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PHYSICIAN SPOTLIGHT PAGE 3
David Bichell, MD
ON ROUNDS Cholesterol Conversations New Guidelines Open the Door for Dialogue with Patients While guidelines are meant to clarify best practices and offer a clear clinical path, sometimes changes wind up being more confusing … leading to debate over what truly is best for patients ... 4
Saint Thomas Heart Debuts MitraClip Clinical Trial Offers Open-Heart Surgery Alternative for Patients with CHF, MR By CINDy SANDERS
As part of the national COAPT trial, Saint Thomas Heart debuted the first MitraClip® implantation at Saint Thomas West Hospital in November 2013. An alternative to open-heart surgery, the device offers patients with congestive heart failure and mitral regurgitation another option when they aren’t candidates for traditional invasive surgery, the standard-of-care treatment. Saint Thomas Heart, the only program in Tennessee currently participating in the COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy) trial, performs the catheter-based procedure in a hybrid operating room with collaboration between interventional cardiologists, heart failure specialists, cardiac surgeons and advanced cardiac imaging physicians. Evelio Rodriguez, MD, a cardiac surgeon and the principal investigator for the trial, and Mark Stankewicz, MD, interventional cardiologist, were part of the team that performed the first MitraClip implantation. (CONTINUED ON PAGE 8)
M&A Trends in the Reform Era A Look Back at 2013 … Look Ahead in the New Year March of Dimes Celebrates Outstanding Community Nurses Middle Tennessee Organization Hosts Annual Nurse of the Year Awards On Dec. 10, 2013, nurses from across Middle Tennessee gathered to honor their own at the fourth annual March of Dimes Nurse of the Year Awards ... 12
ONLINE: NASHVILLE MEDICAL NEWS.COM
By CINDy SANDERS
The Affordable Care Act, coupled with new models of reimbursement, has undoubtedly impacted the way the healthcare industry conducts business today and strategically plans for the future. For some industry sectors within healthcare services, a ‘strength in numbers’ mentality has caused a marked uptick in mergers and acquisitions in comparison to a few years ago. For others, the strategy has been to take more of a ‘wait and see approach’ while trying to figure out just how the new rules will impact their specific markets. Frank Morgan, the Nashville-based managing director for Healthcare Services and Equity Research with RBC Capital Markets, recently shared his thoughts with Nashville Medical News on the level of activity in 2013 and his expectations for Frank Morgan
the coming year. With more than two decades experience in equity research and investment banking, Morgan primarily focuses his research on facility-based healthcare services including hospitals, skilled nursing and assisted living facilities, long-term acute care (LTAC), behavioral health services and rehabilitation. Morgan, who has been recognized for his expertise within the health services industry by multiple national publications and industry rankings, is a popular speaker and participant in financial panels. Overall, Morgan said there was a general uptick in activity in 2013 compared to 2012. That was particularly true within the hospital sector. “’13 … if not a record year … was a very good year for M&A activity,” he noted. “You really saw it on the not-for-profit side,” he added. There are several reasons for the ‘super-sizing’ of hospital systems starting with implementation of ACA but exacerbated by other
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As the number one killer in America, the sheer volume of cardiovascular cases makes this specialty an attractive one for health systems and providers … both from the standpoint of searching for innovative ways to care for a large segment of the population and from the more pragmatic need to balance the bottom line. While most metro areas are lucky to have one center known for delivering quality cardiac care, Nashville has multiple options led by three highly regarded programs with numerous outposts and community clinics. In the last few years, Nashville has seen growth at Saint Thomas Heart, TriStar Heart, and Vanderbilt Heart & Vascular Institute. The following pages highlight just a few of the new procedures and technologies being used to innovate care and improve the quality of life for patients. In ongoing efforts to capture the hearts (bad pun intended) of patients and physicians, the area’s leading programs have raced out of the gate to be the first to introduce new procedures or to achieve accreditations. In August 2010, Saint Thomas West became the first in Middle Tennessee to earn certification from The Joint Commission for ventricular assist devices and destination therapy, a distinction Vanderbilt now also holds. TriStar Heart was the first in the state and among the first in the nation to achieve chest pain accreditation, which all the area’s key players now hold. As an academic medical center, Vanderbilt has been on the cutting edge of a number of research initiatives including being the first U.S. medical center to give patients recovering from heart failure the drug CGF2, which has been shown in trials to help re-grow damaged heart muscle. With program growth has come physical plant expansion, too. In January 2012, Saint Thomas Health announced the opening of the Saint Thomas Heart Ventricular Assist Device Center, which was one of only 33 dedicated VAD centers in the country at the time of opening. The following month, TriStar Centennial Medical Center opened its $150 million Heart & Vascular Center. And Vanderbilt Heart has just relocated key procedure areas to the Critical Care Tower, which connects to Vanderbilt University Hospital. (For more information, see page xx.) So who is the ‘winner’ in the highly competitive race to be crowned cardiac king in Middle Tennessee? Ultimately, the rivalry among the market leaders means the real winners are the patients, who are able to tap into the innovation that results from such competition, and the referring physicians, who now have a wealth of options to tailor treatment to best suit their patients’ specific needs. Cindy Sanders, Editor
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Subcutaneous ICD Offers Viable Option for a Number of Patient Populations By CINDy SANDERS
For nearly three decades, many patients with arrhythmias or at high risk for sudden cardiac arrest (SCA) have benefited from implantable cardioverter defibrillators (ICDs), which help regulate the heart’s electrical signaling. For some, however, the traditional ICD poses problems that a new subcutaneous iteration avoids while still effectively treating ventricular tachyarrhythmias. Sharon Shen, MD, an electrophysiologist with Vanderbilt Heart, explained the difference between the traditional system and the new subcutaneous system (S-ICD). “The subcutaneous ICD doesn’t have any transvenous leads,” Shen said. “Instead of the generator sitting under the collarbone, it sits on the left lateral chest wall. From there, the defibrillator lead travels underneath the skin across the chest and goes up along the left of the sternum.” She added, “The benefit of this system is it’s outside the chest wall so there are no components inside the vascular system or inside the heart.” Shen, an assistant professor of Medicine at Vanderbilt, said the different routing for the leads avoids the acute complications that can come with transvenous placement, including myocardial perforation, pericardial tamponade, venous thrombosis and pneumothorax. “When these leads have been in the vascular system and the heart for a long time, there is the potential for occlusion of those veins, risk of infection in the veins, and potentially infection in the heart,” she noted. Another consideration is lead failure. In younger patients, individuals can easily outlive the longevity of the leads. When that happens, the intravascular leads can be difficult to extract and replace since fibrosis tends to occur over time. Shen, who came to Vanderbilt from Northwestern University, worked with the Cameron Health subcutaneous device (now part of Boston Scientific) during the clinical trial phase in 2010 and 2011. The device, which has been routinely used in Europe for several years, received FDA approval for use in the United States in late September 2012. Currently, Shen said, Vanderbilt is the only site in Tennessee offering this technology. She noted, “It is FDA approved for anyone who is a candidate for a defibrillator including primary and secondary prevention indications.” However, she continued, “A transvenous defibrillator also has pacing capabilities. This device does not … its sole function is to shock patients out of dangerous arrhythmias.” She added, “If you need chronic resynchronization therapy, this would not be the device for you.” It might, however, be just the device for several patient populations. “There is a group of patients that just don’t have the
studies, there is evidence that because the S-ICD “sees” the rhythm rather than just counting how fast the beat is, it might actually help patients avoid unnecessary shocks by effectively discriminating AF and SVT from the more dangerous VT/VF. However, Shen said more research with a larger study population would be required to fully establish that advantage. Like traditional ICD, the subcutaneous system is programmable as a single or dual zone device to tailor therapy to the patient’s needs. Unlike the transvenous method, the S-ICD can be implanted using only anatomical landmarks, which eliminates the need for fluoroscopy during implant thus reducing radiation exposure for both patients and physicians. Although the subcutaneous procedure is less invasive than the traditional method, the generator used with S-ICD is actually a little larger. Yet, many patients still prefer it from a cosmetic standpoint because the pulse generator is implanted on the side of the chest near the armpit, making it easier to hide in clothing. Shen said the traditional ICD generator, located near the collarbone, is more noticeable when wearing an open-neck shirt or dress. “The studies so far show it (S-ICD) has equal efficacy in shocking people out of dangerous rhythms,” Shen said. However, she added, this is still a new device and therefore doesn’t have the same duration of follow-up as traditional implantation, which has been used since the 1980s. “I don’t see this as a replacement for the transvenous ICD,” Shen continued, “but I see it as an addition to what we can offer our medically complex patients … I see it as a tool to customize care for our patients.” PHOTO COURTESY OF BOSTON SCIENTIFIC
EDITOR’SNOTE
venous access to allow the standard ICD,” Shen noted. Others who could benefit from S-ICD, she added, are those who have already experienced lead failure or infection with traditional ICD, younger patients with primary electrical problems who could potentially face lead issues over the long haul, and those with congenital heart abnormalities that preclude implantation of a standard transvenous defibrillator. Patients with renal failure, Shen noted, are another candidate group. With the ongoing potential for introducing bacteria into the bloodstream during dialysis, the Dr.. Sharon Shen S-ICD might help mitigate infection risk since the subcutaneous leads leave the heart and vasculature untouched. Instead of counting beats, the S-ICD uses a sensing algorithm to analyze the heart rhythm and deliver defibrillation when ventricular tachyarrhythmias are detected. Shen said S-ICD reads the heart more like an EKG would. In some small
Sumner Regional Receives Chest Pain Center Accreditation with PCI Sumner Regional Medical Center (SRMC) in Gallatin recently announced the facility has received full accreditation with percutaneous coronary intervention from the Society of Cardiovascular Patient Care. “When a patient is having a heart attack, the longer the time to treatment, the lower the chances of survival,” said Ray Pinkston, MD, medical director of the SRMC Emergency Department and for Sumner County Emergency Medical Services. Noting that the hospital staff and Sumner County EMS have worked diligently over the last few years to set up the best system possible for cardiac care at SRMC, he said the recent accreditation was validation that the team has been successful. “We can now treat patients as fast as … and as well as … the best hospitals in the country, right here in Sumner County.”
