Nashville Post Fall 2019

FALL 2019

BET TER BOULEVARDS Positive changes for thoroughfares in The Nations, SoBro

HEALTH ISSUES Debating balance billing, buying into Blue Button

Most Powerful Women Our all-star panel on effective leadership, growth and mentoring

Next Nexus Nashville’s redevelopment compass finally points north

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CAPITOL VIEW NASHVILLE

INSPIRED COMMUNITIES INSPIRE CONNECTION

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16 FALL 2019

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YOU SHOULD KNOW Local carpenter wants women in construction careers

10 DATA BANK Assessing job growth condo prices, street safety

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OUR NEXT NEXUS Nashville’s redevelopment compass finally points north

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THREE QUESTIONS Developer knows challenge of offering attainable housing

12 VIABLE VIADUCTS? Bridges spanning interstates, railroad tracks need updates

24 BUILDING A BOULEVARD Centennial set to improve as The Nations unfolds

26 NEW-LOOK L AFAYET TE NCDC envisions big changes for SoBro thoroughfare

28 STRETCH OF STREET Key Lafayette segment suitable for overhaul

30 A CAPITOL VIEW HealthStream’s office offers ‘a room for every mood’

DANIEL MEIGS

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45 INDIVIDUALISTS’ HEALTH CARE FREEDOM An excerpt from ‘Priced Out: The Economic and Ethical Costs of American Health Care’ TECHIE

56 BACK TO THE FUTURE Online Computing celebrates 50 years — and returns to roots

58 SURVEY NOW SAYS… Polling industry grapples with tech turning point

60 EYEING AN ESPORTS WIN

Maneet Chauhan

VITALS

36 SENIOR LIVING SURGE LURES DEVELOPERS Out-of-state assisted-living, home care players eye city

38 PAINFUL SIDE EFFECTS Crackdown on overprescribing opioids yields unintended consequences

40 BLUE BUT TON BIRTH ‘How can the government be the innovative player?’

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Gaming’s giddy growth as big business has locals making moves

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MOST POWERFUL WOMEN Our all-star group talks leadership, growth, mentoring

42 BAL ANCE BILLING BAT TLE BREAKDOWN Lawmakers, industry jockey over benchmarking rates vs. mandating arbitration

64 OVERCOMING TECH FATIGUE Indecision, ignoring innovation are paths to failure TOURISM

65 MAKING THE OLD NEW Venerable cultural attractions benefit from reinvention FAVORITES

68 PAR 5 Digital marketing pro hits green at Greystone Golf Club

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OPEN

Breaking old ground In our third-quarter magazine a year ago, we wrote in an editorial about the change in tone from those in our city who “see a growth spurt with potentially negative long-term consequences for their neighborhoods, green spaces and other community amenities. And they see too few city leaders paying too little attention to real fixes.”

It’s fair to say those voices have grown a good bit louder and that more leaders are, indeed, listening.

And yet the rapid growth continues seemingly without regard for the clouds on the global economic horizon and into parts of the city that have been relatively unaffected until now. One of those is North Nashville, the historic heart of African-American life in Music City. In our cover story package, we’ve attempted to balance the viewpoints of those who see the redevelopment of large parts of North Nashville as at least somewhat inevitable — and definitely better than leaving underused lots as they are — and those concerned the horse already has bolted the barn. There are no quick answers, but given the history of North Nashville, there is a desire among many to not let redevelopment (or gentrification, if you choose to see things more bleakly) run rampant in these long-established neighborhoods.

Also growing quickly and covered in this issue are Centennial Boulevard in The Nations as well as some of the more historic tourist attractions around town — you know, the ones not bathed in Lower Broad’s ample neon light — and Nashville’s quickly-coalescing esports community. It all adds up to the kind of variety we envisioned when we redesigned our quarterlies for 2019; we hope you enjoy it.

Looking ahead to what remains of 2019 and into 2020, we’re focused among other things on sustaining our tremendous growth in online traffic — 20 percent year to date after growing more than 30 percent in 2018 — as we work on an update of our website that will continue to bring you the content you’ve said you want from us while improving its presentation and adding new features. Look for much more on that soon at nashvillepost.com — and become a subscriber if you aren’t yet fully on board.

editorial EDITOR Geert De Lombaerde MANAGING EDITOR William Williams CONTRIBUTING EDITORS Felicia Bonanno, Nancy Floyd STAFF WRITERS Stephen Elliott, Kara Hartnett, Holly Hoffman, J.R. Lind CONTRIBUTING WRITERS Lena Anthony, Cedric Dent, Vince Troia, Sam Zern

art & production ART DIRECTOR Christie Passarello STAFF PHOTOGRAPHERS Eric England, Daniel Meigs PRODUCTION COORDINATOR Matt Bach GRAPHIC DESIGNERS Mary Louise Meadors, Tracey Starck

publishing ADVERTISING DIRECTOR Daniel Williams DIRECTOR OF MARKET STRATEGY Jennifer Trsinar BUSINESS DEVELOPMENT DIRECTOR Heather Cantrell Mullins ACCOUNT EXECUTIVES Maggie Bond, Robin Dillon, Michael Jezewski, Carla Mathis, Mike Smith, Stevan Steinhart, Keith Wright SALES OPERATIONS MANAGER Chelon Hill Hasty ACCOUNT MANAGERS Rachel Deloach, Gary Minnis

marketing EVENTS DIRECTOR Olivia Moye EVENTS MANAGERS Ali Foley, Caleb Spencer

circulation SUBSCRIPTION MANAGER Gary Minnis CIRCUL ATION MANAGER Casey Sanders

business Geert De Lombaerde, Editor gdelombaerde@nashvillepost.com

PRESIDENT Frank Daniels III CHIEF FINANCIAL OFFICER Todd Patton CREATIVE DIRECTOR Heather Pierce IT DIRECTOR John Schaeffer SPECIAL PROJECTS COORDINATOR Susan Torregrossa

FW Publishing, LLC

On the cover Lee Mollette Photo by Daniel Meigs

OWNERS Bill Freeman and Jimmy Webb 210 12th Ave. S., Suite 100 Nashville, TN 37203 nashvillepost.com

Nashville Post is published quarterly by FW Publishing, LLC. Advertising deadline for the next issue is Wed., Oct. 30. For advertising information, call Daniel Williams at 615-744-3397.

For subscription information, call 615-844-9307.

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YOU SHOULD KNOW

Nolee Anderson Local carpenter seeks to lure women toward construction career

EARLIER THIS YEAR Nashville-based carpenter Nolee Anderson launched Joist, a local organization designed to provide young women with opportunities related to the building trades.

Anderson, a trim carpenter originally from Montana who works for TEG Studios, is also a co-founder of Girls Representing In Trades (GRIT).

In short, the woman is serious about the construction business.

“I finished about two semesters of my first year [at a four-year university] when I realized that trade school was an option,” she says.

Since graduating, Anderson has worked in commercial hardwood flooring, remodeling/residential trim carpentry and, now, in a production wood shop.

“I have had great luck in being employed by forward-thinking contractors like Matt Millsap and Tony Hirsh of Building Company No. 7, who have created diverse job sites,” she says. “I have also had encouragement from … Barber Woodworking, which actively takes on female apprentices. But it has taken me two years of employment to work alongside another female tradeswoman. And in a shop of about 20 carpenters, only two of us are female.”

Anderson says it’s difficult to connect with other tradeswomen given how few there are.

“Nashville needs better infrastructure for female trade workers and women interested in trades skills to be able to connect with one another,” she says.

“That’s what I hope Joist can accomplish.”

Wolverine, a Michigan-based footwear and apparel company, is supporting Joist.

“It was a natural partnership … given Wolverine’s advocacy for young people to pursue a career in the trades,” Anderson says. “Wolverine has given away thousands of free pairs of boots to trades students and workers all over the country through their Project Bootstrap initiative. The support they have given Joist has been beyond measure.”

Anderson says she enjoys helping friends learn to be handy.

“I’ve become tired of being the only woman on the job site, so I’m taking action to create more of us,” she says. “If a program like Joist had been available to me when I was younger, I think I would have found my career path a lot quicker.”

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Data Bank

PRET T Y PRICES

ANOTHER STRING of big ECD wins this year — Mitsubishi, Icee and Pilot. com among them— suggests Music City still appeals to national decisionmakers. But job growth is slowing and housing costs continue to rise. The city’s spending priorities — on housing and education, for instance, over incentives and downtown amenities — were the subject of many a discussion during this summer’s mayoral and Council election campaigns. The solutions could influence how some of those numbers evolve in the coming years.

About 450 condos changed hands in the Nashville area in June, a number that was in line with the previous four years of sales. The prices of those units have continued to appreciate handsomely, albeit a little more reasonably than in recent years.

Median Price $250,000 $200,000

2.3%

2019: 451

0

2018: 446

Jan 2018

2017: 418

3.2%

May 2017

2016: 470

$50,000

Jan 2019

2015: 425

3.8% 3.4%

$100,000

2014: 360

y 2018

2013: 343

3.1%

$150,000

2012: 282

Barring major data revisions, Nashville’s post-recession run of job growth topping 3 percent month after month looks to be history. With the exception of a big swing in January, non-farm payroll growth has steadily slowed since the middle of last year. The big question: What will be the new normal?

2011 Closings: 225

BELOW TREND

Source: Greater Nashville Realtors

May 2019

3.5%

May 2016

3.4%

SAFER STREETS

3.1%

Jan 2017

May 2018

Source: Bureau of Labor Statistics

RENT-WAGE WOES

AREA

The Nashville MSA is an outlier in many positive ways. But when it comes to the hourly wage needed to afford a fair-market two-bedroom apartment without paying more than 30% of income on rent and utilities, it stands out in a bad way.

NEEDED WAGE

Chattanooga

$16.29

Knoxville

$16.44

Maury County

$16.52

Clarksville

$16.67

Tennessee

$16.58

Memphis

$16.83

Nashville

$21.21

In the 10 years that ended with 2017, nearly 50,000 U.S. pedestrians were killed by drivers, an average of about 13 per day. In Nashville, 232 pedestrians lost their lives to cars during that time. Here’s how that compares to some other cities.

METRO

AREA ANNUAL DEATHS PER 100,000 PEOPLE

1. Daytona Beach .......................................................................3.45 2. Tampa ..................................................................................... 3.07 3. Palm Bay-Melbourne ........................................................... 2.94 4. Jacksonville ........................................................................... 2.94 5. Bakersfield ............................................................................. 2.83 14. Memphis ................................................................................2.21

That’s primarily because the median two-bedroom apartment rent in Nashville and surrounding areas continues to grow steadily and now tops those in Dallas and Phoenix, among other large cities.

32. Atlanta ...................................................................................1.79 34. Louisville ............................................................................... 1.77 42. Birmingham..........................................................................1.57 43. Austin.....................................................................................1.56

CITY

MEDIAN RENT

YOY CHANGE

National average ........................................................................1.55

Nashville

$1,160

2.6%

46. Charlotte............................................................................... 1.51

Murfreesboro

$1,140

3.1%

54. Raleigh...................................................................................1.37

Frankin

$1,320

1.3%

55. Indianapolis ..........................................................................1.37

Hendersonville

$1,250

3.1%

58. Nashville................................................................................1.29

Smyrna

$1,270

2.3%

59. Denver ...................................................................................1.28

Gallatin

$1,060

0.8%

63. Knoxville ...............................................................................1.23

Goodlettsville

$1,170

1.4%

76. Chattanooga ........................................................................1.10

Source: Apartment List

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Source: Smart Growth America

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THREE QUESTIONS

Bruce McNeilage Local developer discusses the challenge of offering attainable housing

BRUCE M C NEIL AGE is CEO and co-founder of Kinloch Partners and Harpeth Development.

A veteran Nashville-based developer and real estate investor, McNeilage has garnered local headlines the past few years for his work in South Inglewood (Solo East), Williamson County (Fairview Station) and in the Crooked Creek and the Derryberry Estates subdivisions on the Maury County side of Spring Hill.

What is “affordable” housing?

Affordable for one person may not be affordable for others. A waitress living in Nashville may only be able to afford $400 a month and a doctor living in Brentwood has a mortgage payment of $5,000 a month.

Workforce housing, affordable housing, attainable housing … each term can have a negative connotation. I struggle with what to call it. I often use “middle-class housing,” which in Nashville is, unfortunately, between $250,000 and $350,000.

I’m a boutique developer. The other type of developer is financed by a bank, insurance company or pension fund. Those development companies do larger projects.

My job is to deliver a product that few other developers are offering. I realize there is a little ego in that goal. But I stand on the shoulders of folks who came before me and want others to eventually stand on my shoulders.

What is Nashville’s main challenge for creating a diversity of housing (design styles, price points, sizes, condo/free-standing single-family, etc.)? And what mid-sized city can offer tips?

Increased density is desired, encouraged and necessary due to land costs and land scarcity.

Eventually, there will have to be an increase in smaller houses and condos offered. Affordable/attainable housing will have smaller square footage than ever before. There will also be a push to build in areas that in the past were not desirable. Look at Dickerson Road and the TSU/City Heights areas, for example.

The next big push could be Clarksville Pike.

ERIC ENGLAND

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We’ve become a rentership society, and I understand the importance of having quality rental residential product. But the largest asset for most people is their homes, and we need as many reasonably priced for-purchase residences located as close to downtown as possible.

Gallatin Road used to be Dickerson Road.

Now Dickerson will see new housing. In 15 years, Dickerson will offer nice buildings with residential, art, music, retail, restaurants and bars. Most people are familiar with the street now. To a certain degree, I’m surprised the progress the past five years has not been as significant as I, and others, was expecting.

I believe I have a knack for looking at demographic changes and placemaking trends.

I want to get ahead of the curve on Clarksville Pike, West Trinity Lane and Dickerson. I’m high on those areas because they physically connect to one another and, by extension, to the urban core. The urban planning experts say, “Connect the dots.”

At this point, you can’t as easily or affordably go south or west of downtown to develop. So I’m focused on the north and northeast. And now that I’ve done this a few times, it’s easier to work with the bankers.

Regarding creating reasonably priced for-purchase residential product, Nashville can look to Austin, Raleigh and Greenville/ Spartanburg, South Carolina. And Atlanta re-

cently announced a big initiative. Regardless of what city, the effort must be focused on public/private partnerships.

The median household income for Nashville is about $65,000. The old rule is that no individual or family ideally should pay more than one-third of annual income on housing costs.

That’s about $22,000 per year on housing in this market, and lots of folks pay a good bit more. Thoughts? And similarly, what is a noteworthy multi-unit residential building that offers reasonably priced, quality units?

Unfortunately, with many younger buyers having student loan debt and making wages outpaced by the cost of living, housing costs in this city are difficult to meet. This leads people to seek second jobs or roommates — out of necessity.

I want to offer some affordable for-rent free-standing homes. But I’m about 50-50 on this issue and need to decide soon. So I might do a 180 at Derryberry Estates and make them all for-purchase. If so, they will be the least expensive for-sale homes in the Spring Hill segment of Maury County.

A reasonably priced quality project is Alloy (in South Nashville on Tech Hill). Mark Deutschmann and Core did a great job by offering a price-attainable product in an up-andcoming area with units with very nice views.

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Viable viaducts?

City’s bridges spanning interstate, railroad tracks need updates

BY CEDRIC DENT

anger awaits the 6-foot-7 tall or taller man who, a bit lightheaded after a few drinks, walks the Demonbreun Street viaduct spanning Interstate 40-65.

One misstep and that gentleman could be shredded by the fast-moving vehicles underfoot — the result, in part, of a woefully old and inadequate structure.

