After Testing According to Hamilton, BRCAlinked cancers behave differently and are

driven by cellular signaling. Preventative strategies including medications and surgical options (such as mastectomies and oophorectomy) reduce a woman’s risk of developing cancers.

“We also now have a FDA-approved PARP inhibitor (olaparib) for heavily pretreated ovarian cancer so knowing an ovarian cancer patient’s BRCA status may open them up for commercially available treatments,” Hamilton said of the new drug class, which received accelerated approval December 2014. However, she said the jury’s still out on the best settings for PARP inhibitors.

“There are a variety of clinical trials using PARP inhibitors and certain classes of chemotherapy (platinums) aimed at improving our standard-of-care treatments for patients whose cancers may be driven by a mutation in BRCA 1 or 2,” she said. “We know there are many patients who would benefit from them, and we still need to find out who the best candidates are and in which cases they work best as a single agent or combined with other therapies. There are still a lot of questions.”

Sarah Cannon Research Institute currently has three trials available for patients with BRCA mutations and metastatic beast cancer, one trial for early stage triple negative patients with or without BRCA mutations combining platinum chemotherapy with a PARP inhibitor, two trials for BRCArelated ovarian cancer, and a final trial for patients with platinum sensitive ovarian cancer as a maintenance strategy to prevent disease recurrence.

For more information visit sarahcannon.com/clinical-trials.

PHiiT: Statewide Initiative, continued from page 4 outcomes, Coffman was quick to say that PHiiT provides tools and data but allows providers the freedom to be innovative in how they address issues with patients.

With the first pilot successfully drawing to a close, PHiiT is looking to expand that project and others across the state.

The collaborative recently announced an award of a $1.49 million, three-year contract with the Bureau of TennCare to take PHiiT’s efforts statewide.

The next project is to develop a pediatric metric dashboard with the assistance of all four pediatric residency programs in Tennessee. PHiiT’s quality coach will assist participating practices in gathering data pertaining to the measurement of the metrics. “That will give practices ongoing feedback as to what their practice is doing compared to the state aggregate,” Coffman said of the dashboard, known as the Provider Best Practice Resource.

From there, specific quality improve-

ment projects will be added. Coffman said asthma would be among the first initiatives with obesity, behavioral health and developmental screening modules as other likely candidates to roll out in the near future.

“What we’re hoping is to give practices real data to make business decisions around investing in quality improvement,” he said. “I think providers are going to learn a lot about the way they deliver care.”

PHiiT has begun enrolling additional practices to participate in the expanded programming. Coffman said pediatric, family and general practices that see children are all welcome to participate. In addition, school-based clinics, health department clinics and federally qualified health centers are also encouraged to enroll. For more information, contact Becky Brumley via email at becky.brumley@ tnaap.org.

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Society for Women’s Health Research Celebrating 25 Years of Moving the Science Forward

By CINDy SANDERS

Are women being adequately represented in clinical trials at the National Institutes of Health?

That simple question, pondered by Florence Haseltine, PhD, MD more than a quarter of a century ago, has led to sweeping changes in the way women are viewed on a physical, behavioral … and now … molecular basis.

Changing the Status Quo In the mid-1980s, Haseltine was working at the National Institute of Child Health and Human Development, which focused almost exclusively on women’s health in terms of maternal issues. Haseltine, who coined the term ‘sex-based biology,’ began gathering friends and colleagues together to champion additional women’s health concerns including endometriosis and ovarian cancer. Quickly, the mission grew to encompass much broader issues that disproportionately or differently impact women beyond the narrow scope of gynecologic disease.

The result was the formation of the Society for Women’s Health Research (SWHR) in 1990.

One of the people tapped to be part of that early volunteer board was Phyllis Phyllis Greenberger, who agreed Greenberger

to go to Capitol Hill with Haseltine to speak to the Congressional Caucus for Women’s Health Issues. “It turns out there was a 1985 Public Health Service report that was written by two doctors at the NIH that looked at whether there was enough attention on women’s health issues and were women being included in research. We used that report as ammunition,” Greenberger recalled, noting the answer to both questions was a resounding ‘no.’

At the behest of Greenberger and other SWHR volunteers, several members of Congress asked the Government Accounting Office (GAO) to investigate the NIH’s inclusion of women. Greenberger noted at that time the focus was on the disease without consideration of gender … even when the disease in question was known to disproportionately affect women, such as osteoporosis. “Nobody had any sort of separate designation for women,” she said.

Greenberger added the safety profiles and effectiveness data of many drugs were based on outcomes of the mostly young, healthy, white men who populated clinical trials.

In the aftermath of the severe birth defects that resulted from use of thalidomide and DES, women of childbearing years had been generally excluded from participating in pharmaceutical trials by a Food & Drug Administration (FDA) guideline released 13 years earlier. When NIH directors were effectively ‘called on the carpet’ as a result

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of the GAO audit, Greenberger said the excuse for not using more women (of any age) was pinned on hormonal changes that could make it more difficult to measure results, coupled with a belief that men and women were basically alike except for the reproductive system.

of medical research in terms of sex in 1996.

Five years later, “Exploring the Biological Contributions to Human Health: Does Sex Matter?” concluded that, indeed, it does.

“Phyllis’ effort between 1993 and 2001 was to try to change the scientific and medical practice perspective,” said Nolan.

SWHR launched scientific advisory meetings designed to engage the A Big Year for Change research community in debate By 1993, the volunteer For more and discussion about the role group made the decision information on of sex and gender differences to formalize and become in a variety of diseases and a 501(c)(3) organization. the organization’s conditions including the Greenberger, who viewed work and upcoming autoimmune system, carthe daunting task of changinitiatives, go online diovascular health and ading the status quo as “fun to swhr.org. diction. and challenging,” applied for Although getting more the founding staff leadership women into trials was certainly position with SWHR. As presiimportant, Nolan said it was only part dent and CEO, Greenberger has witof the battle. “Just including women in nessed tremendous change in how women equal numbers doesn’t matter if you’re not are assimilated into biomedical research but analyzing for differences,” she noted. Who still sees the long road ahead to fully embenefitted? Who got hurt? Was it equal brace diversity from bench to bedside. among subgroups, or was one outcome That same year, Congress passed the more predominant among men or women?