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PhysicianSpotlight
David Bichell, MD: The Art of the Heart cardiology here to what they’ve built.” Fast-forward eight years, and Vanderbilt’s pediatric heart program boasts some of the best outcomes in the country. Arterial switches, hypoplastic left heart operations and heart transplants are among the more common procedures accounting for some 500-plus operations each year.
By: MELANIE KILGORE-HILL
There’s no question that heart surgery is an art form, but Vanderbilt’s David Bichell, MD, has taken that to a new level. The chief of Pediatric Cardiac Surgery for Monroe Carell Jr. Children’s Hospital at Vanderbilt is an accomplished surgeon, professor and medical illustrator, and he uses all those gifts to educate and inspire patients and staff.
Beating the Odds
Art & Medicine Collide
Bichell graduated from Columbia University’s College of Physicians and Surgeons in 1987. As a post-graduate, he worked his way up to chief resident in cardiac surgery in pediatrics through Harvard Medical School at Boston’s Brigham and Women’s Hospital and at Harvard’s Children’s Hospital. But the road to medicine was a winding one for the Maryland native. As a fine art major at Johns Hopkins University, Bichell stumbled across the school’s medical illustration class and soon became the program’s only undergrad. “The program included an overlap of curriculum with medical students, and I thought, ‘what a funky and odd and esoteric thing to be doing,’” Bichell recalled. His medical path narrowed further when asked to illustrate pediatric heart transplantation for a textbook publisher. “I watched this surgery that few people get to see, and I thought, ‘Well this is the coolest thing,’” Bichell said. “You’re doing a highly technical, demanding and exhilarating operation that few can do and turning this child into a possible Olympic athlete. What can possibly be better than that?”
The Road to Nashville
Bichell trained and remained on staff at Boston Children’s Hospital, where he immersed himself in the elite field of pediatric congenital heart surgery. That path led to appointments in cities including San Diego, Chicago and Boston before landing in Nashville in 2006. “Vanderbilt seemed like an extraordinarily collaborative and civilized gem of a place, with the entire spectrum from basic science to clinicians working collaboratively in a scientific enterprise that’s top in the country for NIH funding,” Bichell said. “There had always been a strong cardiology program thanks to (division chief) Scott Baldwin, MD, and (former chief of cardiology) Tom Graham, MD, and I attribute much of the strength of
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Bichell said patients with hypoplastic left heart syndrome typically have a 75 percent survival rate, with 85 percent survival considered rare. In 2013, Monroe Carell Children’s Hospital saw a 100 percent survival rate among these patients. “After 25 years, we’ve honed things
down to the finest they can be with a team of specialists who live and breath pediatric heart surgery,” Bichell explained. “That’s what you have to have to get those kinds of outcomes. This also speaks to the teamwork here. There’s not one individual who accounts for the success of that. It truly is a coordination of services, from intensivists to anesthesia.”
Advances in Heart Transplantation
While the hospital averages 10 pediatric heart transplants each year, Bichell said advances in medication and technology, such as ventricular assist devices, mean more patients are living longer, more productive lives without surgery. “We’ve seen so much success in ‘destination therapy’ that it may be the future of heart replacement,” Bichell said. Still, the majority of technology is developed on the adult side, and Bichell noted the innovation required to adapt those tools to the pediatric realm is much more com-
plicated. More than half of the program’s surgery patients are under a year old, and a quarter are younger than one month. “In the past, the success of transplant was hinged on cardiology … and it still is … but an awful lot of advances are on the surgical and technical sides, which is where change is taking place,” Bichell said. “It’s become a big segment of what we do.” Bichell and his research team also participate in multi-center clinical trials, and the surgeon has created a heart tissue bank to help researchers better understand the genetics behind pediatric heart disease and abnormalities.
Healing through Art
Through it all, the father of five continues to draw. While his images have been published in countless journals and textbooks, Bichell’s most enthusiastic fans are his patients. “I’ve really gained appreciation for the adage that a picture is worth a thousand words,” said Bichell, who carefully sketches each patient’s heart condition while explaining the diagnosis for patients and families. “Unless someone’s in the medical field, it’s hard not to lose them within a few minutes. If you can make a drawing as you’re talking, it’s amazing how they get it and appreciate it.” Families have asked Bichell to sign his drawings, commissioned him for projects and have even turned his drawings into tattoos to commemorate their child’s surgery. “There’s a great appreciation for it among colleagues and patients … and more importantly, it lets me convey information in a way few people can,” concluded Bichell.
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Cholesterol Conversations New Guidelines Open the Door for Dialogue with Patients By CINDy SANDERS
While guidelines are meant to clarify best practices and offer a clear clinical path, sometimes changes wind up being more confusing … leading to debate over what truly is best for patients. The latter seems to be the case with four guidelines released by the American Heart Association (AHA) and American College of Cardiology (ACC) last November. A great deal of discussion has already arisen over new cholesterol treatment guidelines, which significantly change the threshold for starting a statin regimen. In answer to publicity focusing on the number of Americans who might now qualify for a statin prescription, AHA President Mariell Jessup, MD, said, “The goal is not to get more people on statins. The goal is to help Americans reduce their risk of cardiovascular diseases and stroke. The goal is to help people live longer.” No matter what the goal, local cardiologist David Huneycutt, Jr., MD, FACC, said the reality is that the new guidelines greatly expand the number of people now recommended for statin therapy. Huneycutt, a general cardiologist for Centennial Heart with a focus on prevention of cardiovascular disease, said the guidelines specify four groups for statin therapy:
• Everyone with a history of cardiovascular events. • People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher) Dr. David • People ages 40-75 Huneycutt, Jr. with Type 1 or Type 2 diabetes. • People 40-75 years old without cardiovascular disease who have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years as determined by a downloadable risk calculator (located in the professional section of the AHA website as part of the 2013 prevention guideline tools). “I think the biggest area of controversy is over the new risk calculator,” Huneycutt said. “This risk calculator is very different than the previous one.” He explained that physicians previously used the Framingham Risk Calculator, which had a higher threshold and harder endpoints for determining when to put a patient on statins. Huneycutt added age and gender carry great weight in the new calculator. “It’s really pretty easy to have a 10year risk of more than 7.5 percent,” he said. “A man can be 65 years old with no
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other risk factors and still meet the threshold.” Huneycutt added, “If a physician is relying on the risk calculator alone to determine a patient’s need for a statin, then yes, we are going to see more patients on them.” He noted the new guidelines are a mixed bag with some steps that he thinks are positives for patients. Previously, Huneycutt noted, a patient with established coronary disease with an LDL of 85, which is 15 points over the target of 70, would have gone on a high-dose statin regimen or additional drug therapy. “More side effects occur in higher doses of statins or in combination with other medicines,” he pointed out. “While the new guidelines might increase the number of overall people who are candidates for statins, it might reduce some of the very high doses of statins and the addition of non-statin medications because you’re not treating to a numeric target.” Huneycutt’s frustration with the new guidelines is in the quickness to jump to a pill when other options are available. “Overall, I think we’re off track,” he said. “I think we use medications way too soon.” He continued, “I don’t think we should be having conversations around medications. I think we should be having conversations around risk modification. In the entire guideline, which is 85 pages, it has basically one paragraph about lifestyle modification. “It is a failing of these guidelines and the medical community. I think 90 percent of the conversation should revolve around nutritional counseling and lifestyle modification and 10 percent around drug therapy. Unfortunately, right now with the state of healthcare, it’s exactly opposite.” In counseling patients, Huneycutt said he encourages a healthy diet. “For me, that means a plant-based diet that includes veg-
For More on Nonpharmacologic Interventions David Huneycutt, Jr., MD, a general cardiologist with Centennial Heart, fashions his practice around primary and secondary prevention of cardiovascular disease. Lifestyle modification plays a key role in his toolkit. He suggested a couple of resources for physicians or patients interested in learning more about the nutritional changes that can play a major role in keeping hearts healthy. “Forks Over Knives”: a 2011 documentary, directed by Lee Fulkerson, available on Netflix and YouTube. “Eat to Live: The Amazing Nutrient-Rich Program”: book by Joel Fuhrman, MD.
etables, fruits, whole grains and beans and is devoid of animal products, highly processed foods and oils.” He recognizes this is a more aggressive diet than is recommended by the AHA. However, Huneycutt added, “In my clinical practice, many patients are able to reduce their risk factor profile without requiring drug therapy.” He said the nutrition recommendation is in combination with physical activity and is typically the first step he takes as part of primary prevention. Huneycutt was quick to add that he absolutely uses drug therapy when warranted but noted statins, like all medications, do have side effects … some significant. And, he continued, medication and lifestyle modification certainly aren’t mutually exclusive. “Many patients with established heart disease benefit from both. I like to try lifestyle modification first, when possible, making that the cornerstone of treatment,” he concluded.