No doubt, as Nashville further urbanizes and its population continues to grow, the grievances of planning and placemaking experts regarding the condition of the city’s bridges and viaducts become increasingly salient.

Those concerns are particularly noteworthy regarding the viaducts that span the interstate splitting downtown and Midtown and the CSX railroad tracks in The Gulch. The gripes focus on age and safety concerns and how the outdated bridges might be failing to maximize the chances to offer attractive and connected segments of the city that are seeing high-rise infill and that interact with the railroad and I-65/40 overpasses on Church Street, Broadway, Demonbreun Street and Division Street.

Often ugly, unsafe and dysfunctional, the viaducts are emblematic of the city’s struggle to properly process its growth.

D

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Nashville’s rate of population increase augurs a smaller-scale metropolis such as Atlanta or Dallas, but those two Sun Belt cities accommodate their citizenry with attractive and efficiently functioning viaducts. Comparatively, the viaducts on Broadway and Church Street are horrendous, according to those interviewed for this article. Guardrails on the two Broadway viaducts, in particular, are barely as tall as the headlights of a Ford F-150. In fact, Nashville has been plagued in recent years by people deliberately dropping large rocks from the sides of bridges similar to these, occasionally killing motorists.

Current bridge standards are old enough that many local viaducts are arguably antiquated compared to those of the cities Nashville aspires to rival in the future, according

to Mark Hollingsworth, president of the local chapter of UrbanPlanet.org — a popular online website devoted to international placemaking issues. Hollingsworth sees bridge rail height as a significant concern.

“They’re really [not much more than] three feet tall; it’s kind of scary,” Hollingsworth says of the guardrails on the Broadway viaducts that pass over the railroad tracks and the interstate on downtown’s western fringe. “[Such design] was more common back when things were built in the late 1950s to the mid-’60s, especially over freeways.”

Hollingsworth has visited 55 countries and all 50 U.S. states and is considered by many locals a citizen observer expert, regarding city types. He contends the existing height of the aforementioned guardrails is dangerous and

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decreasingly common with recent and contemporary infrastructure nationwide, partly because both manmade fabric connectivity and overpass rock drops are increasingly taken into consideration.

In addition, Hollingsworth notes Nashville is missing a chance to offer “land bridges” as found in Atlanta (on 5th Street NW over I-85 and at Folk Art Park) and in Dallas (Klyde Warren Park).

Hollingsworth says even small and mid-sized cities recently have updated their viaducts with tall rails that simulate walls, with such improvements undertaken regardless of traffic volume or vehicle types; moreover, these viaducts also often serve as canvasses for public art.

“One [that] comes to mind is Lima, Ohio,” says Hollingsworth, who recently visited the

AERIAL INNOVATIONS SOUTHEAST

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‘The [Broadway viaduct replacement] project is in the very early stages of development.’

KATHRYN SCHULTE, TDOT

city. “Going over the freeway, they have several beautiful bridges that were recently built — with very beautiful, ornate signage about Lima, and some flags” but also “higher [rails] so that nobody could throw a cinder block over the side without a tremendous amount of effort. There are a lot more — in many states anyway — guidelines about preventing that sort of thing from happening.”

In Columbus, Ohio, in which Hollingsworth once lived, a segment of High Street that spans I-670 and connects the Arena District to the Short North Arts District is a viaduct acting as, interestingly, an actual street.

On either side of the structure are commercial buildings with restaurants.

Metro Nashville officials are not oblivious to the need for more attractive and efficient viaducts. In 2018, the Division Street connector opened in SoBro, spanning CSX tracks and complete with bike paths and safety walls sufficiently able to combat illegal and dangerous activity. CSX, an interstate rail transportation company whose railroads dominate the eastern half of the U.S. and parts of Canada, influenced that structure’s design, which has won general praise for being both reasonably attractive and functional.

But will future such structures be likewise?

The Tennessee Department of Transportation intends to overhaul the Broadway viaduct that passes over The Gulch from the Union Station Hotel on the east to the site once home to The Tennessean on the west. According to TDOT Community Relations Officer Kathryn Schulte, the structure’s guardrails are compliant because, due to its age, they have been grandfathered into a current era of new regulations and, second, the rail height regulations are directly correlative to traffic.

“The minimum height of the bridge rails is dependent on the traffic that uses the bridge.

The height for the bridge rails can vary from 32 [inches] to 51,” Schulte tells the Post. This means, though, that regulations do not currently account for the dangerous prospect of overpass rock drops or tall people tumbling over the side. When asked if these concerns were on TDOT’s radar regarding the future bridge reconstruction project, Schulte says, “There have been no discussions on this aspect of the project, as the project is [in] the very, very early stages of development.”

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‘I would think that if the capping idea proceeds, then doing it all in the same process would make the most sense.’

GARY GASTON, NASHVILLE CIVIC DESIGN CENTER

Regardless, though, Schulte says that bridges spanning CSX right-of-way “have their own requirements that [TDOT] must follow — which includes provisions for the bridge rail.”

Those provisions call for “a protective barrier fence” on “all highway structures,” according to a TDOT manual. CSX describes the socalled “barrier fence” it wants on the bridges as being 8 feet tall at minimum, whether placed on top of the guard rail or starting from the sidewalk. It even specifically reads: “The fence shall be capable of preventing pedestrians from dropping debris onto CSXT’s right-ofway, and in particular, passing trains.”

These guidelines apply to at least 20 states and provinces with which CSX holds public contracts. The Broadway viaduct TDOT is preparing to rehab was built in 1946, whereas CSX instituted the barrier fence requirements sometime within the last 14 years; moreover, those requirements don’t apply to viaducts that span the interstate.

When asked if TDOT is or should be updating standards across the board, Schulte says the department “evaluates bridge sites, traffic and alternate uses in determining the appropriate bridge rail for each structure.” On the other hand, she adds that such evaluation pertains only to federally mandated “crash-worthiness criteria,” which deal exclusively with height relative to how well guardrails handle vehicle collisions.

As the Broadway viaduct project awaits a start, the city’s current boom has prompted some to examine the prospect of the aforementioned interstate capping. It’s a trend — Seattle and Pittsburgh, among others, have deployed the method — that involves land-bridging.

The method “connects” viaducts located within close proximity, thereby rendering the interstates or railroads below as underground tunnels, so to speak. Above the interstate in this scenario, cities often create parks with recreational spaces and art. In some cases, commercial buildings are constructed.

14

That’s what appealed to Nashville Civic Design Center officials and some Vanderbilt University engineering students, who conducted and published a feasibility study on the subject. The academic project was characterized as a particularly beneficial remedy for Nashville, whose downtown and Midtown are essentially bifurcated by I-65/40. The proposed “cap,” or land bridge, would start with the 12th Avenue viaduct and extend north, connecting to the Division Street bridge, then extending farther north to the Demonbreun bridge, followed by the Broadway and Church Street viaducts, respectively.

NCDC Executive Director Gary Gaston maintains there is nothing about the condition of downtown’s viaduct to date that would hinder future infill development.

Several have been upgraded in recent years, though not always with the concerns of overpass rock drops or drunken walkers in mind.

So while neither state nor federal guidelines require an updated guardrail height, interstate capping would eliminate that problem for all the aforementioned bridges in addition to various other benefits.

“The Demonbreun viaduct over The Gulch was replaced completely in 2004,” Gaston says, “and NCDC helped in that process to make sure public art was incorporated into the design. Broadway is probably the [last] remaining historic viaduct. TDOT in the past few years replaced the interstate bridges over Charlotte in its Quick Fix [initiative] — which I think would serve as a model for how to build the Interstate Cap Park.”

The primary obstacle to interstate capping, of course, is cost, — almost $250 million if undertaken today. This pits the idealistic perspective that Nashville should wait to act when it is ready to embark on the entire interstate capping project against the pragmatic view, albeit unlikely to happen, that the state should overhaul several viaducts individually

first, starting with the Broadway project currently anticipated but not scheduled.

“I would think that if the capping idea proceeds,” Gaston says, “then doing it all in the same process would make the most sense”— an argument for wasting no time in installing land bridges and updating guardrails as the effort is undertaken.

Hollingsworth disagrees.

“Tennessee is fairly well-known for not being a highly regulated state because of low taxes,” he says. “The state doesn’t have as much money to throw around” compared to, for example, Ohio and Illinois.

Interstate capping would add a distinctive aesthetic to Nashville’s urban fabric and function. But for many cities comparable to Nashville, attractive viaducts already serve that purpose. Both caps and high-end viaducts create spaces for public art, which lends any city a certain character. On this theme, the NCDC ensured in the early 2000s that public art with a train theme was incorporated into the Demonbreun viaduct. Likewise, the Division Street connector that spans the tracks in SoBro offers mesh designed to look like beer bubbles to allude to the area’s history as the brewery district.

The Broadway viaduct spanning the railroad once had a segment of The Tennessean building tucked beneath it. Highwoods Properties, the building’s owner, began demolishing the modernist structure in July. Randy Rabon, Highwoods’ senior director of development, said at the time there was no plan to have a future building interact with the existing Broadway bridge structure.

Highwoods’ future redevelopment of the property is not expected to be negatively impacted by the future reconstruction or replacement of the bridge, Rabon told the Post in June: “We all hope that future development will be done in such a way that we will all be pleased — and many will enjoy.”

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OUR NEXT NEXUS Nashville’s redevelopment compass finally points north

BY VINCE TROIA

t was only a matter of time before Nashville’s explosive growth finally reached its northern zone. But with expansive redevelopment occurring seemingly on every piece of vacant land, questions pop up like rooftops.

Who wins and who loses with housing demands and rents both steadily rising? Where are the communities with the most to gain? What are the roles and responsibilities of public officials and developers and when does Nashville’s runaway real estate train slow down?

The impressive mixed-use apartment complexes and tall skinny single-family homes, along with added commercial services and amenities, have transformed older Nashville neighborhoods such as East Nashville, 12 South and The Nations. With that came greater property values, higher taxes and rents, and most importantly, new neighbors. The juxtaposition of bright shiny new structures next to dated, rundown old ones has created some uneasiness about residents being displaced and the shape of things to come.

And nowhere is that more noticeable than in the communities of North Nashville.

It should be pointed out there isn’t a single, cohesive North Nashville. Rather, there are many smaller pockets stretching from Charlotte Avenue and Interstate 440 to Rosa Parks Boulevard and Jefferson Street and from MetroCenter back to Tennessee State University.

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In those pockets, developers have been getting plenty of attention and, at times, just as much criticism from people saying they are taking advantage of a neighborhood that is on the whole still cheaper than most of the rest of Nashville.

“People make developers out to be the bad guys, but nobody does anything without going through the proper channels,” says John Eldridge III, who heads E3 Construction Services, a company that is helping transform the area around McKissack Park with several residential projects, including 27N. at City Heights, The Cottages, Twenty Five 07and the Summit at City Heights, as well as various single-family homes.

“We are not bullying anybody; we host community meetings to hear from everyone,” he says. “We’ve gone a long way to make this work — especially with cost-effective workforce housing.”

Within the general McKissack Park area, which E3 has christened City Heights, Eldridge owns an upwards of 50 properties that could, via their zoning, accommodate about 300 residential units.

However, longtime North Nashville business owner Rosetta Miller-Perry thinks Eldridge is forcing people out of the area when “all the small homes in McKissack Park are going to be gone,” and anyone wanting to stay will be priced out.

“It’s all about development and money. All the vacant lots are being bought and these tall skinnies are going up. Once they are built, the itty-bitty taxes folks over there are paying are going to go up,” says Perry, who also is founder and publisher of The Tennessee Tribune.

“They can build all the nice apartments they want and set rents at $1,200 to $1,500 — who can afford that? I can’t.”

Lee Molette, a Nashville developer and financial advisor, thinks the notion that developers are evildoers is wrong, and defends the work Eldridge is doing in trying to create something sustainable and profitable from abandoned properties.

The lots weren’t made vacant by developers, Eldridge and Molette says. They view abandoned properties as a sign of the times.

“It’s the demand of the city,” Molette says about his work building housing for Nashville’s population growth. “People accuse folks like me of stealing land, but that’s not the case.

If you want to see development, everybody’s got to win. And the developers are the ones that have all the risk — front-end money, architectural fees, permits, everything to get the property titled.

“We have to get everything ready before a dime gets made,” he adds. “In all fairness, we should make a profit at some point. But people are not focused on that.”

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‘If you want to see development, everybody’s got to win. And the developers are the ones that have all the risk.’

LEE MOLLET TE

Plans versus urgency The issues people focus on in North Nashville changes with each individual. In the years it has taken for Nashville’s redevelopment wave to make its way to parts of North Nashville, different opinions, desires and wishlists have been created. Even Perry, who founded the Greater Nashville Black Chamber of Commerce, sees a double-edged sword in that tension.

“It’s both a blessing and a curse that growth didn’t come to North Nashville until recently,” she says. “Growth has to occur and you can’t have a ghetto forever. But I think it could have been planned a little better.”

With the acceleration of the city’s growth, especially in the urban core, plans may be getting supplanted by urgency. Molette believes land prices and construction costs will continue to rise substantially, and with so many proposals in the works simultaneously, every minute counts in order to make projects’ finances work.

Complicating matters, he says, is that smaller developers often are having to jump through more hoops than some of the bigger developers and getting meeting times with Metro government officials can be difficult.

That can delay projects or stifle them altogether and many of Mollette’s projects focus on one parcel at a time.

Metro City Councilman Freddie O’Connell, whose District 19 includes the North Nashville enclaves of Germantown, Salemtown and Historic Buena Vista, has been besieged with rezoning or redevelopment proposals since taking office four years ago. (O’Connell was re-elected to another term on Aug. 1.)

“It’s ceaseless. It’s been four years nonstop,” says the councilman of the paperwork crossing his desk. “But I will say, I want it. A vacant lot is one of the worst things I can go look at. I want to see the infill. I want to see appropriate density.”

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A number of larger redevelopment projects are clearly visible now on the north side. Some of the most heralded ones are Hope Gardens, Werthan Lofts, LC Germantown and now City Heights. Prices, whether renting or owning, can vary widely — recent Hope Gardens home listings have ranged from $170,000 to $799,000 — but many places such as Werthan regularly command $2,000 monthly rents.

Then again, the Lofts offer a regulation Bocce ball court, an award-winning saltwater pool and a fitness center while LC, from Lifestyle Communities, has an alley that winds through the complex to hidden garages and is just steps from Cumberland River Greenway.

O’Connell knows that his district’s amenities, such as the greenway, First Tennessee Park and the proximity to downtown, have made it easier for developers, businesses and new residents to establish what’s become a vibrant community right next to the Jefferson Street corridor considered one of the centers of North Nashville’s African-American history.

But he thinks it can work anywhere with the right people in place.

“I want the growth to be as good as we can get it. I wouldn’t want this to be on autopilot. My role is to ask, ‘Can we make it fit the community preferences better, make it include some piece of affordability, make it sustainable?’ Can we hit on any of these moments?”

Several parts of the area — many of them the predominantly black neighborhoods generally assigned as “North Nashville” — aren’t seeing those types of development. And they may not see projects of the type being built in Salemtown or Hope Gardens for a long time.

Once a thriving hub of Nashville’s African American community, the area along Jefferson Street was a mecca for blues and jazz until the 1950s — construction of Interstate 40 tore

HUB-TO-BE City looks to build Clarksville Pike transit center

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ayor David Briley earlier this year announced the city is pursuing grant money to create a North Nashville Transit Center on vacant land at 26th Avenue and Clarksville Pike, a few blocks east of Ted Rhodes Golf Course. The hub is designed to create and enhance multimodal transportation options and connections in North Nashville.