NIH Revitalization Act of 1993, which Drilling down in the data was crucial.

SWHR had worked tirelessly to get passed.

In fact, Greenberger noted, “A 2001 The legislation mandated women and miGAO report that was an investigation of norities be included in clinical research and the FDA found that eight out of 10 of the required Phase III trials be analyzed by most recent drugs pulled off the market gender. In light of the changes at the NIH, had disproportionate adverse effects for the FDA rescinded its earlier guideline women.” mandating the exclusion of women with Recently, Nolan added, another vicchildbearing potential. tory was achieved in moving the needle on meaningful analysis by SWHR and other Moving the Science Forward advocacy organizations. “In 2012, we manAlthough 1993 was a landmark year aged to get an amendment attached to a in terms of new rules and regulations for ‘must pass’ bill – the FDA Safety & Innovawomen’s health, Martha Nolan, JD, vice tion Act – on demographic reporting that president of Public Policy forced the agency to really look at how well for SWHR, noted it was demographic subgroups were represented simply a starting point. in drugs already approved and to what ex“Just changing the law tent demographic analysis played in the apdidn’t necessarily turn a proval process and issue a report … which switch and have everyit did in 2013.” one be in agreement,” she Since then, she said, an action plan has said. “There was a lot of been crafted to explain how the FDA will pushback.”

Martha Nolan address research gaps. “There are 27 points One example of the to that action plan, which gives us much to uphill battle to institute change is evident in digest and work on with the agency,” she the amount of time it took to codify various noted. women’s health initiatives across the federal government. The 1993 Revitalization Act Drilling Even Deeper made the Office of Research on Women’s “What we learned after the IOM reHealth at the NIH permanent. However, port is it isn’t just clinical science, it’s basic a number of other similar initiatives were research, too,” Greenberger said. soon launched across federal agencies such Nolan added, “Our priorities are a as the Substance Abuse and Mental Health continued focus on both the FDA and NIH Services Administration (SAMHSA) and due to changes that have occurred over the CDC. The Women’s Health Office Act last several years. One is the determination (WHOA) was an effort to make these new by the director of NIH that sex be a variable entities permanent. and be considered in pre-clinical research.

“In 1994, then Rep. (Olympia) Snowe This is wonderful … it’s something we’ve (R-Maine), who became Sen. Snowe, inbeen focused on for quite some time.” troduced this legislation for the first time,” While recognizing it will take time to Nolan said. “It became law in 2010 when it implement such changes, Nolan promised, passed in the Affordable Care Act.” Green“The key is they’re going to do it, and we’re berger added, “It took us 16 years to get the going to make sure they do it.” women’s health offices into law to protect Similarly, SWHR’s attention on mothem.” lecular diagnostics and precision medicine It only took about one-third of that also aims to discover the benefits of drilltime to get the Institute of Medicine to acing deeper to find genomic variations and knowledge the validity of sex-based biology. mutations impacting women’s health and The organization submitted a proposal to treatment options.

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Security Risk, continued from page 1 be addressed. “Threats paired with vulnerabilities helps us get to risk,” he explained.

Fulford said vulnerability management has to be approached with almost a religious fervor. “It’s got to be a top priority,” he stressed.

Fulford added it is mission critical to routinely scan systems looking for known threats and then working aggressively to find the fixes.

Even very large companies with big IT Mark Fulford departments can have critical risks … just ask Anthem. For large companies, Fulford noted, “Just the sheer volume of systems makes it hard to scan and patch quickly to close vulnerabilities.”

He pointed out, “It’s an overused cliché – but it is overused and a cliché because it’s true – that security is not a project, it’s a process … and you’re never really done with a process.”

Limit Data Sets A certain amount of risk is inherent if data is to be useful. “There’s a trade-off there,” said Amy Leopard, a partner at Bradley Arant Boult Cummings and a member of the firm’s Health Care Practice Group. “You can lock data down tight as a drum, but you need to share that data for qual- Amy Leopard ity. There is sometimes tension between the ease of use and availability and the need for security.”

She continued, “Everybody is using big data for analytics and population health.” But does everyone need all the data all the time? “To manage the risk of using and sharing health data, you first need to manage the scope and the volume of the data you are using,” she said.

Leopard added there is a tendency to overshare. If an analysis is being conducted on how many people are referred to a specific HIV clinic by a specific physician or practice, is it actually necessary to have those patients’ names, contact information and Social Security numbers … or do you just need an aggregate number of referrals? “De-identify data when you can,” Leopard said.

The Weakest Link “As a business associate under HITECH, you become part of the regulated community as soon as you start handling my PHI,” Leopard said. “If you are going to handle my data, I’m going to ask a lot of questions. I’m going to do a lot more due diligence on your company.”

That caution is well warranted. “You can’t outsource accountability,” Fulford noted of business associates. “If at the end of the day, it is their breach, it’s still your problem.”

While outside the healthcare realm, Leopard said the same concept applied to the Target breach in late 2013. “There was a little, independent contractor, and 10

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Common Sense Steps to Greater Security • Move to a more than two-factor authentication. While the current standard is a username and password, it’s becoming more common to require a third step such as a pin number or biometric identifier.

• A range of open source technologies is available at low or no cost to encrypt data and add another level of protection.

• Use and regularly update anti-virus and anti-spyware software on all computers and automate patch deployments across the organization.

• Don’t forget to change administrative passwords on peripheral equipment like wireless printers or security cameras.

• Plug into a good cyber security threat briefing. There are a number of options for monthly briefings including one by the American Hospital Association and HITRUST, which has partnered with the U.S. Department of Health and Human Services.

it was through that little contractor that cyber thieves got into the credit card information of millions of Americans,” she noted.

Very few people know the name of that subcontractor, but everyone knows Target had a major breach. It was Target that had to pay for credit monitoring, Target that got sued, Target’s CEO who resigned, and Target whose reputation and sales suffered.