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On Feb. 3, Vanderbilt Heart and Vascular Institute moved all of its key procedure areas to a new home in the Critical Care tower, which originally opened in 2010. VHVI has just completed building out the fifth floor of the 11-story tower to meet the needs of providers and patients better. The fifth floor, which connects to Vanderbilt University Hospital and offers direct access to the cardiovascular intensive care unit, centralizes services and includes the electrophysiology lab, cardiac catheterization lab and cardiac observation unit. The new area also allowed for two additional procedure rooms, taking the total to nine, and features two hybrid OR suites, which could be converted into full operating rooms if needed. The space also makes the most of technology, including teleconferencing capabilities and a hemodynamic monitoring system with direct visualization of right ventricular function following surgery. Additionally, there is dedicated research space included on the floor. Patients and families will have larger, more private waiting areas and holding rooms. For the most acute patients, four bays open to the nurses’ station for direct observation. “Consolidating our procedure rooms, holding and waiting areas, and staff work space on one floor will result in improved care for our patients and greater efficiency for the staff caring for them,” said Keith Churchwell, MD, executive director and chief medical officer of Vanderbilt Heart. nashvillemedicalnews
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Vanderbilt Grows, Expands LVAD & Heart Transplant Program By CINDY SANDERS
When noted cardiac surgeon Simon Maltais, MD, PhD, FRCSC arrived in Nashville in July 2011 to lead the Heart Transplantation and Ventricular Assist Device (VAD) programs for Vanderbilt Heart & Vascular Institute (VHVI), he was given a mandate … to grow Vanderbilt into one of the top-ranked programs in the nation. Since then, the team has garnered naDr. Simon tional accolades, but it Maltais doesn’t mean they see their work as ‘mission accomplished.’ Instead, Maltais and colleagues are focused on continued program growth, research expansion, and setting new benchmarks in outcomes and patient satisfaction. Some of Vanderbilt’s growth in transplantation was a natural byproduct of the Saint Thomas Health decision to discontinue the city’s oldest heart transplant program in January 2012 in order to concentrate on a new VAD Center with a focus on destination therapy. But that doesn’t tell the whole story. Although Saint Thomas was responsible for approximately 350 heart transplants since performing the state’s first one in 1985, volumes had been on the decline in recent years with only eight such surgeries in 2010 and 10 heart transplants in 2011, according to the Organ Procurement and Transplantation Network. By then, Vanderbilt’s numbers were already climbing. In 2013, Vanderbilt hit new heights in terms of volume. “This last year, we had our busiest year ever with over 40 heart transplants,” said Maltais. “That’s putting us in the top 10 programs in the country for heart transplantation.” Although volume is an important marker, it’s the survival rates that have really set Vanderbilt’s program apart. “There are only two programs in the U.S. with 100 percent survival rate at one year … Vanderbilt and the Cleveland Clinic,” said Maltais, a native of Canada who came to VHVI by way of the Mayo Clinic. Like Saint Thomas, Vanderbilt also has a dedicated VAD center, which has taken an active role in device trials over the past decade. The VHVI program became certified for destination therapy in 2012. Previously, Vanderbilt implanted VADs as a bridge therapy to heart transplantation. The volume of LVAD implants, however, has really soared since Maltais arrived. From 2009-2011, Vanderbilt performed 12 LVAD implants (with nine coming in 2011). By 2012, that number had increased to 33. Last year, Vanderbilt’s LVAD program hit a major milestone. On July 30, 2013, patient William Whitwell became the 100th patient to receive a nashvillemedicalnews
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Middle Tennessee Schools Participate in American Heart Month It’s never too early to start learning about … and taking care of … your heart. That’s a message being spread throughout Middle Tennessee during February, American Heart Month. To promote student health, more than 250 Middle Tennessee schools are teaching heart health and the importance of physical activity, participating in the American Heart Association’s “Jump Rope for Heart” and “Hoops for Heart” events, and raising awareness and funds for AHA research and education programs. High school students will participate in RED OUT, raising awareness of the AHA mission by selling T-shirts and then wearing them at sporting events. Participating schools include 54 in Davidson County, 29 in Rutherford County, 28 in Sumner County, 14 in Wilson County and 11 in Williamson County.
VAD implant at Vanderbilt. By the end of 2013, Vanderbilt led the nation in HeartWare implantations as a Maltais noted the growth in bridge therapy. the VAD program has put Vanderbilt among the top five in the nation with more than 80 long-term implants in 2013. have a very large team now in our Last year also saw the LVAD Center. We have four VAD introduction of the new coordinators plus dedicated ancilHeartWare venlary staff,” he noted, adding tricular assistance the integrated clinisystem (VAS) cal team includes for bridge impharmacists, plants. VHVI nutritionists and became the social workers in first program addition to physiin Tennessee to cians and nurses. implant the minia“With Dr. Mary COURTESY HEARTWARE turized circulatory E. Keebler as the medisupport device in cal director of our LVAD January 2013, followprogram, we have four advanced ing HeartWare’s FDA approval the previheart failure cardiologists and just hired ous November. By year’s end, Vanderbilt two (more). By July 2014, we’ll be at six ranked first in the nation for the number cardiologists that are focused on LVAD of HeartWare device systems implanted and transplant,” he said. In addition, the in patients with end-stage heart failure team has just hired another surgeon who bridged to transplantation. will join Maltais at the beginning of April. “It can be used in a larger populaThe increased manpower and retion because it can be implanted with difsources undoubtedly will be put to good ferent strategies or with different implant use as more than five million Americans configurations,” explained Maltais, noting suffer from heart failure with nearly 5 perHeartWare also provides the team with cent of them facing end-stage disease. more options for patients with congenital heart disease. The pump, he continued, doesn’t need a pocket. “It’s completely within the pericardium. We have much more versatility for patients with small habitus,” he added. As for the outflow portion of the device, Maltais said it is much easier to implant at different arterial sites. “With our new minimally invasive … sometimes offpump … HeartWare implant approaches, we avoid a full sternotomy. We don’t have to split the breastbone open,” he continThe cytogenetic laboratory and ued. information resource of choice for According to Maltais, the small size physicians who demand accurate, and minimally invasive surgical requiretimely, and state of the art ments make HeartWare easier to implant cytogenetic diagnostic services and decrease the risk of perioperative for their patients. bleeding and infection. At present, HeartWare is only approved for bridge therapy. • Chromosome Analysis However, Maltais said it is highly effective, • Polymerase Chain allowing patients to remain on the support Reaction (PCR) system for as long as needed. In fact, he anticipates a change in the HeartWare ap• Fluorescence In Situ proval status pending completion of curHybridization (Fish) rent trial evaluation. “Hopefully a year • Array Comparative from now, the indication will expand to Genomic Hybridization destination therapy.” (Microarray) Although Vanderbilt employs several devices in the acute setting, Maltais said Genetics Associates Inc. is CAP accredited, CLIA the team depends on the HeartMate II and and State of Tennessee Licensed. HeartWare devices for long-term implantation to achieve haemodynamic stabilizaOur professional staff includes five American Board tion. “The technology is better. The risk of of Medical Genetics (ABMG) certified directors. complication has gone down dramatically with those two devices,” he noted. 1916 Patterson Street, Suite 400 • Nashville, TN 37203 With the increases in transplant and (615) 327-4532 • 1-800-331-GENE (4363) VAD volumes has come significant growth Where advanced cytogenetic technology meets old-fashioned service in staff. Maltais said three years ago, the www.geneticsassociates.com VAD program had one coordinator. “We FEBRUARY 2014
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Health eHeart
Ambitious Research Project Launched to Advance Heart & Stroke Science By CINDy SANDERS
What if gathering critical heart health information from around the world was as simple as entering a few keystrokes on a laptop or smartphone? Turns out there is an app for that … actually several apps … and researchers with the Health eHeart Study hope to turn those rich data sources into powerful tools to predict, prevent and treat heart disease and stroke. “In my 30-year career as a researcher and physician, I’ve never seen a study as innovative as the Health eHeart Study,” said Elliott Antman, MD, president-elect of the American Heart Association (AHA) and co-chair of the study’s Scientific Advisory Board. “This is a seamless way to participate in a research study while going about your daily activities.” Dr. Elliott Launched last year, Antman the AHA has joined forces with the University of California, San Francisco (UCSF) to support this longterm, large-scale health research project. The transformative study is led by three USCF faculty members — Jeffrey Olgin, MD, professor of Medicine and chief of the Division of Cardiology; Greg Marcus, MD,
Robert A. Frist Jr.
Fou nder, CE O Health Strea m
The Health eHeart Study makes it easy to log important data without disrupting the day.
MAS, director of Clinical Research for the Division of Cardiology; and Mark Pletcher, MD, MPH, a cardiovascular epidemiologist and the director of Research Consultation for UCSF’s Clinical and Translational Research Institute. The goal is to enroll one million adults from around the globe, and the only inclusion criteria are that participants be over 18
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and have access to the Internet. Researchers are seeking individuals across the spectrum … from the very healthy to those diagnosed with cardiovascular disease or other chronic conditions. Rather than having to make an appointment to see a physician to submit or update health and activity information for the study, participants can log info on the go and at their convenience via computer or mobile device. Antman and colleagues are hopeful that the ease of participation will translate into more robust data collection. Initially, participants are asked to answer a series of demographic questions, including information on lifestyle habits and personal and family medical history, to establish a baseline. Then every six months, they are asked to answer additional questions about activities and health events. Additionally, participants have the opportunity to share information gathered from smartphone apps and wireless devices (such as blood sugar monitors, at-home blood pressure equipment, and digital scales) with the study’s protected data system. A number of apps are free, and sites including iHealth (ihealthlabs.com) and Withings (withings.com) have electronic health tracking devices that sync with the Health eHeart Study data collection. “Getting a blood pressure reading or an ECG in your doctor’s office is just a snapshot of the given moment, but now we’ll be able to see big data streamed almost in real time as people are going about their daily activities,” noted Antman. “This presents a total paradigm shift in how we learn about human health.” Antman, a professor of Medicine at Brigham & Women’s Hospital and associate dean for Clinical/Translational Research at Harvard Medical School, is clearly excited about the possibilities afforded by such a large collection of data among global populations. “This research initiative makes use of cutting-edge digital technology to perform not only a stateof-the-art observational study but also to provide the platform to facilitate randomization. This is really an electronic, decentralized cohort,” he said. “The goal,” he continued, “is to use
the big data to predict who is going to develop heart or stroke problems.” However, Antman noted, the immediacy of the media also opens up possibilities to test the efficacy of various treatments and behavioral modifications. “This is nimble and has the potential to change the way we study health behaviors and test interventions to modify those behaviors,” he explained. For example, Antman noted a subgroup of participants who identified themselves as regular smokers on the baseline questionnaire could be pulled from the larger study. From that subset, one group could be randomized to receive a weekly email from a health coach reminding them not to smoke, while another group might receive a link to a website with information on how to make behavioral changes. Subsequent follow-up could show one method to be more effective than the other. That, noted Antman, is where the nimbleness of the technology comes into play by allowing researchers to quickly switch all participants to the more effective intervention. Antman said physicians and other providers could be major allies in helping get patients signed up for the study. He encouraged physicians to go online to learn more about the project and to share the website information with their adult patients. Antman added the AHA has brochures available for distribution at clinic and office sites, as well. Again, he stressed, the goal is to include everyone across the health spectrum from young, active adults to those with multiple comorbid conditions. Antman also noted that while this is a long-term commitment, participation is extremely easy. “This is a study that doesn’t impose on a person’s time the way other research studies do,” he said. Signing up is simple, too. Just go to health-eheartstudy.org to learn more about the project and join the thousands already enrolled. Join the Movement to Stop Heart Disease & Stroke www. health-eheartstudy.org
Bonus Editorial Even after you’ve read the entire February issue of Nashville Medical News, there’s still more news to uncover. Go online to nashvillemedicalnews.com for online exclusives including: • Vanderbilt Expansion Plans • Preparing for ICD-10 Conversion • Detecting Lung Cancer Earlier • Physicians Selling Practices
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When Minutes Matter
AirStrip Technology Provides Critical Data in a Heartbeat By CINDY SANDERS
Time is muscle. When someone experiences a major cardiac event, every second counts. Getting data into the right hands in a timely manner can literally be the difference between life and death. Even before the new TriStar Centennial Heart and Vascular Center opened in February 2012, the leadership was already focused on finding sophisticated technologies to enhance care delivery, save valuable time and minimize heart damage. COO Jim Drumwright said AirStrip Cardiology is one of the solutions Centennial added to its armamentarium. “We were early adopters of the technology,” Drumwright said. “We saw an opportunity to improve the care we provide our patients and make our cardiologists more efficient.” A mobile health application, AirStrip Cardiology allows physicians to remotely monitor a patient’s heartbeat Jim by viewing a live elecDrumwright trocardiogram (ECG) with diagnostic imaging clarity. Previ-
ously, paramedics would obtain a 12-lead ECG for patients with symptoms of acute myocardial infarction and then send the information to the hospital Emergency Department via fax or PDF. However, quality was often degraded in transmission. If the images then had to be faxed from the ED to a cardiologist for review, visual clarity suffered even more. Explaining the benefits of the technology, Todd Dorfman, MD, an interventional cardiologist with Centennial Heart, said, “When a patient has a heart attack, the goal is to restore blood supply to the heart within 90 minutes. The TriStar hospitals are the only hospitals in the state that have AirStrip technology. It reduces door-to-balloon time by probably 10, maybe 15, minutes.”