WeGo Transit, the former Nashville MTA, has requested $18 million from the federal government through a BUILD grant. In a letter of support to Transportation Secretary Elaine Cho, Briley said the hub will improve access to workplaces, health care and other services in the economically disadvantaged north side area.

If built, the enclosed station will have up to four open-air bus bays with a climate-controlled passenger-waiting area, cyclist amenities and facilities conveying real-time locations of incoming buses, according to the grant application.

In sharp contrast to their Germantown and Buena Vista neighbors to the south, Metro estimates that nearly 36 percent of residents in this heart of North Nashville have incomes below the poverty level — making it one of the most economically disadvantaged areas in the city. Hub supporters hope to break ground next summer and have a target opening date of August 2023. > VINCE TROIA

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through the core of the district — and is home to several historically black universities. However, the area has suffered from a disproportionate share of the city’s crime and poverty, and properties deteriorated or abandoned.

“You don’t see the number of apartment buildings in North Nashville that you see in Germantown,” Molette says. “Mostly what you see there are being sold as short-term rentals.”

He thinks this is an area perhaps where government can play a role. The $750 million affordable housing plan presented by Mayor David Briley, is a first “actionable step to address it,” says Molette.

Briley announced in March that nearly half the money he is setting aside will help pay for 5,000 low- and middle-income homes, primarily through the redevelopment of aging public housing communities. With the “Under One Roof 2029” plan, he wants to see the city build 10,000 affordable housing units over the next decade. By most standards, an affordable home is where no more than 30 percent of monthly income is spent on housing.

Metro’s investment, according to the initiative, could result in about 5,000 new units — and 20 percent of them would be dedicated to extremely low-income individuals.

Still, bigger developers aren’t working on affordable housing. Instead, they focus on high-profile projects such as hotels, according to Molette, who added, “If we had a way to include workforce housing in a development, we would work with the city to make that happen.”

‘A vacant lot is one of the worst things I can go look at. I want to see the infill.

I want to see appropriate density.’

A next step: Commercial uses For his part, Eldridge has attempted to build affordable units in North Nashville. He points to The Vibe at Marathon Village, a 67-unit gated apartment community E3 built in 2017 in the 1600 block of Herman Street, near Fisk University.

“Workforce housing is tough, but we built the Vibe as affordable rentals, offering reduced rents — around 20 to 30 percent less than downtown apartments,” says Eldridge.

“We were 100 percent leased out 15 days after making that decision.”

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‘Growth has to occur and you can’t have a ghetto forever.

But I think it could have been planned a little better.’

ROSET TA MILLER-PERRY

It is apparent that wherever he builds now, there is no shortage of people ready to move in. The demand for living in these neighborhoods is there.

Eldridge is incredulous that other developers didn’t beat him to the McKissack Park area, which features views of the city’s core and is close to hospitals and universities. After meeting with community leaders as he shaped his plans, he moved E3’s offices to the intersection of Clifton Avenue and 28th Avenue North, at the heart of the district. His team’s home is across the street from Swett’s Restaurant, the community’s cornerstone.

Eldridge says he wanted to show the community that he “was all in” and called his decision “the right move.” David Swett, who has owned the iconic restaurant since 1954, has supported Eldridge and E3’s work in revitalizing the area,

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helping to host community meetings and offering some history and perspective.

“What these developers are doing isn’t at all a bad idea,” Swett says. “It brings more people in the community, more residential here, and it upgrades and makes the community a better place to live.”

In time, the density being added may also bring needed commercial ventures such as grocery stores or banks. Other than the Kroger supermarket at Rosa Parks Boulevard and Monroe Street, residents of all these new developments still need to travel several miles to buy groceries.

(A Publix store is being built at the Capitol View development on the edge of downtown.)

Banks are scant as well. Along Jefferson and Buchanan streets from downtown to TSU, there are just two, one of them the long-standing Citizens Savings Bank &

Trust, the nation’s oldest continuously operating minority-owned lender.

Molette is hoping that the commercial growth in MetroCenter eventually will spread back toward some of North Nashville’s smaller communities. He points to several hotels being built and the large number of apartments going up but acknowledges that it is “a long way to travel” for many people.

While North Nashville redevelopment is just getting started, Eldridge says he sees revitalized and successful communities from these shared efforts.

“We have been successful and welcomed into the communities where we are building because we are establishing credibility, and earning a reputation based on trust,” Eldridge says. “The type of developments we are doing pays back dividends that you can’t see on a balance sheet.”

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MORNING IN NEW NASHVILLE An excerpt from an essay by local artist Adia Victoria

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or years now, Nashville has been heralded as the new “It City” in both the local and international press. It has taken to this new title with all the gusto and greed one might expect when a city smells newfound admiration and the possibility of money to be made. There is a rapaciousness in the air, bordering on the obscene, as the city contorts, bends, shucks and jives to become whatever version of itself will bring about the largest turn of profit.

Those positioned to make money do so, while all those standing outside the circle of profit are left on their front porch wondering when their lives will be razed and paved over.

There is a common thread linking our current situation with a larger American story. Since the arrival of the first slaves, blackness has stood as an impermanent commodity to be removed,

replaced and uprooted, unremembered, at the whims of capitalism. Black folk have stood as a nameless, faceless presence to be extorted.

While certain among us have managed to break through and make ourselves into individuals to be counted, this must be understood as an exception to capitalistic American rule.

To the folks coming to claim their piece of “New Nashville,” people who live on streets like mine do not lead singular lives. At most we are an anonymous bump on the road to greater prosperity. We are as human as a forest to be cleared, a mountain to be blasted through in order to manifest destiny. This is the cool, efficient work of capitalism and plunder.

Those who have been given the loudest platform from which to speak would glibly summarize my community’s displacement as

progress. As always, we are collateral damage for the attainment of the “greatest good.” Our pain isn’t counted as pain — our presence is but a temporary placeholder for white permanence and profit.

As the city rolls further and further away from itself, I ask not for the halting of progress. I understand that Nashville is a city that has rightfully captured the imaginations of people the whole world over. Our ability to tell stories that get at the heart of universal truths stirs fascination in music fans from every corner of the earth.

I write this essay in hopes that we all take a pause and consider those of us standing on our mother’s front porch, trying to locate themselves within a city in the throes of rebranding. I sit writing this on my mother’s porch in a full August heat. The for-sale sign has been removed from the yard of the nearby tall-and-skinny. I understand that my time here may not be long.

I write this essay to ask who and what “New Nashville” will stand for.

Adia Victoria is a poet, musician and longtime resident of historically black North Nashville.

Read her full essay at nashvillescene.com.

Changing the industry.

One project at a time.

DPR Construction was founded in 1990 with the desire to be something different in the industry. We exist to build great things—great teams, great projects, great relationships and lasting friendships. We strive to be a place where people have opportunities to learn, grow, and become better builders. We are an organization that cares deeply about changing the world and our surrounding communities.

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‘NOT A BLACK-ANDWHITE THING; A GREEN THING’ Gentrification is never far from talk of North Nashville’s growth

BY VINCE TROIA

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s Nashville’s redevelopment moves northward into historically black communities, a big question consistently rears its head: Can there be diversification without gentrification?

The area’s furious residential growth — and the commercial activity that accompanies it over time — creates a challenge for those looking to avoid the oft-inevitable conclusion that a new white population is replacing a traditionally black one.

“The long view for development in this area is this is going to be white. Gentrification is here. And it’s going to move fast,” says Rosetta Miller-Perry, a Jefferson Street business owner and founder of the Greater Nashville Black Chamber of Commerce.

Perry, never one to mince words, says it was only a matter of time before working poor African Americans on Nashville’s north side were pushed out of their traditional neighborhoods.

Many community leaders and developers agree that, by and large, people in affordable housing now likely will move out to other areas when their homes are sold or redeveloped.

“People know it’s coming and there’s such a distrust for developers and Realtors, and you hear so many different stories,” says Lee Molette, an African-American Nashville entrepreneur and developer.

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Historically, North Nashville was an economically viable, self-sustaining community where residents could get almost all the goods and services they needed. It had its own retail hub, its own entertainment district.

“It was predominantly African-American but it was essentially the American Dream,” Molette says. Then the city and federal government made the decision to slice through the district to make room for an interstate. “It killed Jefferson street, the vibe, and it literally ruined generational wealth in the community.”

Perry says she held out hope for a renaissance of sorts through the years but says the building of the interstate was the beginning of the end: “We got left behind.”

John Eldridge, who owns E3 Construction Services, doesn’t believe developers such as himself are chasing folks away. Eldridge, who is white, says his area developments, including the Vibe at Marathon Village, and several near McKissack Park, are not racially motivated.

“We are not running people off. We are allowing these communities to remain a part of Nashville, but also giving a new destination to people coming here,” he says. “Folks here can’t say Nashville’s left them behind because it’s not true.”

Eldridge knows that what E3 does can be viewed as gentrification. He also knows some people may not be able to afford to live in the same community.

“It is not some evil-doing. It is just reality in a city growing like Nashville is,” he says.

“Gentrification is not a black-and-white thing; it’s a green thing. It’s about money, about the increase in value and services.”

Still, when asked if the scenarios unfolding in McKissack Park and elsewhere mean the community suffers, Molette says, “I think so.

Different neighborhoods can still have their own character, but it is being redefined. If you had a community that was predominantly one ethnicity or religion, all of sudden it’s all gone.”

Even though North Nashville communities are getting whiter and more affluent with the influx of renters and buyers, some see an opportunity to foster diversity. Bonnie Bashor of the Hope Gardens Neighborhood Association says she was drawn to the neighborhood because of its diversity.

“We don’t want to gentrify,” she says.

Gentrification continues to be a cringe-wor-

Rosetta Miller-Perry

thy word no one really wants to use, but replacing it with diversity is irresponsible, according to Molette, when money is the prime reason “something greater” isn’t borne from these mixed neighbors.

“Was there a chance for something greater?

I think there was, but I think we missed it,” he says. “The disparity makes it hard to establish neighborly relationships.”

Sharon Hurt, president of the Jefferson Street United Merchants Partnership and incumbent Metro Council at-large member, is on record calling Hope Gardens “a model of transformation from chaos to community.” Hurt says a racial, social and economic mix is the right recipe for a thriving, viable community.

Ultimately, it will be neighbors — old and new — themselves that determine whether these North Nashville communities thrive.

Like the new developments themselves, these results can be mixed. Molette says he has gotten reports about new neighbors calling Metro Codes on folks who have lived in the area for years. Some, he adds, have left notes on doors, saying things like ‘You poor people need to move out of here.’

“They already have a sense of entitlement,” Molette says. “That third-generation family next door isn’t their concern. Or they will complain about crime when they knew where they were buying the property.”

Perry, who grew up in her family home in a primarily white neighborhood in Pennsylvania, isn’t surprised to see white people moving to North Nashville, but one particular group did surprise her.

“These young white women living next to black folks... I never thought that would happen in Nashville,” she says. “That’s shocking to me.”

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Building a boulevard Centennial set to improve as part of The Nations’ unfolding

BY WILLIAM WILLIAMS

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f all Nashville’s commercial streets, Centennial Boulevard may be possessed of the most ear-catching

moniker.

Multi-syllabic and big-city-sounding-esque — and an anchor street in the ear-catching The Nations, no less — the name simply feels right for a Nashville that continues to trend toward the cosmopolitan and the urbane.

The “boulevard” designation could suggest to someone unfamiliar that Centennial has an elegant or grand feel with huge homes.

But take an actual drive along the street’s stretch between Tennessee State University on the east and 63rd Avenue on the west, and Centennial feels anything but right. In fact, the 2.5mile segment is rough and ramshackle, its industrial remnants a reminder of working-class West Nashville before The Nations was home to hipsters and when a Sylvan Park house could be bought for well under $100,000.

Despite its flaws, Centennial Boulevard — or at least many of the properties that front it — is slated for major upgrades.

Indeed, Centennial is changing already.

Though many years will be required for the

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street to be transformed, by 2022 a noticeable bit of updating will have unfolded. The changes will have come from new construction, adaptive reuse of existing structures and some streetscape infrastructure updates via Metro.

Michael Kenner, Miken Development founder who has long focused his efforts on The Nations and nearby Charlotte Park, says the intersection of Centennial and 51st Avenue North is becoming the “epicenter” of the area. He points to looming mixed-use projects (retail and apartments) from Phoenix-based Alliance Residential and Lifestyle Communities (LC) of Columbus, Ohio.

“The LC and Alliance buildings will be transformative — not just for the northern node of The Nations but for the entirety of the district,” Kenner says, adding that Stocking 51, home to Frothy Monkey and Southern Grist Brewing Co., among others, has been key to focusing attention on the intersection.

Kenner says it is unfair to compare Centennial Boulevard to Nashville streets that move through popular commercial districts as they terminate into downtown or Midtown — for example 12th Avenue through 12South, Woodland Street through Five Points, 21st Avenue through Hillsboro Village and Eighth Avenue through Melrose.

“Centennial is not a gateway into the city,” he says. “And that’s why it’s key to get the right mix of retail.”

Kenner says that because The Nations is not located close to downtown — like mixed-use districts Five Points, Germantown, Hillsboro Village and Wedgewood-Houston — it will need to become a destination. The aforementioned quartet of urban neighborhoods are

fueled, in large part, by their always-present residents, business owners and workers and their proximity to multiple other vibrant parts of the city located no more than 2.5 miles from downtown. Such districts in Nashville (and in many cities more broadly), simply put, benefit from having a “captive audience,” Kenner says.

In contrast, the intersection of 51st and Centennial is located about five miles from downtown, and The Nations is — both physically and psychologically — somewhat isolated from Nashville’s urban vibrancy.

As such, Kenner says having The Nations become, for example, a craft beer district and a place known for murals — both of which are evolving — could prove helpful.

One dynamic to monitor is the energy that could be generated by multiple buildings being constructed and updated on the north side of Centennial and west of the intersection with 51st. Moving from east to west, there are 5202 Centennial Partners buildings (both new and adaptively reused), home to Oscar’s Tacos, Dollar General, Branded Tattoo Co. and White Bison Coffee; the old Nashville Lumber warehouse (that 5202 is upgrading); the Silo Studio project from South Carolina-based Flyway; and The Flats at Silo Bend by Southeast Venture and owner R. Manuel–Centennial.

On paper, the impressive number of projects and their accompanying multiple residential and retail units suggest there is solid potential for significant pedestrian vibrancy along that stretch of Centennial. However, two considerations cannot be overlooked. One, there is no similar large-scale development underway or planned for the south side of that stretch. And

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two, the stretch will potentially hinder walkers with significant segments of dead space.

Bill Hostettler, with the aforementioned 5202 Centennial Partners, predicts the street will see no “big box” retailers. He says Centennial will become a “walkable area” in the future, despite is sheer expanse and currently lacking sidewalks in some areas.

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Kenner agrees, noting the general growth is “starting to sprout off the epicenter of 51st and Centennial.”

It is worth noting that the western fringe of the Tennessee State campus is located less than a mile from the 51st and Centennial intersection. And though development of the stretch located specifically between TSU and the site

of phosphate salt maker Innophus will be modest — the proposed Anthem project from Mississippi-based York Developments perhaps notwithstanding — the campus can provide some synergy with Centennial, Kenner says.

“Centennial will become one of the hottest corridors [in West Nashville],” he says. “The key is to get the right mix of retail and residential.”

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A new look for Lafayette The Civic Design Center team envisions big changes for major stretches of the SoBro thoroughfare

he rapid redevelopment of SoBro has brought apartment and office buildings, hotels and large storage facilities to the area between Korean Veterans Boulevard and Lafayette Street. What it hasn’t done much, however, is deliver large-scale change along Lafayette itself. The thoroughfare that runs diagonally through SoBro features notable buildings such as the Nashville Rescue Mission and the Greyhound bus station, but the majority of its downtown stretch has been given over to getting cars in and out as quickly as possible. Functional streetscapes have been an afterthought.