Fulford added the weak link might be found even closer to home. “As users of the technology, we’re often the weakest link. It’s very important that we educate all members of the workforce on how to spot attempts at unauthorized access to PHI.” Similarly, he said really good technology exists to monitor traffic and look for anomalies. However, if no one is actively monitoring the system, threats might be detected but still not caught.

Breach Notification “The reality is you’re going to be breached. It’s just a matter of when so you have to be prepared,” Leopard stated.

“HIPAA requires there be an incident response policy to detail what to do when a breach is discerned and how to determine if notification is required and then remediation.”

Following a breach of unsecured PHI, covered entities must provide notification to affected individuals, the OCR, and in some cases, the media. “You’re going to have a lot of scrutiny from multiple stakeholders – your patients, government enforcers, the media, and other concerned parties,” Leopard said. “When there is a reportable incident, the most immediate issue is going to be to get out in front of it,” she continued. “It feels random that it’s your turn at bat, but how you get through that process is going to be determined in large part by how thoughtful you have been in preparing for the eventuality of a breach.”

When more than 500 individuals in a state are impacted by a data breach, you not only have to inform those individuals, but the size also triggers a requirement to alert the media. Even with smaller breaches, the media might have to be notified if the covered entity has insufficient

or out-of-date contact information for 10 or more affected individuals per OCR requirements.

When assessing the cost of a breach, Leopard said the first thoughts are often tied to the immediate, tangible cash outlay attached to notification. However, for those who have gone through the process, she noted, “It’s the reputational harm that occurs among your customers that is often cited as one of the primary costs.”

Get Covered Parker Rains, a vice president in the Nashville office of Fisher Brown Bottrell Insurance, said it’s time to consider cyber insurance.

“Everyone in healthcare is at high risk of breach because of the kind of information they have,” he noted. “Your Parker Rains first reaction is, ‘Oh my gosh, we’ve been breached.’ Your second

thought is, ‘How are we going to pay for this?’ That’s the crux of insurance … to protect against catastrophic claims.”

And, he continued, the cost truly could be catastrophic. Rains said covered entities should look for a policy that will help offset the long list of out-of-pocket expenses that come with a reportable event.

“The insurance would cover the cost of notification. It would also pay for crisis management. It would also cover regulatory proceedings, legal fees, fines and penalties. And then, the big thing, credit monitoring expense for those affected and lawsuits,” he listed.

Rains added there could also be additional expenses a practice or business might not even think about at first. One example, he said, would be enlisting the help of a third party call center simply to handle the volume of calls if a large number of individuals had identifying data compromised.

Although cyber or data insurance is relatively new, Rains said brokers should already be talking to clients about coverage options, which are continuing to evolve to keep up with regulatory requirements and emerging technology.

He added that good data breach policies should include not only electronic breaches but also physical breaches such as a stolen file folder or laptop and verbal breaches where information is inadvertently given out in phishing scheme.

Rains noted there has been a tremendous spike in both interest and availability over the past five years for this type of protection.

“I wouldn’t go another renewal period … and maybe not even another day … without talking to my insurance broker about a cyber option,” Rains said. After all, he concluded, it doesn’t cost anything to get a quote to see what options exist for financial protection.

Meaningful Use Proposed Rule Offers Relief Last month, the Centers for Medicare and Medicaid Services released a 210-page draft rule regarding an easing of some elements of Meaningful Use criteria to satisfy requirements of the EHR program.

“The shortened reporting period that the Centers for Medicare and Medicaid Services proposes gives hospitals more time to transition to Stage 2 and increases the likelihood they will meet CMS’s timetable. However, the inclusion of numerous additional program changes at this late date risks causing confusion and added burden for hospitals on top of the elements proposed in the Stage 3 rule,” said Linda Fishman, senior vice president of Public Policy Analysis and Development for the American Hospital Association.

The 60-day comment period ends in June, and a final rule is anticipated this summer.

Clearwater Compliance Webinars Hendersonville-based Clearwater Compliance has several upcoming webinars geared toward HIPAA-HITECH compliance. Webinars run from 11 am-noon CDT unless otherwise noted.

• Friday, May 15: HIPAA Security Evaluation vs. HIPAA Security Risk Analysis • Friday, May 22: Bona Fide HIPAA Security Risk Analysis and Risk Management • Thursday, May 28: Blue Ribbon Panel: Information Risk Management Essentials (11 am-12:30 pm) • Thursday, June 4: How to Calculate the Cost of a Data Breach & How to Get the Budget for Your HIPAA-HITECH Compliance Program (11 am-12:15 pm) • Thursday, June 11: How to Develop Your HIPAA-HITECH Policies & Procedures • Thursday, June 18: How to Conduct a HIPAA Security Compliance Self Audit For more information or to register, go online to clearwatercompliance.com and click on the Education tab. nashvillemedicalnews

.com

HIT: Optimization Through Integration

By CINDY SANDERS

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes on both a clinical and operational level.

Therefore, you might as well learn to optimize it.

That was a key part of the message Chris Miller, principal with Nashville-based Cumberland Consulting Group, and Deb Dulac, director of PRISM and business systems for the University of Vermont Medical Center, shared with audiences at the recent HIMSS15 Annual Conference & Exhibition. Chris Miller More than 38,000 professionals flocked to Chicago last month to attend the premier health information technology conference, which included more than 300 peer-reviewed education sessions, vendor exhibits touting the latest technology options, updates on government regulations impacting the industry and keynote speakers ranging from Bruce Broussard, president and CEO of Humana, to George W. Bush, 43rd president of the United States of America.

“Over the past five years, there has been a huge shift towards technology largely because of the HITECH Act of

2009 and government programs like Meaningful Use that have helped drive the technology in healthcare,” Miller said.

Although slower to adopt technology into daily operations – particularly in a clinical setting – than many other industries, healthcare has increasingly been pressed to take an ‘all in’ stance.

Miller noted that over the last few years, technology has fundamentally changed the way providers … both large and small … operate. He added the challenge is balancing the adoption of technology with everything that brings.

“Today anything a healthcare organization wants to change in a business or clinical process requires a change in their technology, and likewise, any change in their technology has an impact on the care they provide or their revenue,” he said.