Dorfman noted that being able to see the ECG data in real time allows him to activate the cath lab whether he’s in his office or at home. The sooner that blood supply is restored, he said, the less damage there is to the heart and the less likely the patient is to face recurrent heart failure. Dr. Todd Looking Dorfman at year-end 2013 data, Drumwright said, “In December, our 12month average for door-to-balloon was under 50 minutes, which is well below the national standard. It’s technology like this that allows us to bring better care quicker to the patient.” With AirStrip, emergency responders with the capability of transmitting 12-lead ECGs can get detailed images to providers from the field. Similarly, an ED physician can quickly consult with a cardiologist whether the specialist is onsite or not. “AirStrip allows us to digitize that image and get it into the hands of the cardiologist on his iPhone or iPad. It’s a diagnostic quality image no matter where he or she is,” Drumwright said. “It’s like having
a cardiologist in the ED or the ambulance with the patient when they’re not really there,” he continued. “We’re able to start that treatment sooner.” It also can help ensure treatment occurs in the correct setting. Drumwright noted a patient presenting at the ED with an acute AFib episode would typically be admitted by an emergency medicine physician and a consult with an electrophysiologist scheduled for the next day. AirStrip allows the EP to see what is happening with the patient and assess the severity to avoid unnecessary admissions. While emergency care is one major use for the technology, Drumwright said it has a number of other applications, as well. “We use it frequently for consults,” he noted. AirStrip is used to alert physicians of changes among cardiac inpatients. Since the app stores the tracings, a physician is able to compare images and alter treatment plans if warranted. Already used extensively, Drumwright said Centennial Medical Center plans to grow with the technology. Future applications, such as remote hemodynamic monitoring, will be adopted as the company rolls out new iterations. In addition to Centennial, TriStar Skyline and TriStar Summit also use AirStrip Cardiology.
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Saint Thomas Heart Debuts MitraClip, continued from page 1 The two specialists explained mitral regurgitation (MR), the most common type of heart valve insufficiency in the United States, occurs when blood flows backwards into the heart or lungs because the leaflets in the mitral valve don’t seal tightly when closed. Symptomatic patients often experience fatigue, shortness of breath, a dry cough (especially when lying down), poor exercise tolerance, lightheadedness, heart palpitations and swelling in the legs. There are two forms of MR: Degenerative (or primary), which is a mechanical problem with the valve itself, and Functional (or secondary), which typically results from a problem with the heart that hinders the otherwise normal mitral valve from operating properly. An example of functional MR might be an enlarged heart that keeps the mitral leaflets from meeting all the way. Rodriguez said MitraClip, a product of Abbott Vascular, received FDA approval in late October 2013 for patients with degenerative MR at prohibitive risk for mitral valve surgery. The COAPT trial is studying the efficacy of the device to impact the progression of heart failure in high-risk Dr. Evelio patients with functional Rodriguez MR. “Saint Thomas is the only site in Tennessee that has the technology at this point,” Rodriguez said. “With the
trial, we are enrolling patients dinner for her family just a few right now.” days after leaving the hospital. After patients matching Although still an investiinclusion criteria are selected gational procedure, outcomes and appropriately screened, data does exist from an earlier they are randomized to receive U.S. trial, EVEREST, which either the MitraClip or maxiwas conducted in association mal medical management. with degenerative MR prior to Currently, medication therapy FDA approval. “All the patients treats symptoms but does not had severe mitral regurgitation. halt disease progression. After their first clip, 64 percent In those receiving the clip, of them had less than 2+ mitral Stankewicz explained, “A small regurgitation,” said Stankewicz. tube is inserted near the groin He added that number rises to and goes up through the cir- Dr. Stankewicz (L) and Dr. Rogriguez (R) led the team effort to implant the first 84 percent when including paculation to the heart, crossing MitraClip as part of the COAPT trial. tients who ultimately had adthe interatrial septum.” The ditional clips or procedures. At durable result over the years, a significant placement device, he continued, is inserted 2+ MR, patients are considered to have number of patients are deemed too unthrough the tube, through the heart, and mild regurgitation and are most likely asstable to survive the operation or to do so directed down towards the mitral valve. ymptomatic. “It was durable at 36 months with a reasonable quality of life. “Anytime With the heart still beating, the moving and significantly improved quality of life,” you open the heart, you have to go on the leaflets have to be captured and aligned. he added of the three-year follow-up. bypass machine,” Rodriguez pointed out. “Once we’re able to grab both leaflets Rodriguez pointed out that patients “It’s a big stress to go on bypass,” and ensure we’re in the correct spot, then who receive the MitraClip are not preStankewicz agreed, adding the risk of the clip is deployed and cluded from having open-heart surgery at stroke and clot is higher with traditional catches.” Stankewicz a later date if their risk profile improves surgery than with MitraClip. added, the placement and the need still exists. He noted the The first patient to receive the Midevice is then removed MitraClip procedure is a complement to traClip has done extremely well to date. from the catheter and the Saint Thomas Heart’s transcatheter aortic “As soon as she woke up, she said she felt small incision above the valve replacement (TAVR) program for better,” noted Stankewicz. “The evening femoral vein is closed. patients with severe aortic stenosis. Mitraof the procedure, she was sitting up in Although the ideal Clip is the only valve repair alternative for Dr. Mark her chair. The next day, she was walkin younger or healthier many of these patients. Stankewicz ing around and basically wanting to go patients would be to Stankewicz concluded. “To be able home.” The patient went from extreme open the chest and repair or replace the to offer a new technology to patients who fatigue to cooking a large Thanksgiving valve, which has been proven to offer a had no options before is very exciting.”
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M&A Legal Nuances By CINDy SANDERS
With changes in reimbursement and new collaborative models on the horizon, medical practices and hospital facilities that have long operated independently have begun dipping their toes into the M&A waters. Large systems and corporate operators who have deep experience in ventures that merge, join or purchase facilities outright are well aware of the intricacies involved in crafting such deals and employ a team of seasoned lawyers, accountants and consultants to ensure regulatory mandates don’t sink the transaction. For the newer, smaller players who arrive at the M&A shores expecting smooth sailing, the legal and regulatory undertow can quickly make them feel like they’ve gotten in over their heads.
course, he continued, the Supreme Court desicion that each state has the right to decide whether or not to expand its Medicaid program has left many hospitals in states like Tennessee in financial pergatory with reduced federal payments and no increase in Medicaid rolls. “You’re running into some very cashstrapped hospitals who are looking for partners to help them weather the storm,” he said. Hardcastle noted that although these facilities don’t seem like very attactive targets in the short term, there are investors
and partners who believe they can acquire facilities at a bargain price today with an eye toward long-term returns as efficiency improves and reimbursements are revisited in the future. On the practice side, he noted physicians were selling to hospitals long before ACA. However, healthcare reform has probably magnified some of the trigger points that prompt physicians to sell their practice. Hardcastle said three reasons often given are that physicians believe 1) a hospital system has more clout and can negotiate better payer rates; 2) hospitals
are generally willing to pay a base salary, perhaps with productivity incentives, that exceed what the physician could do on his or her own; and 3) the physicians are simply tired of the administrative hassel to run a practice. “Rightly or wrongly, physicians belive if they are with a ‘cash rich’ hospital system, they can feel safer ... have more security,” he said.
Easier Said Than Done
“I think people underestimate the operational difficulties of these sorts of en(CONTINUED ON PAGE 10)
ACA Impact
Jay Hardcastle, partner with Bradley Arant Boult Cummings and chair of the firm’s Healthcare Practice Group, said the Affordable Care Act impacted the M&A landscape in two very signficant ways. In the pre-ACA world, he said hospitals expected their Jay rate of reimbursement Hardcastle would rise each year as part of the market basket update. Second, many hospitals relied heavily on the Medicaid Disproportionate Share Hospital (DSH) payments that helped offset costs from uncompensated care. The idea behind Obamacare, Hardcastle said, was to balance DSH and market basket reductions with increases in Medicaid and private coverage. Of
AHLA Health Care Transactions Conference Loews Vanderbilt Hotel • Nashville April 10-11, 2014 The American Health Lawyers Association is presenting a unique opportunity for attorneys to learn more about the latest commercial developments, strategies and deal forecasts in healthcare transactions. Programming features insight into the business and legal issues involving healthcare transactions including emerging care models, M&A trends, financing techniques, deal risk management strategies, post integration lessons and more. Registration is open both to AHLA members and non-members. Group rates and discounts are available, but all fees increase after March 19. For more information go to healthlawyers.org and click on ‘Events and Education.’