The Nashville Civic Design Center says now is the time to think about changing that for good. In a section of the second volume of their “Reclaiming Public Spaces” series of publications, center CEO Gary Gaston and his team dive in on possible infrastructure and design changes that would make Lafayette a more complete, safe and multimodal boulevard.

Key to the on-street changes they envision are bus and bicycle lanes as well as a green median that will help narrow the boulevard. But it’s at various intersections from the interstate loop to the KVB roundabout that the designers propose the biggest changes. Here’s a quick look at some of their ideas.

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Sixth The Civic Design Center team sees an opportunity to create a notable public space out of the convoluted coming together of Lafayette and Sixth Avenue South with Lea and Ewing avenues. Across Lafayette from the Church of the Holy Trinity, the designers propose eliminating the short leg of Lea west of Sixth — the stretch that creates the island home to, yes, Island Tattoo — and connecting to the nearby garage property to create an 11,000-square-foot plaza with seating areas and a service building.

Seventh The expansive junction of Lafayette, Seventh Avenue South, Peabody Street and another section of Lea offers a similar chance to streamline traffic flow and create a more pedestrian-friendly environment. Key to that is extending the southeast corner of the property slated to be home to the One KVB Circle office tower as well as widening the sidewalks at the intersection’s other corners — one of which is home to the Rescue Mission — to create a conventional, smaller and safer four-way meeting of streets.

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Fifth Similar to their vision for Lafayette’s intersection with Sixth, Civic Design Center officials propose simplifying sections of the street grid where Lafayette meets Fifth Avenue South.

They would close off the turn lanes from Fifth onto Lafayette, which are technically an extension of Elm Street. (Elm meets Fifth where an investment group that includes Bob Dylan is working on Heaven’s Door Spirits and Center for the Arts in the former Elm Street Methodist Church building.) From there, they would put in place a plaza that would connect to the former home of the Nashville Film Institute.

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STATE-OF-THE-ART MASTER PLANNED PARK

STATEOFTHEART MASTER PLANNED PARK

A look at Lafayette A specific stretch of the key street is suitable for — and needs — a major overhaul

BY CEDRIC DENT

STATE-OF-THE-ART MASTER PLANNED PARK

ecent growth has come as naturally to Nashville’s pikes as it does to toddlers, especially apropos of downtown proper.

Yet physical change has been awkward for Lafayette Street, more akin to adolescence.

Myriad factors have contributed to this, chief among them perhaps being the cumbersome way the Metro Development and Housing Agency’s Sudekum-Napier residential complex flanks the thoroughfare. Many describe the street as brutal.

Nevertheless, Lafayette may be just a few choice updates from more stable progress.

At present, Lafayette’s core value to the city can’t be measured by the sum of its businesses. In the mere three-block stretch from Interstate 40 to Charles Davis Boulevard, drivers pass no fewer than eight used car lots and auto

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parts vendors. Essentially, the segment of the street serves as a vehicle-centric tributary to downtown that is antithetical to the pedestrian model sought for the city’s epicenter. But more thoughtful developments are potentially pushing Lafayette to transition to a linear mixed-use district of singular character in its own right.

Specifically, Lafayette Street is trending toward becoming the nexus of multiple, burgeoning neighborhoods with a distinctive identity unto itself. MDHA’s Envision Napier and Sudekum master plan advocates for future construction that could be transformative for the area. And Chestnut Hill continues to land higher-end homes while bigger brother Wedgewood-Houston furthers its impressive change toward true urban district status.

To see Lafayette successfully transition, though, city planners

madison.wenzler@cushwake.com ERIC ENGLAND

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will need to concentrate on what the street already has and needs rather than on external speculation, according to Eric Malo, a local urban living advocate who runs sustainable architecture firm Studio Malo.

“Smart growth should then continue forward in an organic manner that is thoughtful, sensitive and sustainable in a wholistic sense,” Malo says.

Currently, the aforementioned Metro planners are knee-deep in a study of Wedgewood-Houston, Chestnut Hill and Lafayette Street.

Sean Braisted, Metro Planning Department spokesperson, characterizes Lafayette as “a gateway” between the Murfreesboro corridor and downtown Nashville with potential for greater transit and connections to the airport and Southeast Nashville. Specifically, he references the potential SoBro transit center at the Lafayette and Fifth Avenue intersection just northwest of the I-40 overpass.

The interstate’s elevated loop and Second Avenue, however, create a maelstrom of motion as motorists negotiate odd angles on Lafayette.

Malo describes this area as “the most in need of attention,” partly because of how I-40 divides the rest of Lafayette to the southeast from downtown. Rectifying that physical arrangement will yield better connection between downtown, SoBro, Chestnut Hill and Sudekum-Napier, thus spurring private investment.

As noted, the key characteristics in many urban environments are landmark buildings and major intersections, according to Malo. Lafayette lacks the former but offers a bit of the latter.

NashvilleNext, Metro’s 25-year development plan, envisions Lafayette as a mixed-use corridor, defined mostly by buildings ranging between three and five stories.

“Cameron College Prep and Trevecca Nazarene University have a great opportunity and responsibility to act as civic guides as the area continues to grow and thrive,” Malo says.

Purity Dairy is another key landmark — historic like Cameron College Prep yet also a destination for school field trips. As such, Braisted emphasizes that preserving it be a priority.

BROKER LEASE CONSULT DESIGN A full-service Commercial Real Estate Company for Nashville and surrounding areas.

The plight of Cameron College Prep’s physical positioning related to Lafayette — it actually turns its back to the street — presents a major challenge. While Braisted admits there are “certainly opportunities to improve the interaction” of the school property with Lafayette, “specific ideas” would have to come from school officials and community.

As to primary intersections, Braisted says MDHA envisions high-capacity transit for Lafayette and a stop at its Wharf Avenue/ Charles E. Davis intersection. The same plan proposes a new rapid bus route that would run from the Wharf/Davis and Lafayette intersection through Chestnut Street, Edgehill, 16th, 17th, 31st and Charlotte Pike.

Interestingly, this stretch of Lafayette could offer the opportunity for some small-scale flatiron buildings and lots of large-scale murals.

Its grittiness and quirkiness could actually be a plus, Malo says. “[Lafayette can be] re-envisioned,” he says, “as a welcoming gateway.”

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HealthStream’s Capitol View Health care education company’s new offices focus on openness, flexibility and ‘a room for every mood’

BY FELICIA BONANNO

fter 24 years of growth at Cummins Station, health care information technology company HealthStream this spring relocated to Capitol View on downtown’s western edge. From their humble beginnings leasing 1,000 square feet — and being one of the pioneers of redeveloping downtown beyond its traditional core — Chairman and CEO Bobby Frist and his team now occupy three levels of a 10-story building on 11th Avenue.

Working with Hastings Architecture Associates, Frist saw the move as an opportunity to design a space that mixes technology and modernity with an open, almost spa-like organic ambiance. There are many open sight lines to the building’s windows — helped by the placement of conference rooms at the center of each floor rather than in corners — and touch screens that let workers reserve meeting spaces that are feet away from rows of potted plants thriving in abundant natural light.

The openness was intentional.

HealthStream’s three floors all feature a high ratio of common space to assigned seating, Frist says, with an equivalent number of independent and community spaces. Employees are encouraged to make use of all of the spaces by roaming to other floors throughout their days.

A

“We like to encourage mobility and travel inside the space so nobody finds themselves stuck at their desk all day,” Frist says.

Those desks also are more personalized than previous HealthStream iterations. At the beginning of the move process, employees were presented with eight different chair options and also got to pick their desk lamps. Their desks can be adjusted for sitting or standing, adding to the variety of workspaces.

And while the HealthStream team encourages shared and open spaces, “there is a room for every mood,” Frist says. The library, for example, is a meeting- and phone call-free retreat, and different-sized and -formatted meeting spaces are specifically designed for various types of gatherings.

Another quirk are the booths in the cafés on each floor. They are replicas of the seating at the popular BrickTop’s restaurant on West End Avenue, the place a survey showed was employees’ favorite when it came to seating.

“We wanted to create a space people could be proud of,” Frist says of his team’s overall approach.

“We encourage employees to bring their family and their kids in, so you’ll see kids running around sometimes. It’s a good energy. You never know how it’s going to unfold as a community, but I think it’s building up nicely.”

Brad Slayden VP Commercial Developemt “The key to Urban Design is understanding the unique community in which a project is located and seeking the best solution to integrate it into that environment. We have found listening to our client’s goals and objectives while providing them with sound design principles has been essential to our project’s success.”

Communication is a must.

ragansmith.com | 615.244.8591 DANIEL MEIGS

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Reconfigurable furniture Much of the new furniture on each floor can be easily reconfigured for different types of meetings and has a fun element to it. “The Tetris Lounge” pictured here features blocklike seating and looks exactly as you might imagine it. Elsewhere, a number of “skyfolds,” garage-like doors that open and close like an accordion at the touch of a button, use new technology to allow for an open room or a completely sound-proofed space.

The Forum Modern luxury meets a timeless concept on the development floor’s “Forum,” which is modeled after the plaza that was the center of day-today life in ancient Rome. A wide staircase of alternating dark and light wood can serve as seating for meetings of up to 200 people and there is a food marketplace in the corner for employees and visitors. A covered balcony nearby has a direct view of the Capitol, the future homes of Amazon and Asurion and a city park being built alongside the nearby rail tracks.

DANIEL MEIGS

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‘It’s a good energy.

You never know how it’s going to unfold as a community, but I think it’s building up nicely.’

BOBBY FRIST, HEALTHSTREAM CEO

Lighting The abundance of natural light on each of the three floors is no accident. Both ends of the building almost exclusively feature windows and offer views of the region’s hills to the west and the Capitol to the east from almost anywhere in the office. “It’s been shown that natural light lifts people’s moods and improves productivity,” Frist says. The office’s lighting system auto-dims at certain times of the day and automatically shuts off at night for an added green factor.

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Senior surge brings new players to town Out-of-state assisted-living, home careplayers have Middle Tennessee high on their list

BY KARA HARTNETT

or the first time in our country’s history, the population aged 65 and older is larger than the population under five.

Nashville is no exception: The migration rate of senior citizens to Middle Tennessee is outpacing that of the overall population.

Davidson County’s population of about 708,000 includes about 87,000 senior citizens, or 12.3 percent of the total. That number is expected to grow by 10,000 in the next five years, bumping senior citizens’ share of the county’s population by 2 percentage points, state officials say.

Nashville’s baby boomers are beginning to enter the highest-cost health care years of their lives — as the industry deals with deficits in health care workers. The city is today home to 26 licensed assisted-living facilities, 20 nursing homes, 26 home health agencies and nine homes for the aged. And they’re doing good business: Independent- and assisted-living facilities in Davidson County sported occupancy rates of 90.6 percent and 83 percent, respectively, in late 2018. That’s higher than the average in the Southeast region. Nashville is also seeing

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growth rates of 6.4 percent and 13 percent in independent- and assisted-living facilities, respectively, as compared to a 4.2 percent and 8.8 percent growth rate in the Southeast.

In short: The market is wide open and growing, and companies from all over the country are flooding in with different care models to address the rising need. Virginia-based Smith-Packett Med-Com, for example, has made Middle Tennessee its westernmost expansion market by building four assisted-living facilities in the past few years.

And executives say they have no intention of slowing down. The company’s newest facility, Harmony at Bellevue, will house 180 units — 85 independent-living units, 63 assisted-living units and 32 memory care units — at a cost of

$40 million. The project broke ground in July with a completion date eyed for late spring.

Smith-Packett officials also have announced an assisted-living facility in Mt. Juliet, a 19,000-square-foot, 190-unit project that will cost nearly $38 million. The company’s other two locations are Crossing at Brentwood and Crossing at Victory Station in Murfreesboro, both of which were completed in the past year.

Terry Howard, CEO of Smith-Packett’s management arm Harmony Senior Services, says that — even after the completion of their next two facilities — demand will be there for more. Nothing is in the works yet, but by 2023, he predicts the company will have grown its Southeast footprint from nearly 30 locations to 50 locations.

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“We are bullish on Tennessee, and the early returns we are seeing are very encouraging,” Howard says.

In the home health space, BrightStar Care is running at an even faster pace. The Chicago-based in-home services care franchisor specializes in providing medical and non-medical in-home care services. The company already has four franchises in Tennessee — the first opened for business in 2014 — and recently announced three more open territories within the area.

Since beginning to franchise in 2005, BrightStar has grown to a $350 million system with more than 330 locations across the United States and Canada.

“The things we look for and what we are seeing specifically in Nashville and Tennessee are the population growth and the folks that are moving to Tennessee because of the quality of life and a great place to retire and all of those types of things,” Vice President of Franchise Development Pete First tells the Post.

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of seniors in Nashville live alone.

The Social Security Administration says a woman who turned 65 in 2016 can expect to live to nearly 86.

The average man who turned 65 three years ago can expect to live to about 83.

Tennessee was recently ranked the fifth-best state in which to retire, in part because of its lower-than-average cost-of-living and lack of a state income tax, meaning seniors’ retirement incomes can stretch further. On the flip side, however, the state also ranked 44th in terms of overall senior health, according to America’s Health Rankings. For the team at BrightStar, that means opportunity as they look to do their part to improve those numbers.

“Over the last few years, we’ve brought in several exceptionally strong franchisees in the state who have collectively raised the bar,” First says. “ We are eager to find local business leaders to build on this legacy.”

First says the company also is looking to enter the assisted-living market and has already opened a few such facilities outside Tennessee. Adding this service to their model — helping individuals age in place — lets BrightStar transfer long-term home-care patients into assisted-living facilities if necessary. When future expansion gets rolling, First says, he will have his eye on Nashville.

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CLINIC COUNTS In the wake of subduing the opioid epidemic, two-thirds of the state’s pain management clinics have closed. Here are the numbers for Tennessee’s 20 most-populated counties.

Painful side effects A crackdown on overprescribing opioids has produced broader unintended consequences

BY KARA HARTNETT

he opioid epidemic has been a complex, unprecedented health crisis in many parts of the United States. As the nation starts to see progress in battling substance use disorder, it is also facing some unforeseen consequences enacted by overregulation of the pain management industry.

East Tennessee counties have been some of the hardest-hit in the country during the opioid epidemic. Hamblen County, Fentress County, Grundy County and Smith County averaged more than 130 pills distributed per person per year during the six-year period ending in 2012. State lawmakers and regulators set out to lower the pill tally and rehabilitate those affected by tightly tracking prescribing practices and holding physicians and pharmacists accountable for aberrations.

The big push, which focused on lowering prescription dosages, showed results and took many pills off the street. To adjudicate these new prescription standards, authorities also took legal action against doctors or nurse practitioners who tripped the new thresholds.

But the reform effort also produced collateral damage: Seeing some peers be prosecuted for crossing new limits scared many pain management professionals out of practice or led them to not serve their patients to the capacity necessary in order to circumvent government supervision and investigation.

Today, there are no clinics left in the four counties aforementioned. As a result, nearly 115,000 people there are without nearby pain management options. (Such scenarios aren’t reserved for rural areas: Nashville was home to nearly 65 pain management clinics five years ago. Today, there are only 15.)