“I think healthcare entities were used to thinking of technology as a separate entity, but now it’s so intertwined,” added the Atlanta-based HIT expert.

In their HIMSS presentation, Miller said he and Dulac focused on how to manage and optimize technology now that it has become so pervasive, while at the same time accounting for all the other changes happening in healthcare including a switchover to ICD-10, meeting ongoing and new Meaningful Use requirements, actively engaging patients, supporting accountable care models, and the myriad

other programs that require attention.

The bottom line is that thinking of each of these mandates or initiatives as individual tasks to conquer leads to madness … or at least extreme frustration. Instead, Miller said the question should be, “How can organizations effectively manage all of those together with a higher degree of efficiency and lower overall cost?”

He continued, “When I think implementation, somewhere between 25-30 percent of the time spent on these changes is spent on testing so if you can group – effectively overlap testing on these programs – you can significantly save time.”

More than just testing, though, Miller said very deliberately grouping initiatives under a single governance project structure helps with a range of other issues from interoperability to simplification for end users. “Being able to group things together almost makes it irrelevant as to what changes were made,” he said of the finished product in the minds of those actually using the technology.

The ‘ripping off the bandage’ approach means one educational update for those end users as opposed to having to create an educational module for each individual initiative. Not only does a rolling schedule of changes often feel more overwhelming, but also the time away from desks learning the new processes would typically be less under a grouping struc-

ture than to have 10 separate trainings for 10 separate initiatives.

Miller was quick to admit that creating overarching technology structures could be difficult without staff or contracted expertise, which makes it more problematic for small practices.

“Whether you see it as a good or bad thing, there’s certainly a lot of consolidation in the market. Small private practices are becoming more and more rare,’ he said. “I think one of the reasons is it’s becoming increasingly difficult for groups like that to manage all these changes.”

Miller added larger practices or health systems enjoy the economies of scale that make it easier to incorporate the rapid number of changes taking place.

However, he added that in addition to HIT consultants, software vendors typically also offer at least some assistance in helping clients assimilate new processes into their workflow.

“Managing technology is only getting more complex,” he concluded. “Organizations need to be intentional and strategic in how they do that … whether that’s implementing analytics platforms, system upgrades, system optimization, Meaningful Use programs, or ICD-10. They need to be looking at ways they can consolidate those initiatives to be more effective with their resources and increase the return on their technology investment.”

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Tech Talk: HIT News of Note MEDHOST Launches Order Management Solution Committed to giving physicians technology that fits their existing processes and is easy to use, the MEDHOST Physician Experience has been enhanced with the launch of a unique Order Management solution. The new application streamlines the chart, note and order functionality with a contemporary and intuitive user interface that is designed to drive rapid physician adoption.

Physician Order Management is part of the continuous MEDHOST Physician Experience. This one-of-a-kind clinical suite is designed with the objective to provide improved experience in natural workflow for physicians, enhance patient care and safety, create more efficient enterprise-wide processes and improve financial performance, while allowing meaningful use requirements to be met.

Core elements include: Chart: Fully integrated into physician experience with note and order management, the patient chart streamlines the display of information. Chart uses diagrams like the fishbone display so clinicians can quickly review, enter and update clinical data.

Note: The cornerstone and original physician experience component, note empowers clinicians to enter the context of a patient’s record and to view a list of all notes for the patient’s current and any previous encounter.

Order: Enhanced order management’s intuitive workspace allows physicians to easily modify, suspend, discontinue or reorder existing orders or select new orders, including order sets, which they can customize for the needs of the individual patients. Physicians can select the relevant orders as well as modify the orders in real time based on the patient’s status.

Healthspek Expands Service with Insurance Finder The developers of Nashville-based personal health management platform Healthspek recently announced the addition of Insurance Finder, a free service to aid consumers in researching and finding trusted health and life insurance agents by location.

As an award-winning platform for individuals and families to track, collect and safely disseminate personal healthcare information, Healthspek utilizes healthcare technology to improve patient experience. Dozens of “speks” allow users to own and manage a variety of relevant healthcare needs from vitals and charts to resources on medical conditions and medication reminders. The platform also serves as a repository for legal documents, and now Insurance Finder is now available to all Healthspek account holders on the user-configurable dashboard.

“The dashboard is like a virtual services mall that allows you to consolidate all of your healthcare information and access relevant services in one place.

We’re constantly thinking of ways to grow the dashboard, and Insurance Finder is one result of that,” said Randy Farr, co-founder and CEO of Healthspek.

Once in Insurance Finder, the new feature pinpoints a user’s location and pulls up the profiles and contact information of recommended health and life insurance agents in that area. Users can also run searches by zip code to find trusted agents recommended by Healthspek across the nation.

Maximizing Protection of Assets from Lawsuits

By LAUREN LAW OSCHMAN

Practicing medicine is a highly litigious profession. In fact, a study published by the New England Journal of Medicine found that a staggering 99 percent of physicians in high-risk specialties would be sued by the age of 65. Fortunately, you can defend many of your assets from potential lawsuits by following a risk management model that will systematically title your property in an advantageous way.

Carefully constructed asset protection strategies that are fully implemented before any hint of trouble are more likely to be effective in warding off potential lawsuits or reducing the settlement amount. Having your end goal in mind is extremely helpful when developing a solid plan of protection. The first step is to assess where you are today from a risk standpoint and how that falls short from your preferred state of protection.

Lasting Implications Asset protection plays a critical role in many different aspects of your financial plan. If you’re starting a practice, you’ll need to recognize the implications your business plan will have on your estate … or if you’re developing an estate plan, you need to assess what ramifications those strategies will have on your practice. Ideally, these methods will also be set up in a way that reduces your tax obligations and allows your heirs to avoid the process of probate.

A carefully drafted risk management plan that exempts your assets and business from liability claims will make you a less viable target for a lawsuit. However, assets that are legally exempt from creditors can vary widely from state-to-state on a case-by-case basis. Because every state has different laws to consider, it’s recommended that you partner with an attorney who is familiar with your state’s asset protection laws and case history.