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M&A Trends in the Reform Era, continued from page 1
market forces including an increase in physicians seeking an employment model, implementation of EHR and changing payment methodologies. “The overarching uncertainty about how the world is going to play out over the next four or five years has led to the leveraging of strengths,” said Morgan. He added the leaders of individual hospitals or small systems are faced with deciding to weather the changes on their own or join forces to be part of a bigger group that has the infrastructure in place to manage and deal with the new healthcare delivery landscape. From mergers to acquisitions to strategic joint ventures, there was a lot of movement on the not-for-profit side, which makes up about 80 percent of hospitals in America. Dallas-based Baylor Health Care System and Temple, Texas-based Scott & White Healthcare completed their merger in late September to create the largest notfor-profit health system in Texas. Earlier in the year, Michigan-based Trinity Health merged with Pennsylvania-based Catholic East in one of the largest nonprofit mergers of 2013. And some interesting partnerships occurred between not-for-profit hospitals
and systems and publicly traded operators. LifePoint Hospitals and Duke continued to acquire hospitals for their joint venture. One of the largest mergers occurred between a nonprofit hospital system and a major insurer when the Pennsylvania Insurance Department approved the affiliation between Highmark (a BlueCross BlueShield subsidiary) and West Penn Allegheny Health System, both based in Pittsburgh. After closing that deal in April, Highmark went on to add two more Pennsylvania-based hospital systems to its integrated delivery system, Allegheny Health Network. While a lot happened on the nonprofit side, Morgan noted there were also major acquisitions within the publicly traded hospital space. “On the for-profit side, there were two notable deals completed or announced in 2013 — Tenet Healthcare & Vanguard Health Systems and Community Health Systems & Health Management Associates.” In the first deal, Nashville-based Vanguard was the target of Dallas-based Tenet. The latter completed its acquisition of Vanguard at the beginning of October in a deal valued at approximately $4.3 billion ($1.8 billion purchase price plus
assumption of $2.5 billion of Vanguard debt). The second deal, Morgan said, was announced last year and is anticipated to close in the first quarter of 2014. In this case, Community Health Systems, headquarered in nearby Franklin, seeks to acquire HMA, which is based out of Naples, Fla. Just before Thanksgiving, CHS and HMA announced the companies’ proposed merger had been declared effective by the Securities and Exchange Commission (SEC), clearing the way for a vote by HMA stockholders, who approved the deal last month with 98.7 percent of votes in favor of the merger. With a purchase price close to $4 billion plus assumption of debt, the overall value of the merger is anticipated to be in excess of $7.5 billion, making it the largest deal since the HCA buyout in 2006. Once the merger is executed, CHS will own and/or operate 206 facilities with more than 30,000 licensed beds. “From and M&A perspective, I would expect to see a continued robust level of activity,” Morgan said of 2014. However, given the limited number of publicly traded companies and the amount of activity that has already occurred in that space, he said
M&A Legal Nuances, continued from page 9 deavors,” Hardcastle said. He added there are cultural hurdles to address, particularly when a non-profit is being acquired by or merging with a for-profit system. Religous and ethical directives also come into play when two
hospitals or a practice and a hospital stand on opposite sides of hot button issues such as abortion, birth control and end-of-life decisions. “When you go through an acquisition, there’s uncertainty about who is
The Antitrust Issue “Healthcare deals have become more of a focus for the Federal Trade Commission,” stated Beth Vessel, a partner at Waller. She added the FTC has been forthright in saying their investigators are looking at mergers and acquisitions that might tend to lessen competition in a market. Vessel, who works extensively in the healthcare sector and often advises clients on antitrust law related to due diligence, noted it isn’t enough to think about a deal only in terms of how it effects the main participants ... it’s equally critical to look at the larger implications of the transaction. “You also want to look at your documentation creation policy,” she Beth Vessel continued. “If you are talking about a transaction, you want to be very careful what you put in writing, even emails.” An off-the-cuff remark in an email along the lines of — ‘with this merger, we’ll really dominate the cardiac market’ — could be enough to have federal agents knocking on your door. Vessell said the Hart-Scott-Rodino Act created a federal pre-merger notification program where buyers and sellers involved in large transactions must provide information about competition, their market share and plans. Currently, transactions valued at $70.9 million are subject to HSR filings. However, the valuation trigger point tpically changes early in the year so that figure is expected to shift this month. Smaller transactions, she noted, also are subject to proving the rules were followed when it comes to antitrust allegations. “Just because you don’t have to file a report under Hart-Scott doesn’t mean you won’t have to provide documents in connection with an investigation,” she said. A complaint by another provider or a payer could be enough for the FTC to step in and examine the deal more closely. Vessel also said those involved in a proposed transaction must remember not every deal closes. Being a little too free with information in the beginnning could cause problems down the road. “When you are doing due dilligence on the front end, you need to be careful not to provide competitively sensitive information on pricing,” she explained. “If you are competitors and if the transaction falls apart, it might be viewed as price fixing. You want to be careful not to to appear like there is price collusion.” To avoid this issue, the two parties might consider bringing in ‘clean teams’ — outside lawyers and accountants who can aggregate information so that each side has the information needed to make decisions without having specific price points. “You’re supposed to act like competitors until the deal goes through, as much as you can,” Vessel concluded.
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going to be runing the hospital, and that often causes stress and friction,” Hardcastle said. “The bigger hospital tells the smaller hospital, ‘Look, you’re losing dollars so do it our way.’ A classic example of that is with staffing ratios,” he continued. “It’s just a lot harder than it sounds to cut your cost and not hurt quality.” Hardcastle added, the leaders of small hospitals typically play a prominent role in the community so selling the hospital impacts more than just staff and patients ... it can have a much broader effect on the larger community, as well. “Often the smaller hospital will extract from the bigger hospital some sort of concession to infuse the community with a certain amount of capital,” Hardcastle noted. However, he added, there are different ways to structure the sale and legal considerations to creating a foundation.
Closing the Deal
While some M&A deals might be more complex than others, all have a level of difficulty that require outside expertise. However, Hardcastle said, it isn’t enough to simply bring in an attorney to represent your interests. Instead, he noted, “You have to bring in attorneys who buy hospitals as part of their practice. There are too many nuances.” A good resource for physicians or hospitals looking for that type of expertise is the American Health Lawyers Association (healthlawyers.org). The American Bar Association and most state bar affiliates also have sections on health law. In Middle Tennessee, where healthcare is a $70 billion industry, there are numerous attorneys and firms that have the specialized knowledge necessary to close the deal.
he expects much of the future activity to be in the not-for-profit world. Behavioral health had a “decent” 2013, Morgan said. Franklin-based Acadia Healthcare enjoyed another healthy year of growth. The company began the year by completing previously announced deals acquiring Behavioral Centers of America and AmiCare Behavioral Centers and then proceeded to acquire additional individual facilities in Georgia, Tennessee, Florida, and Puerto Rico during the remainder of the year. Morgan said he expected the company to continue to grow in 2014. A behavioral health “marriage” announced in late 2013 is expected to come to fruition in 2014. In November, the leadership of Centerstone, which has a major presence in Tennessee and Indiana, and the H Group, with facilities in Illinois and Kentucky, announced their intent to affiliate. Although the H Group will operate under the Centerstone flag, David Guth, CEO of Centerstone of America, said the affiliation had no money or assets changing hands and was instead a joint effort to “create a stronger and more effective behavioral health service organization.” Earlier in November, Hazelden and the Betty Ford Foundation also announced a mega-merger in the addiction space. After a slow start, Morgan noted home health saw some movement by late 2013. “In home healthcare, we did see a little bit of pick up at the end of the year,” he said, noting Louisville, Ky.-based Almost Family acquired Nashville-based SunCrest Healthcare in December. Going forward, Morgan said, “2014 could potentially be a year where you see more consolidation in the home health space.” Other sectors, said Morgan, were considerably quieter in 2013. Senior housing saw some limited activity, as did dialysis. Morgan said the latter was already pretty consolidated with the two big players being DaVita and Fresenius. “Between the two, they already control about 55 percent of the domestic market,” he pointed out. It was also a fairly quite year for labs, hospice, skilled nursing and LTACs as these sectors restructure and re-evaluate expectations under ACA and the impact of post-acute bundled payments. In the lab space, Morgan noted, “They’re not redeploying capital for growth right now. They’re trying to pacify stockholders by buying back shares and paying dividends because of the weaker organic growth because of pricing and volume pressures.” In general, Morgan concluded, there was good news in the equity markets for a number of healthcare sectors in 2013. “The S&P was up almost 30 percent … healthcare services was up over 37 percent,” he noted. For some, the gains were even greater. Morgan said behavioral healthcare was up over 100 percent and hospitals up over 44 percent. Looking ahead, he said, “I still think you can have really attractive returns for 2014 given valuations are still reasonable and the growth opportunities presented by the Affordable Care Act, but I think you need to pick your subsectors carefully.” nashvillemedicalnews
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HealthcareEnterprise
Meharry’s 12 South Community Clinic Reaching Out to the Neighborhood By KELLY PRICE
The 12 South Community Clinic is a big player in the Nashville neighborhood where it is located. It has gained traction, creditability ... and admiration ... throughout the broader Nashville community since opening its doors in the fall of 2012. An Idea Takes Shape In 2010, six students at Meharry Medical College discussed their concern about the rising numbers of uninsured Tennesseans and the way the healthcare resources in Nashville treated — or failed to treat — a significant number of them. Instead of just talking about the situation, they decided to find a way to help. Their solution was to design and create a clinic that would provide free care to an underserved community. A nucleus of medical students, led by upperclassman Rebecca Ptaff, founded the clinic to have wide-ranging, tangible implications on the community by providing top-quality healthcare, while also providing a venue for medical students to hone their skills by applying and augment-
Dr. James Sullivan with Student Volunteers from the Meharry 12 South Community Clinic
ing their classroom and laboratory studies with ‘real world’ experience. “It all started with a few students who were interested in starting a free clinic so that they could cultivate a training ground for future primary care physicians and also provide access to care,” said Naomi Bitow, now co-director of Case Management.