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COUNTY

CURRENT FACILITIES

FACILITIES IN THE LAST FIVE YEARS

Anderson

2

5

Davidson

16

63

Greene

0

3

Shelby

7

35

Blount

3

7

Bradley

4

11

Knox

18

80

Hamilton

9

41

Rutherford

13

48

Williamson

5

20

Montgomery

5

21

Sumner

4

10

Sullivan

2

19

Wilson

5

16

Washington

4

14

Madison

4

12

Sevier

3

13

Maury

6

11

Putnam

4

12

Robertson

1

8

Source: TN Dept. of Health

Rural Tennessee is seeing a similar trend with its prescription drug providers. Pharmacies — many of them affiliated with CVS and Wal-Mart — are refusing to fill opioid prescriptions and have barred some still-practicing physicians from writing any period.

For a lot of patients in rural areas, these pharmacies are their only point of accessibility to their much-needed medication. Some, most of whom are elderly Medicare enrollees, are having to travel to nearby cities or other counties just to fill their prescriptions.

The Tennessee Medical Association has begun pushing back against the major corporations, saying their practices are harming patients. Officials will meet with company executives in the near future to discuss the issue and consider whether the businesses’ actions “inappropriately interfere with the Board’s role in regulating the practice of pharmacy in Tennessee.”

The TMA also used last legislative session to combat existing policies the group says have negative implications for physicians, nurses and patients. The body’s president, Knoxville surgeon Matthew Mancini, says: “New restrictions on prescribing and dispensing are no doubt reducing overall initial supply, but are also unreasonably obstructing some patients from accessing legitimate, effective pain management.”

Some are shut out There is lots of money to be made in pain management when not conducted in an ethical way.

Nashville-based Comprehensive Pain Clinics, once the largest pain management provider in the Southeast, was recently hit with an indictment of more than $25 million in Medicare fraud from a mass drug-testing scheme orchestrated from the heart of Williamson County.

Similarly, PainMD, a pain management provider with more than seven clinics throughout

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the region and formerly owned by non-practicing attorney Michael Kestner, was shut down by the federal government earlier this year. That move came after prosecutors filed criminal charges against Kestner, alleging $3 million in fraudulent billing for improper medical care.

Those closures were the proverbial tip of the iceberg: More than two-thirds of Tennessee pain clinics have closed (or been closed) over the course of the 2010s, leaving the clinic-to-citizen ratio of 1:54,000. There are only 126 clinics left in the state, and the number continues to trend downward.

While the aim of shutting down excesses and unethical practices are at the root of that number, the legitimate pain management sector has clearly suffered as well. The unintended effects of the enthusiastic regulation has left behind many Tennesseans who need legitimate pain management.

A pain patient in Tullahoma, who asked to remain anonymous due to safety and medical concerns, knows this well. She has been receiv-

ing pain management treatment for 17 years for advanced multiple sclerosis, multiple stints of cancer, brain surgery and blood clots. She has had four failed back surgeries, a compression fracture in one of her vertebrae and degenerative disk disease.

After her pain clinic, a PainMD location, shut down in May without prior notice, she was left without her prescriptions, medical records or a referral to another pain management facility.

“Without the meds, the situation would have been life-threatening,” her husband tells the Post in an interview. “The whole thing is just senseless.”

“I don’t know if I would be able to walk, or get out of bed, without the medication,” she says. “The fear of going off the medication — I can get through a withdrawal — but how will I deal with the pain on the other side of that?”

This was the second time this happened to her in the past year.

“Our former doctor was great, but he was having complications with his license and

prescribing capabilities and the state changed their licensing,” she says. “We were thrown out in the cold.”

She said switching doctors with her extreme medical needs is very challenging. Out of all the clinics in Middle Tennessee, she said very few will actually agree to treat more complicated patients like herself.

Even after finding a doctor, she struggles to find finding a pharmacist to fill her prescriptions and wrestles with her insurance to get it covered.

“Any other prescription, I can get a script written out by my doctor and go to the pharmacy and pick it up 30 minutes later,” she says.

“Somehow, for this I have to jump through never-ending nonsense of this multi-layered bureaucracy just to get this medication.”

To the patients, the good doctors are the ones who listen — not instantly question credibility. The good doctors, though, she says, are few and far between — or have been run off in fear of prosecution.

www.lbmc.com 615-377-4600

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FROM FETHERLING 1 We are moving rapidly into the age of open data. While patient confidentiality must be protected, the ability to de-identify patient records and then use them for research purposes is fueling the rapid growth of machine learning and artificial intelligence.

2 Blue Button 2.0 is pushing the interoperability from the Federal Beneficiary perspective. The next generation of this program represents a template for all of Health Information Technology professionals to follow. Blue Button combined with the Apple Health Kit for CCD (Continuity of Care Document) for the individual users means we will have access to our health records.

Blue Button 2.0 really has two functions. One is to help the individual gain access to their health records.

Two is to help the industry by providing access to key pieces of information for use in research and configuration of health systems.

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4 Why is this important? With more than 53 million health records, some of the following activities will be much easier for HIT Professionals to pre-populate pick lists for: • Drugs/Pharmaceuticals • Diagnosis Codes • Procedure Codes 5 In the area of value-based care, this can be used to measure the current care pathway across millions of patients.

This is a very valuable resource for anyone trying to understand how health care actually works.

6 The BlueButton 2.0 program contains four years of data from Medicare data for Parts A, B, and D. Over 53 Million Beneficiaries are included. The program’s security is maintained by MyMedicare.gov.

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The birth of Blue Button and open data in health care ‘How can the government be the innovative player?’

The Nashville Health Care Council recently hosted a discussion on open health care data standards featuring Aneesh Chopra, president of CareJourney and the first CTO of the United States, and former U.S. Senate Majority Leader Bill Frist, now a partner at Cressey & Co. Below are edited excerpts from their exchange — flanked by context and commentary from two local health IT veterans, Perception Health CEO Tod Fetherling and AmSurg CIO Eric Thrailkill, who also is president of industry group Tennessee HIMSS.

Frist: You were CTO from 2009 to 2012 when it was a brand new position. There were huge strides made, which is a foundation for what we have today. What were your initiatives for that period of time? What did you win on and what did you lose on?

Chopra: Broadly speaking, I had three assignments from the President. No. 1: On day one of his role, he switched the default setting from closed to open, meaning that if the government

held data in any format, that it would be virtually accessible to the American people — free of any intellectual property constraint — and it could be used however the American people wished, 1 but with security and privacy.

Generally speaking, I would argue that we get an A- in the sense that we got the policies in [via] the executive actions of the Obama years, and Trump signed a law basically substantiating that now forever. [The minus part of ] the A- is the culture change: Not a lot of people [are] saying, “Hey, I would really love to know the information about opioid addiction in my neighborhood. What data sets could be released to answer that question?”

There hasn’t been as much grassroots asking for data, which would have been [a] virtuous cycle. So there’s a little bit where I wish we had more of that.

The second job is we do a lot of R&D investing in the U.S. and I had responsibility for R&D investing on a lot of the data technology and innovation. We put together a research team at Harvard, awarded them an R&D grant and explicitly said, “We are investing in all of this legacy electronic health records stuff for the meaningful use program, but we know we want to get to the internet so let’s bridge [that] with R&D [...] I would say that is, prior to now, a grade B, C, D because no one had actually turned it on.

But now we are entering the era where you are turning it on. I think it is going to be the 2 foundation for information sharing and I can’t imagine a more exciting story that we have effectively as a country invented and scaled a global method for health information.

That is super exciting.

And then, in the third area, I clearly have to get an F [...] We tried to put muscles in the agencies to marry policy experts with technical experts. We called it SWAT teams, we had called it different names. Obviously, healthcare.gov flamed out on day one and that did not reflect well on what we had done.

My successor, Todd [Park], took an F to an A and ended up building a whole other unit of government called the U.S. Digital Service, where now the best and brightest in Silicon Valley and elsewhere sit alongside the best and brightest in policy-making. Together, they are modernizing the VA, modernizing Social Security, all the rest. That is going to have a lasting impact.

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Frist: Open health data, what does that mean to you? And what should it mean to us and to the future?

Frist: Tell us about Blue Button today.

Who uses it and how does it actually work?

Chopra: To me, that really means two things.

3 My data is accessible to me in a machine-readable format, standards-based and that I can connect to any application I trust that will help me make sense of it. That is the implication for me. For society, it is the aggregation of this — and I will just say Medicare and Medicaid for our purposes. There’s a rich, near-real-time understanding about what is happening in the system and if you think we have squeezed the value out of having access to information, we have done nothing. It sits there in a box. Maybe a researcher three years from now can write a paper on an idea that the person had access to. But entrepreneurs [and] innovators, we have not really been able to mine [the data] to learn what works and what doesn’t. [...]

So now, I take that story down to the current state. 4 CMS has created four legal front doors for the private sector to tap that data feed and use it for good. If you operate a Medicare ACO, we made a policy that we will provide ACOs longitudinal claims history with monthly updates. And we cleared it through legal [means] and we said, “This is for treatment, payment and operations.” So CMS was among the first payers to release the data to doctors.

Second, in the Affordable Care Act we created qualified entities — this is Optum, this is nonprofits, a bunch of other stakeholders — and what they say is, under the government, these entities have the raw data from Medicare, the entire data set. [With] the third option, we created a data cloud. Anybody could apply [and] if CMS approves your request, you get access to the full Medicare data set.

Now Seema Varma added Medicare Advantage and Medicaid Managed Care last November. Finally, my mom and my dad can tap a 5 real-time data feed on their Medicare data with Blue Button 2.0 and they can connect it to any app they trust without any HIPAA or regulation burden. Open health data now has come all the way from aggregate spend to granular linked beneficiary data.

And that has come a long way in nine years.

Chopra: Blue Button was born in December 2010. Going back in history, the context of this was at the Markle Foundation. The people there asked, “What are we going to do to make data more accessible?” And a guy named Adam Bosworth made the comment, “Gosh, if only there was some button, like a blue button, that I can push on the website and download my data.”

My successor Todd Park left super motivated to do this.We went out on a limb because the VA said we couldn’t do it and [we] got it functional. In that scenario, you log on to the Medicare site and see this icon. When you push it, it allows you to download machine-readable and human-readable text files. The VA provided a little bit of clinical information, but really it wasn’t a robust functionality. But in the case of CMS, they gave 6 three years of claims history.

In the beginning, there ended up being millions of veterans who downloaded their Blue Button. We ended up calling these people to see what they are doing it for and there was a little bit of a protection feel — they said they want a printed copy. The promise and potential is what is happening now. [...] There are 7 25 in-production apps that can tap the Blue Button and make it useful. 8 I can’t even begin to tell you how confident I am that there are case-use applications for this data.

Frist: How much of that is private use compared to government?

Chopra: A rule was created that says all plans have to do this by Jan. 1, 2020. CMS in the rule said [it] spent $800,000 to build it with an extra $150,000 in fees. Savvy, private-sector people can get this done at a fraction of the cost.

9 The private sector has to embrace this; how can the government be the innovative player?

The apps are not the government; every app is private-sector. It could be your doctor, your hospital or your plan, or Silicon Valley.

The point is, it’s an open marketplace with clear, defined rules that the consumer controls the connection. [There are] zero costs to connect the health data and zero cost for the consumer.

Those are the economics we need to move health care to the place that consumers trust. 10 And that is the exciting place we are in right now.

THRAILKILL THOUGHTS 7 There are now 25 applications listed, many more under development for iOS and Android devices, that transfer the power of information access to the individual consumer. Many of these applications integrated CMS data with data from electronic health records as well as biometric data captured by the consumer.

Health consumers expect a similar customer experience that is typical in banking, travel, shopping and leisure activities. Having access to health data, combined with biometric, lifestyle, scheduling, sleep, wellness, will allow all of us to be more active, engaged and participative in decisions, in concert with medical providers, impacting our health and wellness.

8

9 By establishing standards, such as FHIR (“Fast Healthcare Interoperability Resources” – modern web services designed for the efficient exchange of health information), the industry will be able to innovate and build applications to allow patients to have access to CMS claim information in the context of symptom checking, appointment scheduling, organizing/sharing health information and participating in research.

10 Innovation is occurring at an accelerated pace due to the proliferation of this data, cloud computing environments, advanced analytics – including machine learning and AI – to allow medical innovation to flourish. This will ultimately lead to higher quality, transparency of services, increases in patient safety and health improvements – all with active participation of the patient.

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Inside the battle over balance billing Lawmakers and industry players jockey over benchmarking rates versus mandating arbitration

BY KARA HARTNETT

amar Alexander made it clear (earlier this year): If health care industry stakeholders refuse to eradicate balance billing, he will move to do so.

Balance billing is the practice by which in-network health care providers bill patients for outstanding emergency department fees insurance payers are not obligated to cover. For consumers, this phenomenon is happening much more frequently, according to a study by the JAMA network, leaving unsuspecting patients on the hook for thousands of dollars in surprise medical bills even when the care was rendered at a hospital in their insurer’s network.

According to JAMA’s findings, the frequency of surprise bills resulting from emergency department visits jumped from 32.3 percent in 2010 to 42.8 percent in 2016. More startling still, perhaps: The average bill doubled within that time frame. There was more than a 90-percent chance of receiving a surprise bill at a quarter of the more than 4,000 hospitals studied.

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On average, studies have estimated patients have a 22-percent likelihood of receiving a surprise bill from an emergency department they’ve used. They also have a 9-percent chance they’ll be billed for elective inpatient care and a 51-percent likelihood of being charged for emergency services.

The Senate — with Alexander as chairman of its health, education, labor and pensions committee — is looking to solve this in one of two ways: setting benchmark rates or delineating an arbitration process. Both options, however, already have been vigorously disputed.

The idea of setting benchmarks would default outof-network bills to the median rate of previously negotiated contracts between providers and insurance payers. It would set an agreed-upon rate prior to any services and provide consumers, hospitals and payers more certainty about their financial obligations without diverting the excess payment onto consumers.

Sayeh Nikpay, an assistant professor of health policy at Vanderbilt University, believes setting a benchmark rate would be the most beneficial solution for consumers, despite pushback from industry players who want an arbitration process instead.

“Something like this bill will mean when a patient accepts that ride from the ambulance, they don’t have to worry about going bankrupt when they are cured,” Nikpay tells the Post. “Most certainly, this will mean a reduction in revenue for providers, because you are lowering the rates for lots of people. But one has to weigh the loss in revenue toward the gain in consumers from not facing that terrible uncertainty when they are in a position of great sensitivity.”

Tennessee in particular would benefit from this bill, Nikpay says, because the state does not currently have any consumer protections for balance billing, unlike New York, New Jersey, California and others that have instituted state-level legislation to combat the practice. Even those state regulations, though, don’t help self-insured employers — whose plans cover 61 percent of insured patients — because those types of plans default to federal law.

“This policy plays an important role by basically making one blanket policy that applies to everyone — including those ERISA plans,” Nikpay says.

Alexander’s bipartisan bill, drafted alongside health committee ranking member Patty Murray, a Washington Democrat, uses the benchmark-setting method to end balance billing and put the burden of payment on insurance plans. In a statement after the bill was filed this spring with his committee, Alexander said he hoped to see it pass on the Senate floor in July and soon after become law. But

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Nashville has

GROWN.

Sayeh Nikpay

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after $2.3 million worth of lobbying from a group claiming to represent doctors and patients showed up, the bill has been on hold since the Senate took recess this summer.

“These are common-sense steps we can take, and every single one of them has the objective of reducing the health care costs that you pay for out of your own pocket,” Alexander said at the time.

Rebecca Parker, chief medical affairs officer at Envision Physician Services, a Nashville-based physician staffing group, says it’s not that simple. Parker and Envision — which sparred last year with UnitedHealth over balance billing, among other things — are aligned with the hospitals and physicians in Congress pushing for an arbitration approach. She agrees industry stakeholders need to protect patients and keep them out of billing disputes but believes the benchmark-setting approach would ultimately disincentivize insurers to create comprehensive networks and negotiate with hospitals — a consequence with potentially severe implications for hospitals across the country.