Timing is everything when it comes to risk management. Asset protection strategies are only truly effective if done proactively. A reactive approach to risk management likely won’t be able to keep your assets safe. Asset protection is about preventing wealth erosion – it’s not about trying to defraud or evade taxes.

Titles Matter When purchasing a home, it’s important to title it so that you won’t be vulnerable to unmerited lawsuits while still allowing you to deduct the interest on your mortgage. While some lenders will require you to hold the title in your personal name, some states do not. Certain states offer asset protection for houses held in joint tenancy with a spouse. How-

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ever, this strategy only works if your spouse is not party to the lawsuit. In other states, owning your home as tenants by the entirety might be more beneficial than joint tenancy. Transferring the title to your spouse, a trust owned/settled by your spouse, or an LLC owned by your spouse’s trust might offer superior protection in some circumstances.

When purchasing the facility where you want your medical practice to be located, many of these same issues apply.

You have to decide whether you want to put that property in your name, or in the form of an LLC that you co-own with your spouse. If you have a partner, there should probably be a buy-sell agreement in place that stipulates what would happen to the practice and its real estate in the event of a death or disability.

For planning purposes, you’ll want to look at your complete list of assets and classify them as: • Practice operating assets, • Practice capital assets, • Individual investments, or • Personal assets.

Once your assets are classified, the next step is to build legal walls between your investment and personal assets so that they’re not on the table in the event of a liability. Incorporating your practice normally protects your personal assets from non-malpractice claims against the practice. By doing this, only a portion of your assets would be vulnerable if the liability is limited to wherever the incident occurred.

Oversight is Critical When implementing an asset protection plan, the involvement of several different professionals from a variety of different disciplines is required. The services of an attorney, accountant, insurance agent and mortgage professional might all be necessary at some point, and coordinating their efforts is not always an easy task. It’s critical to work with professionals that have a fiduciary responsibility and are personally familiar with your values and objectives.

Asset protection is an area of wealth management that affluent physicians can’t afford to ignore. A risk exposure analysis will allow you to determine which personal and practice assets could be vulnerable and implement proactive strategies to protect them.

This article was written by Larson Financial Group, LLC and provided courtesy of Lauren Law Oschman, a financial advisor in the Nashville office.

Advisory Services are offered through Larson Financial Group, LLC, a Registered Investment Advisor. Securities are offered through Larson Financial Securities, LLC, Member FINRA/SIPC.

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HealthcareEnterprise

Giving Young Healthcare Companies a ‘Jumpstart’ on Success

By CINDY SANDERS

Make something better … that simple, succinct mission statement was the impetus behind the launch of Jumpstart Foundry (JSF) several years ago and serves today as the litmus test for evaluating companies that would like to participate in the unique, healthcare-focused accelerator program.

Six years ago, JSF founder and CEO Vic Gatto found himself frustrated with the venture capital world. Looking around, he saw three big issues that he felt weren’t being addressed by a business-as-usual approach.

First, he noted, the rate of failure among companies receiving Vic Gatto venture capital was far too high. “Probably one out of four makes it … so three out of four fail, and angel investments are even worse.

The goal is not one out of four,” he continued. “That’s not success … 100 percent is success. You might not ever get there, but that is the goal.”

Second, he believed too much money was being thrown at startups. “It’s a problem because it’s not required capital,” Gatto explained. “More money doesn’t necessarily lead to more products or more success.”

Finally, he wanted to see beautiful, elegant products being made in the healthcare space. “Apple has taught us to expect that in consumer products, but healthcare today does not create intuitive, easy-to-use, beautiful products.”

Although Gatto – who sits on the board of SouthComm, parent company of Nashville Medical News – didn’t have a ready solution to address those three issues, he did have an idea. He brought together about 20 people as a skunkworks project – one that is developed by a small, loosely structured group to solve issues through innovative approaches. In 2009, Gatto , along with co-founder Marcus Whitney, launched Jumpstart Foundry to change the basic approach to supporting young, innovative companies.

“We started in every industry,” Gatto said, adding the best way to learn is to be open to everything. However, Gatto and Whitney, who serves as JSF president, have found their healthcare investments to be far more successful. By last year, the accelerator narrowed the approach to focus on healthcare companies.

To address the amount of capital being provided to those picked for the 14-week program that runs each MayAugust, Gatto said they set a rate of $100,000. “You are forced to be more innovative, more creative, more thoughtful nashvillemedicalnews

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if you have a small amount of money,” Gatto explained. In five years, he added, 37 companies have been launched and 68 percent are still in business or have been successfully sold … significantly better than the 25 percent rate common to the VC world. “We’re already nearly three times as good as the industry, and we use a lot less money,” he pointed out. “I think we’ve proven we have a model that can be more successful than the traditional venture capital model.”

As with a traditional VC firm, JSF has a portfolio of companies. For the $100,000 investment, JSF owns 7.5 percent of the company. Notable JSF alumni include NextGxDx, InvisionHeart, Evermind, and Octovis, among others.

Jumpstart companies have enjoyed a capital raise success rate of 74 percent and have raised an additional $26 million in followon capital. Of the companies launched to date, seven have been in the healthcare industry.

“Healthcare has raised over half that money … more than $14 million,” Gatto said, adding the investor community is comfortable investing in healthcare in Nashville given the city’s global reputation within the industry.

One of the biggest drivers of success, however, has come from a different type of capital … human capital. “We have 120 mentors who help us build these companies,” Gatto said. These experts cover a broad range of skills providing insight

on everything from marketing and design to financial management and technical development. Companies chosen for the summer accelerator also have access to a series of seminars and classes to further refine specific skills.

Recently, JSF has partnered with Nashville business service firms to create Starting Blocks. Accessible to cohort companies, alumni and participants in the six-week Micro-Accelerator™ program, Starting Blocks provides access to best-in-class vendors at pre-negotiated, most-favored-nation rates so that young companies can have access to the tools to grow their company in an affordable manner. “Like track, the whole program gets them off the starting blocks very quickly,” Gatto said, referencing the fast start runners get out of the blocks.

The new accelerator class launches May 17. At press time, companies had not been finalized for the 2015 program, but please visit our website at NashvilleMedicalNews.com for updates.