Four years later, those ideas and ideals have been incorporated into the 12 South Community Clinic. Feet on the Ground With the support of Meharry’s School of Medicine Dean Charles P. Mouton, MD, and the faculty Advisory Board, these students — and the many others
who have since joined them — have been able to establish and sustain the clinic through its first year of operation with results that would be deemed a success by any measure. Student-run under faculty supervision, the clinic was established in partnership with United Neighborhood Health Services clinic network, which has a similar mission. Since opening in October 2012, the clinic has provided an estimated $46,500 in care — $42,630 in free office visits; $3,091 in free diagnostic laboratory studies; $434 in free prescriptions; and $373 in radiology services. Clinic students and staff also work to assist patients who need additional access to diagnostics, prescriptions, specialty referral and transportation. “The services that we provide are comprehensive care, primary care for children and adults, and we refer patients to social services providers,” said Veronica Ralls, co-executive director of the clinic with Nicholas Kramer. She added, “We have recently started doing screenings for oral cancer.” And – they give flu shots. This latest (CONTINUED ON PAGE 12)
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HC Enterprise, continued from page 11
preventive care service recently has been heavily publicized in local media outlets in light of this year’s deadly flu epidemic. On one recent cold evening, more than 79 patients showed up to take part in the Influenza Vaccination Program. A student, Andrews Marshall, recipient of the Martha Ingram Scholarship, funded an initiative that has allowed the clinic to provide free influenza vaccines to patients throughout the entire flu season. On this January night, the flu shots were given by 35 first- and second-year medical students who received training to administer the vaccines. The medical students, who receive no pay or school credit for working, have learned that clinics aren’t just about onsite patient care. In the clinic, they learn about connecting patients to other resources, figuring out how to help them pay for the procedures or follow-ups in hospital settings, helping patients figure out potential Medicaid eligibility, and a myriad of practical information about how the healthcare system works. The clinic is open from 6-9 pm every Thursday evening and is staffed by Meharry medical students and faculty physicians who volunteer their time. An attending physician is on site every week to oversee operations, and Jim Sullivan, MD, serves as chief clinical adviser and regular volunteer. “As our patient numbers grow, we hope to move eventually to having two physicians each Thursday night, which would allow us to see twice as many patients, and then we hope to move to two nights a week,” Ralls said of future plans. “We want to both enhance the educational experience of students, as well as to offer top-quality healthcare at no cost to an underserved community.” The 12 South Community Clinic is located two blocks from a neighborhood that is recognized as a Medically Underserved Area Population and a Primary Care Health Professionals Shortage Area. The clinic augments these barriers to care by seeing patients with appointments and on a walk-in basis. With their evening hours, Ralls noted, “We also serve as a convenient option for uninsured and underinsured community members who often must visit an emergency department for primary care needs. All patient care and training is conducted and tracked in compliance with MMC standards of practice and in accordance with the patient-centered medical home model of care.” She continued, “Our case management model ensures individualized care for all patients.” The clinic is currently working with the Meharry School of Dentistry, Tennessee State University School of Social Work, Vanderbilt University, and other local institutions to best provide a holistic package of services for patients and to foster inter-professional collaboration and learning.
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March of Dimes Celebrates Outstanding Community Nurses Middle Tennessee Organization Hosts Annual Nurse of the Year Awards By: CINDY SANDERS
On Dec. 10, 2013, nurses from across Middle Tennessee gathered to honor their own at the fourth annual March of Dimes Nurse of the Year Awards. HighPoint Health System CEO Susan Peach, RN, BSN, served as the gala event’s chair with Cathy Taylor, DrPH, MSN, RN, dean of Belmont University’s College of Health Sciences and Nursing, in the role of honorary chair. Sumner Regional Medical Center, a LifePoint Hospitals’ facility under the HighPoint umbrella, was the event’s presenting sponsor. Continuing tradition, Nashville Medical News served as media sponsor and Dan Thomas, WSMV - Channel 4 meteorologist, as the evening’s emcee. While top nurses were recognized for their body of work in 16 categories, all of the more than 160 nominees represent the March of Dimes vision for healthier, happier, stronger, safer infants and families.
Advance Practice Sponsored by Cigna HealthSpring Rene Love, DNP, PMHNP/CNS-BC Vanderbilt University School of Nursing Love is described as a consummate practitioner, educator and scholar with more than 25 years experience. An assistant professor and the director of the PsychiatricMental Health Nurse Practitioner Program, she has spent her nursing career collaborating with professionals from multiple disciplines and organizations. Love’s work has focused on helping those who have experienced crisis or disaster. In addition to coordinating relief for individuals, she has trained public school systems to provide mental health support after unexpected deaths, natural disasters and school shootings.
Behavioral Health Jessica Walker, RN, BSN Vanderbilt University Medical Center Walker has been in practice in Tennessee for only two years but has already gained a reputation for exhibiting leadership skills while being a team player. Passionate about psychiatric nursing, she has a heart for service that allows her to connect with patients facing tremendous behavioral health barriers. When not with patients, she is thinking about ways to improve care through evidence-based practice and research. Walker has been heavily involved in a recent project looking at sensory rooms for de-escalation at Vanderbilt Psychiatric Hospital.
Cardiac Denise Gould, LPN Sumner Regional Medical Center Four years into her second career as a nurse after working as a teacher for eight years, Gould brings the skills she learned in the classroom to the cardiac care arena. She has incorporated a ‘leading by example’ attitude to help train other nurses as they join the staff. Patient welfare and satisfaction are her top two priorities. To ensure every patient receives the appropriate level of care, she relies on her personal motto of “See a need; fill a need.”
Critical Care Sponsored by Sumner Regional Medical Center Diane Comer, RNC-NIC, MSN, BSN Monroe Carell Jr. Children’s Hospital at Vanderbilt An experienced NICU nurse, Comer brings 25 years of experience to her passion for quality improvement and patient safety.
In recent years, she has dedicated her leadership efforts to promoting and modeling best practices to reduce hospital-acquired infections and appropriate completion of the required newborn screening tests for the nurses of the Monroe Carell NICU. Her concern for patient safety helps assure Tennessee’s tiniest residents have the best chance at optimal short-term and long-term outcomes.
Emergency Sponsored by Sumner Regional Medical Center Melissa Perkins, RN, BSN, EMT-P, CEN TriStar Horizon Medical Center Awesome, effervescent, inspiring, selfless, unbeatable, superhero … these are just some of the words colleagues use to describe Perkins. The clinical coordinator for Horizon’s Emergency Department, Perkins has been a nurse for nine years. While working as a paramedic, she experienced a life-changing accident that created physical and emotional challenges, which many would find difficult to overcome. Instead, Perkins used those challenges to fuel her desire to pursue a graduate degree in nursing while keeping her paramedic licensure current. She epitomizes the ‘grace under pressure’ mindset required of emergency medicine nurses.
Entry to Practice Nursing Education Sponsored by Lipscomb Univ. School of Nursing Robin Seaton, MSN, RNCOB, FNP-BC, C-EFM Vanderbilt University Medical Center A nurse for 16 years and practicing in Tennessee for 11 years, this nurse educator invests herself fully in ensuring new staff nurses are well prepared and actively mennashvillemedicalnews
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tored along their journey. Seaton strives to foster a team spirit atmosphere and is willing to stand up for her patients and nursing colleagues … even when it might be the unpopular position. She is known and respected for her integrity, passion and intellect.
Graduate Nursing Education Sponsored by Belmont Univ. College of Health Sciences and Nursing Abby Parish, DNP, MSN Vanderbilt University School of Nursing Recognizing educators have the responsibility … and amazing opportunity … to showcase the values and behaviors the nursing profession hopes to cultivate in students, Parish models a collaborative, respectful, professional practice both in the classroom and clinical settings. The assistant professor makes it a priority to know each student as individuals and recognize the different learning styles to best prepare nurses for the responsibility of advanced practice.
Managed Care Sponsored by BlueCross BlueShield of Tennessee Community Trust Kathy Shinkle, RN, BSN UnitedHealthcare A problem-solver by nature, Shinkle is constantly looking for innovative solutions to improve the patient experience. She embraces opportunities to build a collaborative environment and bridge communications between departments. Her passion for nursing extends well past the workday. She is actively engaged in assisting organizations that support families going through the adoption process and promotes awareness of human trafficking. Shinkle also volunteers her time and skills overseas including two mission trips to Thailand to work with an orphanage.
Nursing Administration Sponsored by Healthcare REIT Lori Ferranti, RN, BSN, MSN, PhD, MBA Tennessee Department of Health As director of the TDH Office of Policy, Planning and Assessment, Ferranti is a population health champion. The way she leads her team is rooted in her early career experiences as the lone registered nurse in a rural hospital more than two decades ago. With ink barely dry on her diploma, she instinctively realized the best way to be an effective leader and clinician was to engage colleagues and work side-by-side with staff. Today, that collaborative mindset helps inform evidence-based practices and programming designed to promote, protect and improve the health of Tennesseans.
Pediatric Sponsored by Monroe Carell Jr. Children’s Hospital at Vanderbilt April Graves, RN, BSN Saint Thomas Midtown Hospital nashvillemedicalnews
.com
Graves, who has been practicing for nearly a decade, looks at her profession as a calling. She embraces her responsibility as a healthcare provider to deliver evidencebased care consistently and with the highest quality to patients and their families. Admittedly inquisitive, Graves isn’t afraid to ask questions when encountering new challenges or processes that don’t make sense. Never satisfied with a “that’s just the way we’ve always done it” reply, she looks at those types of responses as reasons to review current practices to ensure they offer the best options for optimal patient outcomes.
Public Health Sponsored by Amerigroup Carolyn Riviere, BSN, MS Metro Public Health Department Described by colleagues as one of the “gladiators” in public health, this 43-year nursing veteran is passionate about harnessing her many personal and professional experiences to improve the health of Tennessee families. Riviere energetically works with staff, clients and community partners to formulate programs and influence policy aimed at improving infant mortality rates at a time when many in her position would be considering retirement. Actually, Riviere did retire once … only to find she missed nursing too much to stay home. Those who depend on her insight and experience are certainly glad she returned to the workforce.
Quality and Risk Management Sponsored by Community Health Systems Sherree Spry, RN, BS, CPHRM TriStar Centennial Medical Center As vice president of Quality and Risk Management at TriStar Centennial, Spry brings more than 35 years of experience to her crusade to assist healthcare professionals in identifying the processes and methods to help them deliver care in the safest, most effective manner possible. While part of her job is to share rules and expectations, she takes the time to explain the rationale behind the processes. Colleagues say she models her mantra — quality is doing what’s right … even when no one is looking.
policymakers … whether it’s hearing their stories, helping their voices be heard or joining forces to speak up for lasting change.