The push for an arbitration process, formally known as independent dispute resolution, comes down to a federal law from 1986 that requires hospitals to stabilize a patient and perform a medical exam before asking for insurance or financial information.

“The law is very much a patient protection, but on the other side of the point, what happens is that insurers don’t have to pay for it,” Parker says. “So it’s federally required, but not federally funded.”

What Parker says the situation boils down to is an unequal and unfair balance in terms of negotiating, disincentivizing insurance companies to contract with emergency departments. Setting benchmark rates would weaken a hospital’s ability to hold insurers accountable to pay for rendered care.

“We are very concerned that [benchmark setting] will endanger access to care. Hospitals will close — some hospitals have already closed — and the insurers’ dollars float this entire very fragile safety-net system,” she says. “We are very concerned this will continue to drive reimbursements lower and lower, and really puts all the power into the insurers’ hands when [the Emergency Medical Treatment and Active Labor Act] would then come into play and we would have no ability to negotiate at all.”

An arbitration process would create a forum between hospitals and insurers to efficiently adjudicate claims along the lines of those between professional athletes and their teams. It would leave patients out of billing disputes and would set a legal obligation on the parties to set an agreeable rate to be covered by insurers.

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‘Creating a process to set the rate rather than setting the rate can help the market set the rates.’

DAVID KING, POLSINELLI

Arbitration also could shed light on what has previously been an ambiguous price-fixing process and create public data for insurers, hospitals and even consumers to use in the future. Such data from early rulings of arbitration processes, says Nashville-based Polsinelli Law Firm shareholder David King, could aid the market in setting its own benchmark rates over time.

“It could give some helpful information to a process to which a payer and provider are too far apart to negotiate otherwise,” King says. “You have more publicly available data

points. When you look around the country for out-of-network litigations, there is very little litigation where you can actually see a public result of an out-of-network provider challenging an underpayment by an insurance company.”

Rep. Raul Ruiz (D-California), a member of the House Energy and Commerce Committee, has proposed to add a third-party arbitration process to the balance billing proposal.

“The addition of arbitration was a recognition that setting a rate in the legislation was not a good idea,” King says. “Creating a pro-

cess to set the rate rather than setting the rate can help the market set the rates. I think that is a better process.”

Congress has yet to stand united behind a single solution, although one thing is certain — lawmakers want to keep patients out of the middle.

“As it stands right now, talking about the difference between consumers and providers, insurers — that burden needs to be lifted from consumers,” Nikpay says. “I think that is fairly non-controversial, and I think that is why there is support for this issue.”

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‘Give rugged individualists their freedom’ An excerpt from ‘Priced Out: The Economic and Ethical Costs of American Health Care’ by the late Princeton economist Uwe Reinhardt n an article penned in 2009, before the Affordable Care Act of 2010 had been fully composed, Princeton sociologist Paul Starr had warned the designers of that act to forego the controversial mandate on individuals to be insured. He proposed instead that individuals who failed to purchase health insurance during an initial time window should be barred for five years from the community-rated Obamacare exchanges.

Although I agree with that approach, a penalty period of only five years strikes me as much too short. Therefore, in a New York Times column entitled “Social Solidarity vs.

Rugged Individualism,” I had proposed that by age 26, all Americans must choose either to • join an insurance arrangement that forces on them community-rated premiums or, alternatively, • take a chance on being uninsured or relying on a health insurance market with premiums based on the individual’s health status.

If they chose the rugged individualist route, however, they could never later on join the social solidarity pool. They would be on their own throughout their life. That scheme would accommodate Libertarians who do not wish to be told by the government what to do about their health insurance.

I

By choosing to join the social solidarity pool, young Americans would know that the premiums they pay when young and healthy exceeded their actuarially expected cost of health care, but that they then will be paying premiums far below actuarial costs when they are older and sicker. It would be the health insurance analogue of buying a call option on a stock.

Rugged individualists who had chosen to go uninsured, or to rely on medically underwritten premiums, would know that they could lose all of their assets should they fall seriously ill. If they did fall ill or had a serious injury and then could not pay for their care, Medicaid would cover them, because rugged individualists live in a society that does not like to see people dying in the street.

However, should a rugged individualist receive health care under Medicaid, the government would set up an account for him or

her to which would be charged all of their medical expenditures, priced at Medicare rates. The government would then have a claim on whatever subsequent assets the rugged individualist might accumulate, up to the debit balance in that individual’s health care account. Libertarians should like this arrangement. To the objection that age 26 is too young an age to have to make such a monumental lifetime decision, I would respond that we ask young Americans entering military service to make a far more serious choice, one that may risk their limb and life.

Excerpted from Priced Out: The Economic and Ethical Costs of American Health Care by Uwe E. Reinhardt. Forewords by Paul Krugman and Sen. William H. Frist. Copyright (c) 2019 by Uwe E. Reinhardt. Published by Princeton University Press and reprinted by permission.

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ACKLEN | BELLE MEADE | BRENTWOOD | GREEN HILLS | FIVE POINTS

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LEADERS

After a two-year hiatus, our Most Powerful Women program has returned via a partnership with our colleagues at Nfocus and sporting an all-star lineup of leaders from some of the biggest names in Middle Tennessee’s business and nonprofit spheres. You can learn more about the leadership philosophies and growth stories of Maneet Chauhan, Jane MacLeod, Mekesha Montgomery, Sharon Roberson and Carol Yochem on the pages that follow. Later this fall, Post digital subscribers will receive a digital supplement to this magazine that will feature, among other things, a transcript of our Sept. 18 luncheon and panel discussion among these terrific leaders.

Also new this year to Most Powerful Women is a partnership with Nfocus’ long-running Model Behavior program. Meet this year’s honorees on pages 54 and 55 and read up on their causes at nfocusnashville.com. Through Sept. 18, you also can bid on auction items to benefit the dozen nonprofits they represent at nashvillemostpowerfulwomen.com.

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LEADERS

maneet chauhan

Founding Partner and President, Morph Hospitality

What’s the best leadership advice you recently received? There is no situation that doesn’t have a solution. All you need to do is approach the problem with a calm and collected approach and mindset. This was something that I had to learn. I used to be the kind of person who would get very, very worked up by challenges that were placed in front of me. One day, my husband, Vivek Deora, sat down with me and said, “How is that a solution?” That was my ‘a-ha’ moment. I realized I was making situations worse by not handling them calmly.

Can you tell us about a pivotal moment or decision you made that helped advance your career? Definitely getting on Iron Chef and just getting in front of people! I think that PR and marketing is a very integral part of growth.

I’m a strong believer in working hard but also think it’s important to show the world what you can do and what you can achieve.

How would you say your leadership style and strengths have evolved over time? I used to be a young, overly passionate, aggressive leader. Age has made me a lot calmer and collected in approaching my team. For me, it just boils down to the fact that you have to lead by example. If you come across to your team frazzled by a situation, then you are ensuring that your entire team will be worked up, too, and it will not help solve any problems.

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What’s the most common piece of advice you find yourself giving other leaders? Mutual respect is key. Whoever you work with, no matter how small or big the job, you owe it to your team to give them the respect they give you.

What is the biggest challenge facing women in leadership? It’s a mindset. Most women have the question in their mind — “Can we?” And the trick is to switch those words to “We can.”

Who was an important mentor and what’s the most lasting tenet that person left you?

My most important mentor happens to be my husband and business partner. The best advice he’s given me that has stuck around on a daily basis is: “Make sure that success doesn’t happen in isolation.” We succeed as a team and as an organization. That’s how we build ourselves to be stronger people.

ERIC ENGLAND

8/22/19 2:43 PM

LEADERS

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DANIEL MEIGS

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LEADERS

jane macleod

President and CEO, Cheekwood What’s the best leadership advice you received early in your career? Find your passion, share it enthusiastically, and others will be inspired to follow you.

Can you tell us about a pivotal moment or decision you made that helped advance your career? Leaving Dallas after 27 years — 26 in the same house — to pursue my dream job at Cheekwood. It was the best decision I ever made and, today, I can truly say I am living and working my dream.

How would you say your leadership style and strengths have evolved over time? My leadership style has always been about vision, taking what is and seeing how it can be better, charting the course and leading with passion. I still lead this way, but with a greater focus on encouraging team spirit — because it’s the team that executes the vision. The words “Team Cheekwood” are part of our culture and, if asked, most staff cite their team members as one of the best aspects of working at Cheekwood.

What’s the most common piece of advice you find yourself giving other leaders? Focus on your top priorities. With so many opportunities and daily challenges, it’s easy to get distracted from what is truly most important and will have the biggest impact. I commit to three top priorities each year and work with my team leaders to determine their top three.

Collectively, with a concentrated focus on a few strategically defined priorities, I believe we can keep moving the institution forward every year.

What is the biggest challenge facing women in leadership? Confidence to step out of your comfort zone, take on additional responsibilities or new roles and know in your heart ‘You can do this!’

Who was an important mentor and what’s the most lasting tenet that person left you? My father. He was a hard-working, humble man of the highest character. He taught me the importance of hard work and integrity, not because he ever really talked about those qualities, but because he lived them every day.

I ran out to his car every day when he came home from work so I could carry his briefcase. I aspired to the day I would have one and when I got my first job out of college, I did, indeed, purchase the long-desired briefcase — it was maroon-dyed eel skin, very chic in the ‘80s!

N A SNHA VS IHLVL IELPLO EP ST O.SCTO. C MO|MS P| RF IANLG L 2019

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mekesha montgomery Member, Frost Brown Todd

What’s the best leadership advice you received early in your career? Do not try to be someone you are not.

Tell us about a pivotal moment or decision you made that helped advance your career. When I decided to take on tasks or projects or roles whether or not I felt qualified to do so. I believe the fear of failure is a huge hinderance to professional development, and one that according to a Harvard Business Review article is more prevalent in women — perhaps for good reason, as women get judged more harshly for them.

I had to embrace the concept of failing forward.

Failures are excellent teachers and motivators as long as you own them, learn from them and build on them.

Michael Jordan was right: You miss 100 percent of the shots you never take!

How would you say your leadership style and strengths have evolved over time? I have become a much better listener and less quick to solve problems for others. I now am more patient at letting them come to their own solutions.

What’s the most common piece of advice you find yourself giving other leaders? Recognize your weaknesses and surround yourself with people who are better at those things than you are — and let them do their thing!

What is the biggest challenge facing women in leadership? Feeling like they must be overqualified to become a leader.

What’s your approach to formally mentoring people? And what advice would you give those looking to become an active mentor? With my mentee, I look for opportunities to talk to her about tough decisions and my thought process in making them. I also try to include her in my decision-making process when dealing with people issues — which I think are the hardest part of leading.

I also share failures as well as successes. They are great teachers! Finally, I also look for opportunities to throw her in over her head — so she recognizes her own strength.

As for those looking to become a mentor, I think you have to be willing to be completely transparent with your mentee. If you just show them the “Facebook” side of leadership, they will never learn the hard parts.

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DANIEL MEIGS

8/22/19 2:42 PM

LEADERS

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We’ve been honored since early this decade to bring together these area women leaders for candid and inspiring conversations about leadership, mentoring and paving the way for others. Here’s who preceded this year’s class and where they worked at the time.

2011 Sharon Hurt, Jefferson Street United Merchants Partnership Ellen Lehman, Community Foundation of Middle Tennessee Jenneen Kaufman, Tennessee Titans Linda Rebrovick, Consensus Point Claire Tucker, CapStar Bank

2012 Megan Barry, Premier Agenia Clark, Girl Scouts of Middle Tennessee Aileen Katcher, Katcher Vaughn & Bailey Dawn Rudolph, Saint Thomas Health

2013 Jacky Akbari, Nashville Career Advancement Center Sherry Stewart Deutschmann, LetterLogic Stacey Garrett, Bone McAllester Norton Janet Miller, Nashville Area Chamber of Commerce

2014 Lisa Boggs, Bridgestone Americas Glenda Glover, Tennessee State University Heather Rowan, TriStar Centennial Medical Center Sally Williams, Ryman Auditorium

2015 Paula Lovell, Lovell Communications Joelle Phillips, AT&T Renata Soto, Conexión Americas Christie Wilson, The Wilson Group Real Estate Services

2016 Tammy Hawes, Virsys12 Beth Hoeg, Trinisys Nicole Tremblett, HCA Healthcare Rachel Werner, Built Technologies

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LEADERS

sharon roberson President & CEO, YWCA Nashville & Middle Tennessee

What’s the best leadership advice you recently received? That I must own my phenomenal self. This is advice I have received several times in my career in one form or another, and it was most recently reinforced in a great book by Rita Mitchell, Own Your Phenomenal Self. Leaders lead and, as a leader, you must trust your instincts. There will be good times and there will be bad times. And during the bad times, you need to step up and take more responsibility.

How would you say your leadership style and strengths have evolved over time? I used to think that if I was willing to work at a certain pace and sacrifice, why wasn’t the next person? I thought that leadership was something everyone wanted and worked overtime to create opportunities for others. I would get frustrated when an employee did not accept an advancement opportunity.

Now that I have spent many years in the career world, I see that some people just don’t want to lead in a traditional way. Even if they’d be great, some people aren’t like me and don’t want to jump at every opportunity. I admire those who appreciate where their careers are and understand that they work differently yet are a strong foundation for any organization.

What is the biggest challenge facing women in leadership? The expectations of women in leadership. If men stumble or make a mistake, there’s a view that external forces caused them not to do well. When women stumble and fall, it’s seen as a personal failure. Expectations of women in leadership are much higher across all sectors.

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What’s a doubt you had about your skills early in your career and how did you work on it/ overcome it? I had trouble delegating authority. I thought a lot of things I could do well and should do myself rather than letting others take on the responsibility. I overcame it when I saw other leaders delegating. It takes time, knowledge and maturity.

Who was an important mentor and what’s the most lasting tenet that person left you?

My mother. She taught me to work hard and stand my ground if I’m right. She taught me to make sure I was right and that I got my facts in order. She taught me to speak up. A lot of bad things happen if knowledgeable, smart people don’t speak up.

DANIEL MEIGS

8/22/19 3:27 PM

LEADERS

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DANIEL MEIGS

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LEADERS

carol yochem

President, First Tennessee Bank, Middle Tennessee

What’s the best leadership advice you received early in your career? I would sum up early leadership advice as, “Now Playing: Your life and career — this is not a dress rehearsal.” This means focusing on building productive relationships and developing your personal brand.

Building productive relationships is two times as important as your hard work or IQ. Focus on personal and social competencies like self-awareness, self-regulation, motivation, empathy and social skills. You need to build relationships 365 days a year, because when you need a relationship and don’t have it, it is too late to build it.

What’s the best leadership advice you recently received? Don’t leave base camp without a good map.

It is important to know where you are going, how you plan to get there, who you are taking with you and what resources you will need along the way.

What is the biggest challenge facing women in leadership? Women don’t typically have the robust internal network and senior leader connections men have. This is one of the biggest challenges for women. Women need to be intentional about growing these networks and connections.

Who was an important mentor and what’s something that person taught you? Several years ago, my boss, who was also a mentor to me, asked me to deliver a presentation at the organization’s annual leadership meeting attended by the top 150 leaders. These leaders needed to be inspired to adopt and carry back to their teams certain strategies that would propel the organization forward.

Although I had been given plenty of advance notice to prepare my remarks, I didn’t give the assignment the appropriate attention. I wrote my presentation like a term paper and I delivered it that way, too — simply reading it instead of “presenting” it. I could tell immediately from the audience’s reaction that I had bombed.