TMA Wraps MedTenn15 Dr. John Hale Inducted as President Last month, physician leaders, practice managers and other healthcare professionals from across the state gathered in Nashville for MedTenn15, the annual convention of the Tennessee Medical Association.

During the weekend event, a number of pressing issues impacting health in Tennessee were discussed and the TMA House of Delegates (HOD) passed several resolutions updating TMA policy. The annual meeting also celebrates outstanding members and signifies the transition of the volunteer leadership team with John W. Hale, Jr., MD, a family physician in Union City, being installed as 20152016 president.

Tennessee Department of Health John Dreyzehner, MD, MPD, FACOEM, delivered Dr. John an address on the state’s Hale, Jr. biggest public health challenges. Roland Gray, MD, of the Tennessee Medical Foundation, went into depth on one of the major challenges with a two-hour session on the state’s growing prescription drug epidemic. A physician panel also discussed end-of-life care, including the provider’s role in helping to facilitate difficult conversations with patients and families. TMA in-house experts also presented information on the Tennessee Healthcare Innovation Initiative, which is

the state’s effort to move to a value-based payment model.

Notable resolutions passed by the HOD included: • Improve the state’s Controlled Substance Monitoring Database report so that each prescription reported includes the name of the midlevel prescriber, as well as the midlevel prescriber’s supervising physician.

• Develop a state-specific database for drug shortages, and develop strategies to mitigate drug shortages, working with collaboratively with other stakeholder organizations.

• Pursue legislation to oversee the implementation of the Tennessee Health Care Innovation Initiative and allow physicians and other pertinent stakeholders the opportunity to address relevant issues to the General Assembly.

• Use results from a membership survey on Maintenance of Certification (MOC) to improve the process for Tennessee physicians.

Several outstanding physicians and community organizations were recognized during an awards ceremony. The Outstanding Physician Award was presented to James Eason, MD, of Memphis; J. Mack Worthington, MD, of Chattanooga; and posthumously to Eric Raefsky, MD, of Nashville. The beloved Tennessee Oncology physician was killed

in a car wreck in Mt. Juliet last summer.

Daughter Stacy Macuik accepted the award on his behalf.

Kingsport gastroenterologist Douglas J. Springer, MD, FACP FACG, became immediate past president as he passed the gavel to Hale, who became the organization’s 161st president. A graduate of the Quillen College of Medicine at East Tennessee State University, he has practiced family medicine at the Doctor’s Clinic in Union City for 24 years. Hale is board certified in family medicine and has been an active TMA member, serving on the TMA House of Delegates for 23 consecutive years and holding a number of key positions within the organization.

Other 2015-16 leadership positions include: • Chair of the TMA Board of Trustees: Michel McDonald, MD, a Nashville dermatologist/Mohs surgeon. She is the first female physician ever elected to serve in this capacity; • Vice-Chair of the TMA Board of Trustees: James Batson, MD, a Cookeville pediatrician; • Secretary/Treasurer: Ted Taylor, MD, a Johnson City pediatrician; and • President-Elect: Keith Anderson, MD, a Memphis cardiologist who also will serve as a member of the TMA Board of Trustees.

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GrandRounds Former CMS Administrator Marilyn Tavenner Named to LifePoint Board Last month, LifePoint Hospitals, Inc. announced Marilyn B. Tavenner has been named to its board of directors.

“Marilyn brings an unparalleled understanding of the healthcare industry and the evolving regulatory environment through which our company and associated Marilyn B. Tavenner providers are navigating.

Most importantly, she is an avid supporter of innovation and finding ways to improve the quality of care provided in communities around the country. We are proud to add her passion, knowledge and experience to the leadership of our company, said LifePoint Hospitals CEO Bill Carpenter.

Tavenner served in leadership roles for the Centers for Medicare and Medicaid Services (CMS) for five years from February 2010 until February 2015. She was Administrator of CMS from May 2013 to February 2015 and Acting Administrator for 16 months before that.

Prior to her service with CMS, Tavenner was Secretary of Health and Human Resources of the Commonwealth of Virginia and spent 25 years with HCA prior to entering government service.

AHA Releases New Recommendations for Treating High Blood Pressure in Patients with Vascular Disease A new scientific statement issued jointly by three medical organizations and

published in the American Heart Association’s journal , addresses how low to aim when treating patients with high blood pressure who also have vascular diseases.

The document provides an up-todate summary on treating hypertension in patients who have both high blood pressure and have had a stroke, heart attack or some other forms of heart disease, said Elliott Antman, MD, president of the AHA and professor of medicine at Harvard Medical School.

“The writing committee reinforces the target of less than 140/90 to prevent heart attacks and strokes in patients with hypertension and coronary artery disease,” he said. “This is important since confusion has arisen in the clinical community over the last year regarding the appropriate target for blood pressure management in the general population.”

The current statement is issued jointly by the American Heart Association, American College of Cardiology, and American Society of Hypertension.

According to the statement, while a target of less than 140/90 is reasonable to avoid heart attacks and strokes, a lower target of less than 130/80 may be appropriate in some individuals with heart disease who have already experienced a stroke, heart attack, or transient ischemic attack or who have other cardiovascular conditions such as a narrowing of leg arteries or abdominal aortic aneurysm.

While blood pressure lowering can be done safely using standard medications for most patients, the statement recommends clinicians use caution in patients with coronary artery blockages. In these cases, the committee

Meharry Celebrates Student Research at Annual Event Amma Addai’s Work on HIV, Drug Abuse Highlighted

In just a few days, Amma Addai will become Amma Addai, PhD as the sixth year doctoral student in Meharry’s Biochemistry Department prepares to graduate. However, she won’t be launching a research career … the talented investigator has already done that.

On March 18, Meharry Medical College celebrated the impressive work of Addai and many other graduate scholars at the 59th Annual Student Research Day. While research is conducted across broad disciplines, the four signature areas of investigation at Meharry are cancer, HIV/AIDS, molecular and behavioral neuroscience, and women’s health.