Student Nurse of the Year Sponsored by Lipscomb Univ. School of Nursing John Haltom Belmont University School of Nursing A third year student, Haltom recognizes outcomes are defined as being specific and measurable … yet, he also realizes the nuances of his chosen profession as nurses impact the lives of families dealing with intimate emotions and situations. Sometimes, it’s the ‘gray’ areas that aren’t so easily defined or measured that leave the strongest imprint. This belief was reinforced during a recent mission trip to Cambodia. Participating in home visits for HIV positive families, Haltom witnessed the emotional healing that comes from listening to a patient’s experiences and connecting on both a personal and professional level.
Surgical Services Gay Ensey, RN, BSN Saint Thomas Rutherford Hospital Drawing on 38 years nursing experience, Ensey strives to set an example of nurturing in a spiritual way through her nursing leadership and daily interactions with colleagues, patients and families. Although she holds high expectations for nurses and
addresses issues in a straightforward manner to correct mistakes, Ensey does so in a way that is supportive of professional growth. Her colleagues say she models the type of caring, personal interaction that is the cornerstone of creating an environment conducive to patient satisfaction.
Women’s Health Sponsored by The Center for Women’s Research at Meharry Medical College Nancy Donoho, RNC-OB, RNC-HROB, RNC-MNN, RN-BC TriStar Centennial Medical Center Donoho takes new staff under her wing and helps them find their footing and build the solid foundation needed to grow in the ever-evolving healthcare landscape. Leading by example, this nurse of 30 years also encourages younger colleagues to become actively engaged in supporting their profession. Donoho is involved in a multitude of activities including membership on boards, councils, advisory groups and educational consortiums that enhance the field of nursing. Whether in a clinical setting or a board meeting, her ‘can-do’ attitude is infectious.
save the date Women 20 14 T O WAT C H
Research Sponsored by Vanderbilt Univ. School of Nursing Melanie Lutenbacher, RN, FNP/PNP, MSN, PhD, FAAN Vanderbilt University School of Nursing This dedicated nurse researcher and associate professor of Nursing and Medicine works on projects impacting children and families in crisis. Recent projects have focused on community and home-based interventions to prevent or reduce risks associated with preterm births, family violence and at-risk parenting. Lutenbacher, who has nearly 40 years of nursing experience, is energized by the dynamic interchanges with women, children, clinicians, students and
Wednesday, April 30, 2014 7:30 am - 9:00 am
NOAH LIFE OPERA CENTER
We look forward to having you celebrate 10 women who are achieving great things in the Middle Tennessee healthcare industry.
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GrandRounds Middle Tennessee’s Primary Source for Professional Healthcare News
Save the Date March 7 • 2014 Healthcare Diversity Forum • Vanderbilt University Student Life Center • 7:30 am-1 pm The Council on Workforce Innovation is presenting this half-day seminar on trends and resources impacting diversity in the healthcare workforce. Moderated by NewsChannel 5 Anchor Vicki Yates, panelists include HealthStream Founder & CEO Bobby Frist; Nashville Mayor Karl Dean; Memphis Mayor AC Wharton, Jr., JD; Vanderbilt Associate Dean of Diversity Andre Churchwell, MD; and Vanderbilt Chief Human Resource Officer Traci Nordberg, JD. For more information, call (615) 830-0201 or go online to www. nowdiversity.org. Registration deadline is March 1.
TriStar StoneCrest Names Caputo CEO Last month, Steve Corbeil, president of TriStar Health, announced Louis F. Caputo has been named CEO of HCA’s TriStar StoneCrest Medical Center, effective March 3. Currently, Caputo, who has more than 10 years of executive leadership Louis F. Caputo with HCA, serves as CEO of Summerville Medical Center in Summerville, S.C. Caputo earned a bachelor’s degree in economics from the University of the South in Sewanee, Tenn., and a master’s in business administration from Belmont University.
Vanderbilt Announces Recent Autism Discoveries Last month, Vanderbilt researchers announced the findings of two separate studies on autism. The first, which was released in the Journal of Autism and Developmental
Our annual Women to Watch issue and event is coming in April 2014, and we want your input on women in Middle Tennessee that are
Disorders, found more independent work environments might lead to reductions in autism symptoms and improve daily living in adults with the disorder. The study examined 153 adults with autism and found that greater vocational independence and engagement led to improvements in core features of autism, other problem behaviors and ability to take care of oneself. Participants averaged 30 years of age and were part of a larger longitudinal study on adolescents and adults with autism. Data were collected at two time points separated by 5.5 years. “We found that if you put the person with autism in a more independent vocational placement, this led to measurable improvements in their behaviors and daily living skills overall,” said lead author Julie Lounds Taylor, PhD, assistant professor of Pediatrics and Special Education and Vanderbilt Kennedy Center investigator. The second study revealed the senses of sight and sound are separated in children with autism. Published in The Journal of Neuroscience, the study found children with autism spectrum disorders have trouble integrating simultaneous information from their eyes and their ears … much like watching a foreign movie that has been badly dubbed. The study, led by Mark Wallace, PhD, director of the Vanderbilt Brain Institute, is the first to illustrate the link and strongly suggests that deficits in the sensory building blocks for language and communication can ultimately hamper social and Dr. Mark Wallace communication skills in children with autism. “There is a huge amount of effort and energy going into the treatment of children with autism, virtually none of it
is based on a strong empirical foundation tied to sensory function,” Wallace said. “If we can fix this deficit in early sensory function then maybe we can see benefits in language and communication and social interactions.” Wallace added, the findings could have much broader applications because sensory functioning is also changed in developmental disabilities such as dyslexia and schizophrenia. The study found that children with autism have an enlargement in the temporal binding window (TBW), meaning the brain has trouble associating visual and auditory events that happen within a certain period of time. A second part of the study found that children with autism also showed weaknesses in how strongly they “bound” or associated audiovisual speech stimuli.
Rash Returns to Top Post at RegionalCare
After less than a year in the top spot at RegionalCare Hospital Partners, Kent Wallace has resigned and founder Marty Rash has stepped back into the CEO role. Wallace joined the Brentwood-based rural hospital company last February from Vanguard Marty Rash Health Systems, which was bought out by Tenet in 2013. In addition to his resumed CEO position, Rash continues as executive chairman of RegionalCare. In other company news, Rob Jay, another former Vanguard employee, has been named RegionalCare’s new executive vice president and chief operating officer. The promotion was announced in late Rob Jay January. Jay joined RegionalCare in May 2013 as senior vice
Clinicians, researchers, administrators, policy makers and allied
deliver care are all eligible.
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FEBRUARY 2014
SALES 615.844.9237 Kelley Apoldo, Maggie Bond, Adam Cross, Heather Cantrell, Mike Smith LOCAL EDITOR Cindy Sanders editor@nashvillemedicalnews.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Melanie Kilgore-Hill, Lynne Jeter, Kelly Price, Cindy Sanders ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578
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SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Chief Operating Officer/Group Publisher Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains Nashville Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
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GrandRounds president of operations. Prior to his work at Vanguard, Jay served as the corporate controller for HMA, which has just been purchased by CHS.
Let’s Give Them Something to Talk About! Awards, Honors, Recognitions Bass Berry & Sims has announced Danielle Sloane has been elected to membership. The new partner focuses her practice exclusively in the healthcare industry with a particular emphasis on regulatory, operational, compliance and transac- Danielle Sloane tional issues. Tennessee Health eShare Direct Project hit a milestone in late January when more than 4,000 physicians have participated in the state’s Direct Technology initiative since its launch last July. The push to adopt the technology, which allows secure communication, is a national effort, and Tennessee has been recognized for having one of the most rapid adoption rates. Judge Daniel B. Eisenstein was recently honored during the inaugural NAMI (National Alliance on Mental Illness) Tennessee Vision of Hope Gala. The judge was presented with the Vision of Hope Award for his work with the Davidson County Judge Daniel B. Eisenstein Mental Health Court over the last decade, as well as his collaboration with NAMI Tennessee and advocacy for people with mental illness.
Wishes Granted According to annual figures available through the National Institute of Health, Vanderbilt University School of Medicine is now ranked ninth in the national among U.S. medical schools in total grant support provided through the nation’s medical research agency. During the calendar year 2013, VUSM received more than $292 million in NIH grant support. VUSM moved up four places in the rankings since 2012. Centerstone Research Institute (CSI) is teaming up with Indiana University – Bloomington, Regenstrief Institute, Wake Forest School of Medicine and other organizations in a three-year, $686,000 research grant to study the advance use of artificial intelligence in healthcare decision support. The grant is funded by the National Science Foundation and National Institute of Health. The Martha O’Bryan Center has received a $100,000 grant from UnitedHealthcare Community Plan of Tennessee to support the parent education programming, Tied Together. The 10week program brings together community partners to support young parents … some as young as 14 years old … as they raise their children. Vanderbilt-Ingram Cancer Center has received a $100,000 ovarian nashvillemedicalnews
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cancer grant from the Kay Yow Cancer Fund. The fund, in partnership with the Women’s Basketball Coaches Association and the V Foundation, presents an award annually to an institution based in the host city of the NCAA Women’s Final Four®, which will be held in Nashville April 6 and 8 at Bridgestone Arena. The grant will be used to continue VICC research on imaging ovarian cancer with novel small molecule radiotracers of cyclooxygenase-1 (COX-1).
TriStar StoneCrest Names Wagster Lab Director
TriStar StoneCrest Medical Center recently welcomed Marvin Wagster as administrative director of laboratory services where he will oversee a staff that processes about 270,000 inpatient tests annually. With more than 20 years of laboratory services experience, he has extensive leadership expertise in the hospital laboratory setting. Most recently, Wagster was with Saint Thomas Health Services. He earned his undergraduate degree in medical technology/biology and chemistry from the University of Tennessee and his master’s degree in health services administration from University of St. Francis in Joliet, Ill.
Beverly Joins UNHS as CMO Steven Beverly, MD, recently joined United Neighborhood Health Services as chief medical officer. In his new role, he will provide oversight of the organization as a member of the leadership team and will maintain responsibility for clinical acDr. Steven Beverly tivities. A board-certified OB/GYN, he has practiced medicine for 13 years, most recently serving as managing partner of Dobson and Beverly in Bowling Green, Ky. Beverly is a Fellow of the American Congress of Obstetri-
cians and Gynecologists.