My boss and mentor never said he was disappointed. He didn’t have to; I was disappointed enough for both of us. He reacted with grace and quickly provided guidance about the importance of adequately preparing for significant presentations. My experience of not being properly prepared for such an important presentation kicked me into gear of being a better leader — in particular, a better “prepared” leader.

N A SNHA VS IHLVL IELPLO EP ST O.SCTO. C MO|MS P| RF IANLG L 2019

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LEADERS

The Nashville Post salutes the Nfocus 2019 Model Behavior honorees

Laura Chavarria

DarKenya Waller

Nashville Humane Association is committed to finding responsible homes, controlling pet overpopulation and promoting the humane treatment of animals.

YWCA Nashville & Middle Tennessee is dedicated to eliminating racism, empowering women and promoting peace, justice, freedom and dignity for all.

Tracy Kornet

Connie Bradley

The Sexual Assault Center — the only nonprofit in Middle Tennessee that exclusively serves sexual abuse victims — provides therapy, advocate services, prevention programs and sexual assault forensic exams to rape victims in the SAFE Clinic.

The Saint Thomas Health Foundation serves the people and system needs throughout Middle Tennessee. The Catholic health ministry is dedicated to spiritually centered, holistic care and embraces the mission of healing and service to those who are struggling.

Nashville Humane Association

YWCA Nashville & Middle Tennessee

To learn more about these women and the causes they represent, pick up the September issue of Nfocus, on stands now, or visit nfocusnashville.com.

Sexual Assault Center

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Saint Thomas Health Foundation

ALEX BERGER

8/22/19 1:09 PM

LEADERS

Betty Dickens

Jaimie Robinson

Rankin McGugin

The Next Door provides a continuum of evidence-based substance abuse and mental health services for women in an environment of faith and healing to restore hope and a lifetime of recovery.

JDRF is the leading organization funding Type 1 diabetes (T1D) research. They are improving lives today and tomorrow by accelerating life-changing breakthroughs to cure, prevent and treat T1D and its complications.

The Adventure Science Center exists to change lives through extraordinary experiences in science and innovation.

Sherri Neal

Llew Ann King

Laurie Seabury

Thistle Farms is dedicated to helping women survivors heal from trafficking, prostitution and addiction by providing housing, meaningful work and lifelong support. Thistle Farms believes love is the most powerful force in the world.

Owl's Hill Nature Sanctuary's mission is environmental education, restoration of native flora and fauna and conservation and protection of natural resources while spreading an appreciation and enjoyment of nature.

OZ Arts supports the creation, development and presentation of significant performing and visual art works by leading artists whose contributions influence the advancement of their field.

The Next Door

Thistle Farms/Boys & Girls Clubs

The Boys & Girls Clubs exists to enable all young people, especially those who need them most, to reach their full potential as productive, caring and responsible citizens.

JDRF

Owl’s Hill Nature Sanctuary

Adventure Science Center

Oz Arts Nashville/Nashville Symphony

The Nashville Symphony inspires, entertains and educates through excellence in musical performance.

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TECHIE

THE JOURNEY

Back to the Future Online Computing celebrates 50 years in business — and finds itself where it started

BY LENA ANTHONY

TECHNOLOGY doesn’t usually follow the same pattern as fashion — wait long enough and those bell bottoms are bound to come back into vogue.

But in Online Computing’s case, that’s basically what has happened.

Started in 1969 by Dr. William Rowan, who five years earlier had been named Vanderbilt University’s first department chair of computer science, the company got its start by providing “timeshares” of computer programs to architects and structural engineers.

No, not that kind of timeshare.

“Today, we would call it the cloud,” says Ted Murphy, who became the company’s first fulltime employee in 1975 and has been its president since the mid-1990s.

Owning a computer that could run a structural analysis program was cost-prohibitive for most engineers and architects. Instead, they would dial into Online Computing.

The cost of that technology eventually dropped but that didn’t mean customers were done with Murphy’s firm. They wanted new programs for their in-house computers that could help them run their companies better. Bit by bit, that’s how Online Computing got into the enterprise resource planning software business.

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ERIC ENGLAND

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‘One of my professors called me into his office and asked if I’d like to help with this little company he had.’

TED MURPHY, ONLINE COMPUTING

The company’s core offering today is MasterTools, an ERP software that utilizes a real-time, relational database to combine accounting, supply chain, business intelligence, project management, e-commerce and a dozen other business modules into one service. Murphy says the company has about 100 customers today; combined, they represent 300 facilities and an estimated 7,000 users around the country. In the ’90s, that kind of customer base would have required a lot of business trips to worksites to install on-premise software. But the emergence of the cloud makes management much easier.

The delivery may have changed and the tool has certainly grown more robust over the years, but MasterTools is based on the same rules it was built on decades ago.

Since the ‘90s, Online Computing has primarily used Linux, IBM Informix and IBM 4GL (now Four Js) platforms. Murphy rejects the notion that he’s a visionary but does allow “forward thinker” to enter the conversation.

“At the time, those were the most progressive, powerful tools available,” he says of making the system switch more than two decades ago.

It wasn’t easy, though. No one on staff had experience with any of the tools, so the learning curve was immense.

“It was a complete change,” he says. “But what we didn’t know, we were eager to learn.”

A combination of deliberate growth, superstar employees and loyal customers — some of whom have been with Online Comput-

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ing for 30 years — rounds out the company’s formula for success and longevity.

“We’re doing more than selling them some software before moving on,” says Murphy. “Our customers are really partners, constantly feeding us great ideas.”

Unlike its big-brand competitors boasting millions of usersC each, he says Online ComputingM can respond quickly and tweak its offerings to customers’ ideas,Y needs and requirements.

CM “We’re like a little speed boat compared to their big ship,”MY Murphy says. “Which one’s easier CY to turn?”

CMY MasterTools is used by a diverse set of clients, with concentrations K in the marine, automotive electronics, and lumber and construction industries. Thanks to its recent compliance with FDA regulations detailing electronic documentation and electronic signatures, that list will soon include pharmaceutical and medical device manufacturers and distributors.

Murphy’s time with the company doesn’t stretch back 50 years, but the company’s upcoming golden jubilee is still cause for personal reflection.

“I was a student at Vanderbilt, and one of my professors called me into his office and asked if I’d like to help with this little company he had,” he recalls. “This is the only company I’ve ever worked for. It’s a great source of pride to be part of a thriving business for this long, and it has been fun to watch clients evolve and grow and get better at what they do — and I’m hoping some of that is because of the software and services we provided.”

Nashville is ranked #1 for Economic Strength among metro areas in the United States. We’re also named as one of the Top 10 Fastest Growing Cities. And we’re just getting started.

Behind every headline and ranking is the hard work of the Nashville Area Chamber of Commerce.

Learn more about what we do at nashvillechamber.com.

Sources: Policom, Forbes

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TECHIE

Survey now says…

The polling industry grapples with a technological turning point

BY STEPHEN ELLIOTT

olitical campaigns are won and lost on Election Day, but that has never stopped candidates, news organizations and interest groups from feverishly speculating about the state of public opinion in the weeks, months and perhaps years before a voter ever sees a ballot.

But the way pollsters assess the mood of a given electorate has changed dramatically in the past decade. That is poised to transform even more as the way people communicate continues to move on from the analog methods of the past.

Polling outfits for decades relied on those analog methods: Call a bunch of land-line phones tied to homes in a given area. Ask the resident questions for 10, 20 or even 30 minutes. Repeat.

Now, though, fewer and fewer people use land-lines. With caller ID, people are hesitant to answer calls from unknown numbers. Portable cell phone numbers are harder to link to a voter in a specific jurisdiction. And people are more likely to spend time online than on the phone.

All of those factors have made political polling more difficult. To adapt, polling firms are adopting a number of new strategies, including increased cell-phone polling and, lately, online surveys. Some groups even reach part of a sample online and part of a sample by phone, a multi-modal approach that was frowned upon until recently.

“The last 10 to 12 years is when it’s started to shift a lot, as response rates started declining,” says Dan Judy with North Star Opinion Research, which has polled for Tennessee Re-

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publicans including Bill Lee, Bill Haslam and Lamar Alexander. “Every cycle it seems like we bump up the percentage of completed interviews by cell phone to the point that by last cycle we were doing about half of every poll on a cell phone.”

That has made polling more costly because a human is required to dial a cell phone number while pollsters can use auto-dialers to reach landlines. Like other changes in the polling industry, that particular adjustment also comes with a benefit. Lauren Spangler of Myers Research, who has polled in dozens of Tennessee legislative districts and in Nashville mayoral races, says using human dialers eliminates what she calls the “pause of death” — the split-second click and silence that happens when an auto-dialer connects and can encourage a recipient to hang up.

Online and mobile polling isn’t perfect either, Spangler says. Online survey panels are not “robust enough” yet to support polling in smaller jurisdictions such as state House districts and cities, despite some success at the national and statewide levels, she says.

And while mobile-based surveys can be good for a handful of questions, she can’t achieve the same sort of detail that she seeks for in-depth messaging polls conducted by phone.

“It’s just a bit more involved for someone to do on their cell phone,” she says. “It becomes much harder to get that attention and get that level of detail on somebody’s tiny screen at this point.”

Still, there are silver linings. Timothy Graeff, marketing professor and director of the Office of Consumer Research at Middle Tennessee State University, notes that online surveys can be better than phone surveys because of convenience.

There are no hang ups because the respondent is cooking dinner or changing the baby’s diaper.

“It is becoming more and more difficult to conduct survey research without switching to online surveys,” he says. “This limits the types of questions that can be asked and the format for the survey. So, marketers and pollsters are having to adjust to this. Mobile-friendly surveys are a must in today’s environment.”

Despite all the challenges of adjusting to the new normal, Stones River Group’s Mark Cate, a former campaign manager and chief of staff to Haslam, says, “It’s still better than guessing.”

“At the end of the day, the respondents have to fit the model, regardless of how you’re getting to them,” he says. “The principles behind polling aren’t changing. It’s just the method of getting to the appropriate sample. That’s what’s really changing.”

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COMING IN

NOVEMBER From the board rooms of Nashville to the hallways of Congress, health care continues to grow in importance. The Post’s winter quarterly will lead with comprehensive coverage from multiple corners of Middle Tennessee’s vast health care landscape, including how new technologies and business models are transforming the work of providers. We’ll also feature insights, profiles and analyses in our other regular sections focused on leadership, technology and development.

S AV E T H E D AT E F O R O U R V I TA L S E V E N T !

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TECHIE

Eyeing an esports win Gaming’s giddy growth into a big business has locals making moves

BY SAM ZERN

sports is hitting its stride. Since video games entered the consumer market in earnest in the 1970s — long before we had today’s world for professional competitive gaming — players found ways to battle it out. They lugged their equipment to others’ houses for multiplayer experiences, went to Internet cafés to challenge competitors online or spent hours on fighting games in arcades.

As technology advanced, the competition grew — as did the money involved. Esports today is a full-fledged industry that, by 2022, Goldman Sachs predicts will be worth $3 billion annually and have an audience of 276 million. The landscape is vast, with everything from individual players streaming on Twitch and YouTube to competitive teams playing in global leagues. And surrounding them are the apparel companies, broadcasters, advertisers and other sponsors funding it all.

Brands that partner with esports properties, a 2019 Nielsen report found, have seen increases in their favorability ratings and the likelihood of fans purchasing their products. Rather than treating esports as a nerdy niche, major brands such as Coca-Cola, BMW and ESPN have embraced gaming culture.

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TECHIE

“Gamers get as invested in the brands that support esports genuinely as they do in the games they play, the characters they cosplay, the friendships they build and the experiences they gain there,” says Matt Proctor, the founder of multiple Nashville esports ventures.

Patrick Mahoney, CEO of WeAreNations, a locally based esports apparel company, likens the esports fan environment to the alternative sports of past generations, where much of the early growth was grassroots and spurred by fans who were themselves avid players.

“You’ve got a sport that’s more like surfing and skating than any traditional sport because you have so many participants that are watch-

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ing the pros and it’s way more authentic,” Mahoney says. “Basketball fans and football fans tend to be more passive, while these guys are totally in it.”

WeAreNations outfits both competitive teams and fans, with streetwear fashion and performance jerseys designed in collaboration with the teams. When Team Liquid won this spring’s League of Legends Championship Series, its players hoisted their WeAreNations-branded champion hats on the broadcast, much like a Super Bowl team would.

“We’re trying to tie in those [major sports] experiences, because it really is going to be the same,” Mahoney says.

‘We’re trying to tie in those [major sports] experiences, because it really is going to be the same.’

PATRICK MAHONEY

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TECHIE

Grassroots growth In Nashville, the esports environment, while small, is growing in stride with the industry as a whole. Proctor, who founded the Nashville Rocket League Series, a local esports competition for the vehicular soccer game Rocket League, first got started in esports while in college. He realized that he could combine his passion for gaming with his Belmont degree in event production to organize esports tournaments and cast events. Still, he needed a network of local players to join him.

“What I found in trying to stream gaming events is that the gaming community here was very fractured,” Proctor says.

He became an early and avid customer of Platforms Café, a short-lived gaming restaurant that opened in June 2018 in Rutledge Hill as a place for gamers to come together in person. While the venture lasted only about six months, Proctor says it served as a catalyst for growth by bringing the right people together to spur the Nashville esports scene in earnest.

It was at Platforms that Proctor and Jared Miller first met in person. Together, they

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launched the Tennessee Esports Alliance to create a central touchpoint for the esports events and activities that were beginning to crop up.

Keen on building the infrastructure for esports in Nashville, Miller started Everyday Esports to try to bring the esports tournament experience to a daily audience. Everyday Esports now runs the Thursday Night Throwdown fighting game tournament at the Greater Nashville Technology Council’s space in Tech Hill Commons near the fairgrounds, which draws about 50 attendees per week.

“My competition is everyone’s couch and their TV,” Miller says. “How do I get a person playing Fortnite at home on their couch to get up, get in their car, drive to my place and pay me money to play Fortnite — which is what they were just doing? You have to offer them something they can’t get at home.”

Major esports tournaments are often big, flashy events with stages, bright lights, commentators, cheering fan sections and loud, pulsing music. In short, they look and sound like many other major sporting events. Miller wants to bring that energy to a smaller-scale, brick-and-mortar space for Nashville’s gamers.

He envisions building a Topgolf-like venue where casual and competitive players alike can come out and play or train.

“We have a ton of YMCAs, rec centers, gyms, facilities for people to do these sporting things, and we have nothing for gaming. You can do a lot of gaming at home, but you can also work out at home,” Miller says. “These are thriving businesses, and there’s this huge market that would love to engage in esports and compete or be a fan, just hang out and have food and a drink and watch an esports game be played.”

While Platforms Café was an early attempt at this vision, Miller intends to approach his venture differently. Where Platforms focused on the more expensive and trendy virtual reality gameplay, Miller says, he plans to focus exclusively on esports. This summer, he was in talks to take space in the Franklin Sports Hall, the former A-Game Sportsplex near CoolSprings Galleria. He had been seeking $750,000 in funding for the space, but another company signed a lease before Everyday Esports could.

Undeterred, he is still looking for space and angel investors to launch the venture.

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TECHIE

Corporate connections Miller is jumping in at what looks to be an ideal moment for in-person gaming. Analytics company Newzoo reports that, even as digital esports viewership is increasing on platforms like Twitch and YouTube, there are many local initiatives looking to create physical gamer spaces.