Addai’s work focuses on the link between drug abuse and Dr. Amma Addai HIV progression, specifically how cocaine affects HIV-1 integration in CD4+ T cells. Cocaine, which is often abused among HIV patients, is known to increase HIV-1 replication. Addai’s work focuses on integration and the novel mechanism by which cocaine enhances viral load. Her findings, which were recently published in the Journal of Leukocyte, point to cocaine modulating the epigenetic DNA signatures of the host genome. The hope is that understanding the mechanism by which cocaine modulates HIV-1 integration could lead to the discovery of novel targets to address the co-morbid conditions of HIV/AIDS and drug abuse.

In December 2014, Addai was recognized for her work alongside fellow Meharry student LaKeisha Summers. The duo won first and second place respectively in the Graduate Student Category at the national Minority Health and Health Disparities Grantees’ Conference for their poster presentations. Summers presented her work, “Role of Prolidase in Neuronal Dysfunction of Cocaine Abuse.”

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advises blood pressure should be lowered slowly and strive not to decrease the diastolic blood pressure to less than 60 mm Hg, particularly in patients more than 60 years old.

The statement offers specific, evidence-based recommendations and contraindications to help clinicians select which anti-hypertensive medications to use in patients with various types of heart disease. For most patients, that will mean taking a betablocker by itself or in combination with other classes of drugs. For more information, go to heart.org.

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements

The American Psychiatric Association (APA) honored Nashville psychiatrist J. Greg Kyser, MD, in late March with the Warren Williams Assembly Award, which recognizes outstanding recent or current contributions in the field of psychiatry and is administered

by APA Area Councils. Kyser is in private practice in Nashville and serves as an associate clinical professor at Vanderbilt University’s Psychiatric Hospital.

Nashville laser eye surgeon Ming Wang, MD, PhD has penned an autobiography, “From Darkness to Sight” with Heather Ebert. The book includes his escape from China’s Cultural Revolution to become an American success story and explores his Christian faith in concert with his scientific education and background.

For the 11th straight year, graduates of Belmont University’s Masters of Science in Nursing (MSN) program for Family Nurse Practitioners (FNP) have achieved a 100 percent pass rate on the first attempt of the national certification exam.

Integrated healthcare marketing communications firm ReviveHealth is now the 39th largest independent PR agency and 6th largest healthcare agency in the nation, and the largest agency headquartered in Nashville, according to this year’s ranking of 120 firms by industry publication O’Dwyer’s.

Double-digit revenue growth topping 63 percent catapulted ReviveHealth to the No. 1 spot among Nashville agencies. Brentwood-based Jarrard Phillips Cate & Hancock also ranked in the top 15 (#13) healthcare agencies in the nation.

Tennessee recently ranked #7 in the best column in WalletHub’s report on Best & Worst States for Doctors 2015. Based on 12 key metrics, South Carolina took the top spot and Rhode Island came in as the worst state for physicians.

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

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GrandRounds Certifications & Accreditations

TriStar Summit Medical Center has been awarded The Joint Commission’s Gold Seal of Approval® for its total hip and total knee program at the eight-bed Total Joint Center.

Brentwood-based Onlife Health, a national wellness company dedicated to helping more than 10 million covered members achieve healthier lifestyles, has earned a third consecutive Comprehensive Wellness Accreditation from URAC, an accrediting organization that establishes quality, education, and measurement standards for the healthcare industry.

Saint Thomas Health Hospitals Join AJRR Saint Thomas West Hospital, Saint Thomas Midtown Hospital and Saint Thomas Rutherford Hospital have become participants of the American Joint Replacement Registry (AJRR).

Currently, only seven other hospitals in the state of Tennessee are participating in the registry, and Saint Thomas Health hospitals are the only Nashville-based hospitals. The local health system said the decision to join the registry was made to provide an additional layer of support to its existing programs that are part of the Saint Thomas Joint Replacement Institute.

The registry can help match patients, procedures, and devices to ensure that every patient is provided the best care possible. The AJRR serves as a central clearinghouse for data on total joint replacement procedures performed at participating healthcare facilities throughout the country and aims to carefully monitor the implanted devices throughout a recipient’s lifetime and trace revision rates in a database containing information about the patient, the surgeon who performed the procedure, and the site where the procedure took place in a single data source to help inform decision-making.

Bass, Berry & Sims Announces Humphreys as Head of Healthcare Practice Bass, Berry & Sims PLC recently announced Angela Humphreys has been appointed to serve as practice chair of the Healthcare Practice Group. She succeeds Jim Jenkins who led the 115-member healthcare group for four years.

Humphreys focuses her Angela practice on advising healthHumphreys care clients on a range of operational, regulatory and transactional issues and leads interdisciplinary teams in mergers and acquisitions in the healthcare sector.

She is active in both local and national healthcare organizations and is a Fellow of the Nashville Health Care Council and a past director of Leadership Health Care.

Humphreys currently serves as chair of the Health Care M&A Committee and vice chair of the Health Law and Life Sciences Committee of the Business Law Section of the American Bar Association. Humphreys received he undergraduate and law degrees from the University of Tennessee.

Thurman Named TriStar Skyline & Hendersonville CMO R. Jason Thurman, M.D., FAAEM, CPPS, has been named the first chief medical officer for both TriStar Skyline and TriStar Hendersonville Medical Centers.

Thurman completed his medical degree at The University of Alabama at Birmingham School of MediDr. Jason cine and his residency in Thurman Emergency Medicine at The University of Cincinnati. He previously served in a variety of leadership roles with Vanderbilt University Medical Center, including associate director of the Emergency Medicine Residency Program, director of Quality and Patient Safety for the Department of Emergency Medicine, and associate medical director of the Vanderbilt Stroke Center.

Andrews Takes the Helm at Shareable Ink

Johnson Joins Tennessee Oncology

Local healthcare industry veteran Hal Andrews was named CEO of Shareable Ink last month, replacing Laurie McGraw. immediately.

Andrews has served on the board of Shareable Ink since 2010.

Most recently, AnHal Andrews drews recently served as vice president and general manager of Hospital Solutions for Availity. Prior to that, he was chairman, president and CEO of RevPoint Healthcare Technologies, Inc. until its sale to Availity in May 2014. A member of the advisory board for Nashville Capital Network, Andrews also serves on boards of directors for Lincor Solutions and CurateHealth.