TriStar Buys Capella Facility Last month it was announced that HCA’s TriStar division had signed a definitive agreement to purchase Grandview Medical Center near Chattanooga from Capella Healthcare. The 70-bed hospital located in Jasper, Tenn., serves five counties in Tennessee, Georgia and Alabama. It will become part of TriStar’s growing Parkridge Health System, which will grow to five facilities in the Chattanooga metropolitan market with the completion of this acquisition. The transaction, which is subject to customary regulatory approvals, is expected to close the first quarter of 2014.
PearlPoint Releases New App on Cancer Side Effects Last month, PearlPoint Cancer Support announced the release of a new, free mobile app called, “Cancer Side Effects Helper.” The app, which can be downloaded by oncology patients and their caregivers from ITunes and Google Play, provides information to help minimize common side effects from cancer treatments. The app features a comprehensive list of side effects and the medically approved, practical tips that could help decrease their impact.
The Keckley Report Healthcare guru, political pundit, and former Nashvillian Paul Keckley, PhD, recently launched The Keckley Report. The weekly report – billed as simplifying the world of health policy so you don’t have to – shares insights and explanations from Dr. Paul Keckley Keckley, who is the executive director of the Deloitte Center for Health Solutions and a nationally renowned speaker on health policy. You
Kraft Healthcare Consulting, LLC presents:
can subscribe to the free report at www. paulkeckley.com.
Healthways Inks Three-Year Agreement with California Blue In late January, Healthways announced Franklin-based company had signed a three-year agreement with BlueShield of California to provide wellbeing solutions to the insurer’s Wellvolution health and wellness program. The program will touch three million commercial members plus more than a dozen employer groups. This latest agreement marked the fourth such deal inked by Healthways in January. Other contracts to start 2014 included ones with UCLA, Carondelet Health Network in Arizona and a health coaching program ‘down under’ in Australia.
Duke LifePoint Signs Agreement with Wilson Medical Center It was recently announced that Duke LifePoint Healthcare has signed a definitive agreement with Wilson Medical Center in Wilson, N.C., to form a joint venture, including $120 million in capital investments and resources over the next decade, following a vote by the Wilson County Board of Commissioners. The agreement is now under review by the state attorney general. Under the terms of the agreement, Duke LifePoint would own 80 percent of the joint venture, while Wilson Medical Center and the community would have a 20 percent ownership stake. Governance of Wilson Medical Center will be shared equally by Duke LifePoint and Wilson though the creation of a 10-member board with equal representation from both organizations.
ICD-10 Boot Camp
SAVE THE DATE
This fast-paced boot camp is designed for coders and others in health information management and compliance who are already ICD-9 proficient and need to maintain their professional credentials.
May 21, 22, 23
Two course options available for participants:
Course 1: ICD-10 CM Boot Camp (12 CEUs) Course 2: ICD-10 PCS Boot Camp (12 CEUs) Materials will be provided, and CEUs will be available. Speaker Heather Greene, MBA, RHIA, CPC, CPMA, is an AHIMA-approved ICD-10 CM/PCS trainer and a senior compliance consultant with Kraft Healthcare Consulting, LLC.
Location: KraftCPAs PLLC 555 Great Circle Road Nashville, TN 37228 MetroCenter
Learn more and register at www.kraftcpas.com/ events.php.
This program has been approved for continuing education units (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
FEBRUARY 2014
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News from VANDERBILT UNIVERSITY MEDICAL CENTER * WINTER 2014
Vanderbilt leads region in laser cataract surgery BY JESSIC A PASLE Y
Suzy Gore spent the last 10 years watching her eyesight decline. Unable to see the vision chart at her doctor’s office without corrective lenses, tired of halo effects around lights and the challenge of driving at night, Gore decided to undergo laser cataract surgery. Now she is looking forward to the next few decades of seeing the world from a clearer point of view thanks to the work of Daniel Weikert, M.D., assistant professor of Clinical Ophthalmology at the Vanderbilt Eye Institute. The leading cause of blindness in the world, cataracts affect more than 22 million people in the U.S. “I must admit, when Dr. Weikert told me I was developing cataracts when I was 50, I was floored,” said Gore, a longtime patient of Weikert. “I just didn’t think I was in that category yet and they were not interfering with my eyesight then. “When we discussed it again this past August, I remember asking him, ‘now, if I was your mama, what would you tell her to do?’” “He looked right at me and said: ‘I think having the procedure would make a big difference, and in fact, I did my mother’s cataracts.’” Gore, 60, is now one of nearly
100 patients who have elected to undergo the corrective surgery, which is done by Vanderbilt ophthalmologists at the Cool Springs Surgery Center.
“This tool is putting Vanderbilt on the cutting edge of eye care…We are reaching past our own patient population.” Daniel Weikert, M.D., Ophthalmologists at VEI offer laser cataract technology as well as traditional cataract surgery using hand-made incisions with a surgical blade (used in 80 percent of cases). “In time, the laser will become a larger part of the cataract practice because it gives the potential for better optical results,” Weikert said. “The laser allows for precise incisions every time, reduced complications post-surgery and the ability to treat astigmatism that will sharpen their vision. “This tool is putting Vanderbilt
CARDIOLOGY
Evan Brittain, M.D.
Specialty: Cardiology Medical School: Cornell Medical College Residency: Vanderbilt University Medical Center Fellowship: Vanderbilt University School of Medicine Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Jessica Delaney, M.D.
Vanderbilt University Medical Center Welcomes These Providers
Specialty: Cardiology Medical School: Albert Einstein College of Medicine Residency: Albert Einstein College of Medicine/ Montefiore Medical Center Fellowships: St Luke’s-Roosevelt Medical Center and Vanderbilt University Medical Center Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Deepak Gupta, M.D.
Specialty: Cardiology Medical School: The Ohio State University College of Medicine Residency: Duke University Medical Center Fellowship: Northwestern University and Brigham & Women’s Hospital Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Arvindh Kanagasundram, M.D.
Specialty: Cardiac electrophysiology Medical School: Vanderbilt University School of Medicine Residency: Stanford University Medical Center Fellowships: New York Presbyterian Hospital/ Weill-Cornell Medical Center and Vanderbilt University Medical Center Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
on the cutting edge of eye care. Since utilizing this procedure, we have had a steady influx of area surgeons wanting to be trained at our facility. As we are certifying other community surgeons, it goes further than Vanderbilt. We are reaching past our own patient population,” Weikert said. Although the procedure is not yet covered by insurance, many patients are electing to have the laser cataract surgery because studies are showing it is safer, more effective and efficient. Patients are awake Dr. Daniel Weikert and does a follow-up exam of patient Suzy Gore. Gore had throughout the entire laser cataract surgery on both eyes by Dr. Weikert.(John Russell/Vanderbilt University) 30-minute procedure. no longer requires glasses or readers. I turn off the light at night when I During the laser portion, “I have been wearing glasses since go to sleep,” she said. which takes about two minutes, the I was 9 years old,” she said. “And patient is given anesthetic drops they were a pretty strong prescripto numb the eye. Afterward, the tion. The potential for waking up patient receives an intravenous and not having to search for my sedative before going to the OR VANDERBILT glasses was so attractive to me. And suite, where the cataract is removed EYE INSTITUTE I wanted to give my eyes the best and the lens is implanted. (615) 936-2020 chance. Gore, retired from a 30-year teachvanderbilthealth.com/eyeinstitute “It’s funny because I am still ing career, is still giddy over the success of her cataract surgery. She reaching to take off my glasses when
David Kim, M.D.
Fellowship: Vanderbilt University
Medical School: Northwestern University
Practice Location: Vanderbilt University
Specialty: Cardiology
Residency: McGaw Medical Center of Northwestern University Fellowship: Vanderbilt University Medical Center Practice Location: Nashville General Hospital at Meharry
Referrals: (615) 341-4250
Casey Miller, MSN Specialty: Cardiology
Nursing School: Vanderbilt University School of Nursing Practice Location: Vanderbilt University Medical Center
School of Medicine Medical Center
Referrals: (615) 322-2318 COLORECTAL SURGERY
Molly Cone, M.D.
Specialty: Colorectal Surgery Medical School: Oregon Health & Science University Residency: Oregon Health & Science University Fellowship: Ochsner Clinic Practice location: Vanderbilt University Medical Center
Dawn R. Norman, M.S.N., CNM Specialty: Midwifery
Medical School: University of Texas Medical Branch School of Nursing Practice Location: NorthCrest Medical Center
Referrals: (615) 343-5700
Valerie L. Nunley, CNM Specialty: Midwifery
Medical School: Vanderbilt University School of Nursing Practice: Vanderbilt University Medical Center and One Hundred Oaks
Referrals: (615) 343-5700
Erica Robinson, M.D.
Specialty: Minimally Invasive Gynecology
Referrals: (615) 322-2318
Referrals: (615) 343-4612
Daniel Muñoz, M.D., M.P.A
ORAL SURGERY
Residency: Emory University Practice Location: Vanderbilt University
Medical School: Johns Hopkins University
Luis G. Vega, D.D.S.
Specialty: Oral and Maxillofacial Surgery
Specialty: Cardiology School of Medicine
Residency: Johns Hopkins Hospital Fellowships: Johns Hopkins Hospital, Duke Clinical Research Institute and Vanderbilt University Medical Center Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Sharon Shen, M.D. Specialty: Cardiology
Medical School: Northwestern University Residency in Internal Medicine: Northwestern University Fellowship: Northwestern University Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Quinn Wells, M.D., Ph.D. Specialty: Cardiology
Medical School: University of Alabama School of Medicine Residency: Massachusetts General Hospital
Dental School: University of Costa Rica Residency: University of Alabama Hospital Practice location: The Vanderbilt Clinic
Referrals: (615) 343-9403 WOMEN’S HEALTH
Soheyl Asadsangabi, CNM Specialty: Midwifery
Medical School: Vanderbilt School of Nursing Practice Location: NorthCrest Medical Center
Referrals: (615) 343-5700
Medical School: Emory University
Medical Center
Referrals: (615) 343-5700
MaryLou Smith M.S.N., CNM Specialty: OB-Gyn
Med School: Vanderbilt School of Nursing BSN: St. John Fisher College, Rochester, NY Practice location: Vanderbilt University Medical Center and NorthCrest Medical Center
Referrals: (615) 343-5700