Those efforts will be helped by esports making inroads across Tennessee in other ways. Last year, the Memphis Grizzlies set up an affiliated team called Grizz Gaming to compete against 20 other NBA franchise-affiliated teams. Recent Tennessee Titans addition Rodger Saffold is the CEO of Rise Nation, a competitive Call of Duty franchise. And Clarksville is in its second year of hosting F2 Con, a three-day esports tournament meant to show off the city’s 10-gigabit CDE Lightband internet.

“There’s such a market for local esports,” Proctor says. “It’s getting more expensive, but it’s not the NFL, so it’s a low entrance point for a business to support even a local esports league and to get the eyes of that audience.”

Brentwood-based staffing and consulting firm Vaco is carving out a place as an early

‘There’s such a market for local esports.’

MAT T PROCTOR

supporter of area esports, donating food to Thursday Night Throwdowns once a month and having team members hang out with the players. Chris Spintzyk, a senior associate on Vaco’s technology team, says the recruiting company shows up to the esports event to stay connected to the tech network and give back to the community.

“The folks that are here, if they’re old enough, have jobs in technology, so they’re all potential points of contact for us,” Spintzyk says.

Spintzyk says he can see esports taking off in Nashville and that, if a major team or tournament comes to town, Vaco wants to be ready to jump in. Other groups, including the Tech Council and the Tennessee Entertainment Commission, also make in-kind donations or

otherwise remain plugged into the esports.

Miller says the Tennessee Army National Guard is a regular sponsor as well; as with Vaco, its leaders have a vested interest in the tech talent that attends esports events.

While local businesses may not yet have product placement in livestreams or sponsorships on local team jerseys, those in the gaming community think a boom is not far off. Corey Johns, project manager for digital content at the state entertainment commission, says people have approached him about building an esports arena or bringing a major tournament to Music City. Johns says he sees plenty of potential for Nashville to be home to a robust esports scene in part because, much as in other industries, investment dollars can go further in Tennessee than in the established esports hubs on the West Coast.

“There are probably a handful of places domestically that could have the opportunity with a premier esports facility that feeds right into the tourism interest and the interest from visitors,” Johns says. “We’re blessed here in Middle Tennessee to be in that position, so this makes all the sense in the world.”

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TECHIE

Overcoming technology fatigue Taking too long to make a decision or ignoring innovation are paths to failure

BY MARSHALL TOWE

usinesses continue to experience unprecedented technological disruption. In addition to the significant effort required to maintain a company’s legacy systems, IT and development departments are buckling under internal and external demands for new products and services while trying to digest a tsunami of new programs, languages and applications. Cloud, IoT, AR, AI, VR and managing massive amounts of data to provide real-time analytics have many senior executives simply throwing their hands up in exhaustion. Does this sound familiar? It’s been labeled technology fatigue, and it can quickly derail a company’s success.

The cumulative effect of this continual and overlapping barrage of change in technologies has left employees and customers alike increasingly overwhelmed, stressed and burned out. What might initially seem like a small mistake — implementing the wrong software platform or choosing the wrong direction on innovation — can quickly turn out to be financially devastating and have calamitous effects on the business.

Fear of such failure results in executives taking too long to make technology decisions, causing organizations to fall behind the competition and not meet customer expectations.

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Marshall Towe

Alternatively — and even worse — some executives take a position that it’s easier just to ignore new innovation altogether rather than embrace and deploy something new. Both are paths to failure.

While keeping up with everything is understandably tiring and frustrating, the reality is that the unrelenting stream of new technologies isn’t going to abate. The next wave will force companies to embrace the advent of 5G and even more advances in machine learning and AI. Businesses must reinvent their own wheel, build and innovate new products and systems and embrace new markets. This ongoing change is worth taking and will benefit both employees and customers. Ignoring it can kill even a successful business.

Mitigating some of the fatigue associated with technology and innovation is a must.

Leaders must strategically plan innovation, understand the uses of technology — both today and in the future — and weave this philosophy into their companies’ culture to ensure less impact on staff and budgets. Three key steps in reducing the organizational fatigue are understanding the benefits, embracing partnership and budgeting for technology and innovation.

• Understanding the benefits: Technology must be an enabler of transformation and not the source of fatigue. Clearly, having the time and resources to stay current is challenging. Many leaders also lack experience understanding how new technologies can apply to their own businesses. These are big mistakes and lead to a myriad of negative consequences. Access to a broad range of resources with

knowledge of how technology provides benefits in unrelated sectors and industries is a requirement in today’s hypercompetitive and fast-moving business environment.

• Embracing partnership: It has become commonplace for businesses to work with outside partners for services such as HR, corporate compliance, benefits and accounting.

These historically internal and straightforward administrative tasks now require multi-disciplined experts to provide a range of services in an ever-changing environment.

Technology changes even faster — requiring an even higher and more broad-based employee skill set — and is just as mission-critical across a business. By collaborating and partnering with outside experts, companies can take full advantage of high-end talent without the long-term liability and risk. Further, the flexibility of fractional resources only needed at certain points in the innovation process allows a company to access specific best-in-class experts without the challenges of recruiting, hiring and retaining.

• Budgeting for technology and innovation: Companies budget all areas of their business, from staffing to operations to marketing, to meet targets and avoid surprises. However, few companies include innovation in their fiscal strategy. Budgeting innovation annually allows for ideation and development of products and services across all internal groups and allows a company to respond as new technologies rapidly change a market landscape or disrupt a business cycle.

Technology fatigue can be devastating to an organization. The sheer amount of information and data that managers are expected to digest is daunting and nearly impossible to act on. In today’s world, every company is a technology company. This new reality requires the right understanding, partners, plan and budget to achieve the successful implementation of technology with much less disruption to daily business.

Marshall Towe is chief development officer at Franklin-based software development firm Pilgrim Consulting. pilgrimconsulting.com

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TOURISM

Making the old new Longstanding cultural attractions benefit from reinvention

BY J.R. LIND

n 2008, 8.5 million people visited Nashville.

During the 10 years since, that number nearly doubled, with 15.2 million visiting in 2018, according to the Nashville Convention and Visitors Corp. And with April’s NFL Draft alone luring an estimated 600,000, 2019 should be a record-buster.

None of this is surprising to anyone who has paid even a modicum of attention to the, well, attention that Music City has received from coastal newspapers, travel magazines and lifestyle blogs. The balance between visitors and residents became the key issue in this year’s mayoral campaign.

The conventional — forgive the pun — wisdom is that downtown’s neon canyon of honky-tonks and the surrounding blocks solely explain the increase, with credit given to booming business at the Music City Center, bachelorette parties and various transpotainment vehicles.

No doubt, Nashville’s main tourist attraction remains downtown’s Country Music Hall of Fame and Museum, which typically tops one million annual visitors. It’s a must-stop for all tourists.

Close behind are the Adventure Science Center and the Nashville Zoo. Largely driven by school field trips and locals making repeat visits, the two family-friendly attractions always rank well, the vagaries of the tourism economy be damned.

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Belle Meade Plantation

But what’s surprising are the steady performers far flung from the center of the city and that seemingly lack appeal to the disposable-income twenty-something singletons and soon-not-to-be-singletons who command attention from marketers and politicians.

Nobody is riding a scooter to The Hermitage or pedaling a tavern to Belle Meade. But the former homes that lent their names to their surrounding burgs are enjoying unprecedented success, despite rarely yielding selfies from Instagram influencers or landing glowing reviews in the New York Times.

More than 230,000 people visited The Hermitage in 2018, its best attendance in decades, with the higher figures coming as Old Hickory’s home faced far less competition in town.

In just two years, attendance has grown by 50,000 people annually, a 28 percent jump.

By comparison, the overall tourism figure in Nashville grew by less than 10 percent.

The seemingly constant examination and re-examination of Andrew Jackson’s legacy will keep the seventh president in front of mind for generations. The current occupant of the Oval Office has transparently tied him-

self to the positive part of Jackson’s legacy — outsiderism, populism and the like — and became the first commander-in-chief since Ronald Reagan to visit The Hermitage (on Jackson’s birthday, no less) during a 2017 rally. Bookshelves are still crammed with biographies of Jackson, every new edition cracking the bestseller list.

Our collective fascination with Jackson means The Hermitage — which opened to the public in 1889 — will rarely hurt for visitors seeking insight into the General, a uniquely American mix of laudable accomplishment, unquestioned heroism and astonishing faults.

Appropriate to such a figure, The Hermitage continues its legacy of classical Jacksonian education while effectively bowed to the times. In recent years, exhibits and tours have focused on Jackson as a rock star. For example, some contend he was, perhaps, national politics’ first “punk figure” to gain prominence, coming into Washington brashly and promising to throw the bums out, the masses cheering his snarl.

The nonprofit’s play, clearly, is to engage younger people for whom history can seem

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TOURISM

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stodgy or irrelevant. The property also offers trivia nights, yoga nights and other events that target younger adults — all deployed courtesy of robust marketing efforts.

“People of all ages visit The Hermitage, and we market the site as a family-friendly experience,” says Ann Dee Jones, The Hermitage’s vice president of marketing and communications.

“Our trustees have invested more resources into our marketing efforts each year, which has created significant awareness about all of the fun, educational events that we offer guests.”

In addition, two new and hugely popular programs demonstrate Jackson’s importance related to horses and dueling. Both show facets of Jackson that history textbooks fail to give major play.

The curators also have elevated awareness of the people Jackson enslaved at The Hermitage. For years, the slave cabins and Jackson’s ownership of people were lightly treated. No more. In fact, there is a dedicated tour, given via wagon, focused specifically on the massive plantation’s enslaved community.

The story is similar across town at Belle Meade Plantation.

Famous for horses, the progeny of which still race for the Triple Crown, the ex-Harding family home also is increasingly emphasizing the experience of enslaved people at the massive complex that served as combination horse farm, cotton gin, grist mill and saw mill. Specifically, Belle Meade employs a director of African-American studies.

Like The Hermitage, the Belle Meade main tour has added deeper explanation about the lives of the enslaved people, while also offering Journey to Jubilee — a dedicated tour focusing

exclusively on the home’s history.

The plantation also offers a popular winery and added a bourbon tasting tour, in conjunction with Belle Meade Bourbon, that is equal parts imbibery and history.

Those innovations keep Belle Meade among Davidson County’s top five tourist attractions, with annual growth that, like that of The Hermitage, outpaces the general tourism increase number.

Even lesser known legacy spots are benefitting, quietly. Traveler’s Rest in South Nashville, for example, has seen its attendance spike by almost a third in two years.

CVC chief Butch Spyridon is unsure how much more tourism Nashville can capture from the American market. But he hopes there’s still room to boom internationally, particularly with the success of the non-stop flight to London. A more global tourist population could bolster the city’s longer-in-the-tooth tourist spots.

International travelers tend to stay longer, see more and, maybe most importantly, spend more than their domestic counterparts.

If — or perhaps when — the overall tourism rise flattens, the now-new hotspots could learn a valuable lesson from their still-successful older counterparts, which have managed to stay relevant and mission-faithful by careful reinvention.

And, as Jones says, maintaining the authentic is a key draw.

“The Hermitage is one of the largest, most well-preserved presidential homes. In fact, 95 percent of what visitors see — furnishings, artwork, textiles, personal items, wallpapers and much more — is original to the home and the Jackson family. In a digital era, guests appreciate the historical and educational opportunities our interpreters provide them.”

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INDEX

A-J Adia Victoria 21 Aneesh Chopra 40 Adventure Science Center 65

HealthStream 31

Online Computing 56

Highwoods Properties 12

Patrick Mahoney 61

Hope Gardens Neighborhood Association 22

Perception Health 40 Pete First 37

Jane MacLeod 47

Pilgrim Consulting 64

Jared Miller 62

Polsinelli Law Firm 44

AmSurg 40

Jefferson Street United Merchants Partnership 22, 51

Ann Dee Jones 66

John Eldridge 17, 22

Rebecca Parker 43

Belle Meade Plantation 65

Joist 8

Rosetta Miller-Perry 17, 20, 22

Randy Rabon 14

Bill Frist 40 Bill Hostettler 25 Bobby Frist 31 Bonnie Bashor 22

Sayeh Nikpay 42

K-S

Sean Braisted 29 Sharon Hurt 22, 51 Sharon Roberson 47

BrightStar Care 37

Kathryn Schulte 13

Smith-Packett Med-Com 36

Bruce McNeilage 11

Kinloch Partners 11

Stones River Group 58

Butch Spyridon 66

Lamar Alexander 42

Studio Malo 29

Carol Yochem 47

Lauren Spangler 58

Cheekwood 47

Lee Molette 17, 22

Chris Spintzyk 63

Maneet Chauhan 47

Comprehensive Pain Clinics 38

Mark Cate 58

Country Music Hall of Fame and Museum 65

Mark Hollingsworth 12

Cummins Station 31 Dan Judy 58 David Briley 18 David King 44

T-Z Ted Murphy 56

Marshall Towe 64

Tennessee Department of Transportation 13

Matthew Mancini 38 Matt Proctor 61

Tennessee Entertainment Commission 63

Mekesha Montgomery 47 Metro Development and Housing Agency 28

Tennessee Esports Alliance 62

David Swett 20 E3 Construction Services 17, 22

Metro Planning Department 29

Tennessee Medical Association 38

Envision Physician Services 43

Michael Kenner 24

Eric Malo 29

Tennessee State University 17, 24, 51, 58

Eric Thrailkill 40

Middle Tennessee State University 58

First Tennessee Bank 47

Miken Development 24

Freddie O’Connell 16

Morph Hospitality 47

Frost Brown Todd 47 Gary Gaston 14, 26 Girls Representing In Trades 8 Greater Nashville Black Chamber of Commerce 18, 22 Greater Nashville Technology Council 62 Hannah Paramore 68 Harpeth Development 11 Hastings Architecture Associates 31

Tennessee HIMSS 40

Terry Howard 36 The Hermitage 65 Timothy Graeff 58

Myers Research 58

Tod Fetherling 40

Nashville Civic Design Center 14, 26

Traveler’s Rest 66

Nashville Convention and Visitors Corp. 65

UrbanPlanet.org 12

Nashville Health Care Council 40

Vanderbilt University 14, 42, 56

NashvilleNext 29

WeAreNations 61

Nashville Rocket League Series 62

YWCA Nashville & Middle Tennessee 47

Nashville Zoo 65

Vaco 63

Nolee Anderson 8 North Star Opinion Research 58

NASHVILLEPOST.COM | FALL 2019

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FAVORITES

MY FAVORITE PAR 5 IN MIDDLE TENNESSEE DIGITAL STRATEGIST HANNAH PARAMORE OFTEN HEADS WEST FOR ‘EVILLY WONDERFUL’ LINKS BLISS

I HAD TO GET AWAY from my business, but a golf course seemed the least likely place for me to go.

In fact, it wouldn’t have been anywhere near the list if I’d been making a list. But golf found me at the perfect time. I had owned Paramore Digital for more than 10 years when I took my first lesson, thanks to my VP of sales and Groupon. As the golf pro placed my hands on the club and told me to look down at the ball, I realized that I would never hit the ball if I was thinking about my business. My priorities shifted at that moment.

More than six years later, I’ve sold my business, and I spend more than 20 hours a week at area golf courses. My favorite is Greystone Golf Club in Dickson, where hole No. 9 reminds me of courses I’ve played in Scotland. It’s an evilly wonderful par 5 over gullies and bunkers with an almost impossible breaking putt from every direction.

Hannah Paramore Breen in 2001 co-founded what became Paramore Digital and sold the digital agency to Osborn Barr nearly three years ago. paramoredigital.com

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FALL 2019 | NASHVILLEPOST.COM

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ERIC ENGLAND

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AIMING TO ELEVATE THE TENANT EXPERIENCE, One Nashville is introducing new tenantcentered amenities and experiences in three phases, kicking off in August 2019.

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