Melissa L. Johnson, MD, a boardcertified medical oncologist has recently joined Tennessee Oncology, one of the largest independent oncology practices in the country. Johnson cares for patients at Tennessee Oncology’s Centennial Clinic

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Correction: Last month, we quoted Yogi Berra, but referred to him as the ‘late, great Yogi Berra.’ That, of course, should have just been ‘great’ as the legendary catcher, manager and coach is still alive and celebrating his 90th birthday this month. As another quotable source once remarked, “The report of my death was an exaggeration,’ – the great (and late) Mark Twain.

We apologize for the mistake. – Cindy Sanders, Editor

in Nashville. She is also the associate director of Lung Cancer Research at Sarah Cannon Research Institute.

Previously, she spent four years as a faculty Dr. Melissa member at the Robert H. Johnson Lurie Comprehensive Cancer Center of Northwestern University and Feinberg School of Medicine, where she specialized in the treatment of lung cancer patients. Johnson was a founding member of the Northwestern Medical Developmental Therapeutics Institute (NMDTI). She completed a medical oncology fellowship at Memorial Sloan Kettering Cancer Center.

2nd Generation Capital Admits Ward to Membership Recently, James C. “Jim” Ward has become a member (owner) in Nashvillebased 2nd Generation Capital, LLC, which is an affiliate of KraftCPAs PLLC. Ward, who holds Financial Industry Regulatory Authority (FINRA) License 79, focuses his efforts on M&A and debt/equity Jim Ward placements as well as analysis in the areas of valuation and litigation. He works extensively with clients in the healthcare and technology industries and is principally responsible for developing and maintaining institutional investor relationships throughout the country. He is a graduate of Princeton University and the Vanderbilt University Owen Graduate School of Management.

Onlife Health Announces Two Appointments Brentwood-based national wellness company Onlife Health recently announced the appointment of Sameer Bhargava as chief information officer. He will lead the company’s enterprise systems, software development, shared ser-

vices, data services, and integration teams. Recently, Bhargava served as interim CIO at MedSolutions and previously was chief technology officer at PureSafety Sameer (now Underwriter LaboraBhargava tories). He was also founder and CEO of Callibrain, an employee engagement and social collaboration platform. Bhargava holds an MBA from Indian Institute of Management, Lucknow, India, and an undergraduate degree from the School of Planning and Architecture, New Delhi.

The company also added Kevin Jett as vice president of Enterprise Solutions.

Jett will lead Onlife’s customer migration and device integration teams along with overseeing the software and technological framework for wellness solutions delivered to employer and health plan members. Previously, Jett was co-founder and chief technology officer of Callibrain. He has held leadership and engineering roles at Juris (now LexisNexis) and PureSafety (now Underwriters Laboratories), as well.

He received his degree from Union University in Jackson, Tenn.

Cumberland Consulting Names Meyer Group CFO Cumberland Consulting Group, LLC, a national information technology advisory and services firm, recently added Gary Meyer as chief financial officer.

Meyer brings more than 30 years of experience collaborating with CEOs, private equity firms and boards to Gary Meyer create shareholder value in a variety of industries. In his previous positions with private equity firms, Meyer’s versatility and analytical skills resulted in his taking on operational leadership roles for a number of portfolio companies. He is a graduate of Duke University and holds his CPA certification.

Wishes Granted The Robert Wood Johnson Foundation (RWJF) recently announced that the Tennessee Action Coalition would receive a second two-year grant through the Future of Nursing State Implementation Program (SIP). The $7.65 million initiative is helping states prepare the nursing profession to address our nation’s most pressing health care challenges—access, quality, and cost. Funding is being used to implement the IOM’s future of nursing recommendations in Tennessee.

The Baptist Healing Trust of Nashville has provided a $35,000 operations grant to Mental Health America of Middle Tennessee (MHAMT).

Previously, MHAMT was awarded three consecutive transom grants to support programs for Alzheimer’s caregivers and for multicultural outreach. MHAMT CEO Tom Starling said this grant money would be used to expand prevention and early identification programs and will also focus on educating first responders and clergy on mental health Dr Tom Starling, CEO of MHAMT (Center Left) is presented a check by the Baptist Healing Trust staff. issues.

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PROMISING, NEW DRUG ADDED TO TREATMENT OPTIONS FOR MULTIPLE MYELOMA PATIENTS TENNESSEE ONCOLOGY’S stuart Spigel, M.D. It is an exciting time in the field of oncology, especially blood cancers, because we are discovering more effective treatment options for patients battling multiple myeloma.

Multiple myeloma is the third most common type of blood cancer in the U.S. The disease is more treatable now than ever before thanks to worldwide studies. According to the Multiple Myeloma Research Foundation, treatment options for the disease have increased significantly over the last 10 years. Survival rates have also improved.

Multiple myeloma is becoming a chronic disease, and oral medications are playing a significant role in helping patients manage the disease.

The FDA recently approved panobinostat (Farydak—Novartis) in combination with bortezomib and dexamethasone for the treatment of patients with multiple myeloma. It is not a first-line therapy. Panobinostat is a HDAC (histone deacetylase) inhibitor, the first of its kind to be approved for multiple myeloma.

The drug disrupts the life cycle of the disease by stopping the enzymes that cause the overgrowth of plasma cells, ultimately leading to cell death.

Panobinostat is taken orally and is a member of a new class of drugs, which is making a substantial impact in the fight against multiple myeloma, especially recurrent disease, when other options are limited and/or non-existent. It is a new weapon in the battle to eradicate multiple myeloma, and it looks promising for patients.

Tennessee Oncology is proud to deliver superior cancer care from our state’s large cities to small towns. Our extensive network and collaborative care approach ensure our patients battling multiple myeloma or any type of cancer have access to clinical expertise and advanced treatments and technologies no matter their location in Tennessee. Caring for cancer patients is a privilege.

STUART SPIGEL, M.D.

MORE THAN 80 PHYSICIANS IN 30 LOCATIONS

1.877.TENNONC | www.tnoncology.com