Nashville Medical News July 2013

FOCUS TOPICS RECRUITING HEALTHCARE EDUCATION ADVANCE PRACTICE

July 2013 December 2009 >> $5

Middle Tennessee’s Primary Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Kristina McCain, MD ON ROUNDS

Nashville Health Care Council Fellows Initiative Graduates Inaugural Class

By CINDy SANDERS

Norman Named New Dean of VUSN Veteran Educator Takes the Helm at the Graduate School Last month, Linda Norman, DSN, RN, FAAN, was announced as the new dean of the Vanderbilt University School of Nursing effective July 1. The veteran educator and administrator has spearheaded curricular innovations for 22 years at VUSN, which recently ranked number 15 on the U.S. News & World Report list of the nation’s ‘Best Graduate Schools – Nursing.’ ... 8

Major Expansion Plans Underway for Saint Thomas Health, UT Residency Program

Although the Affordable Care Act still poses many unanswered questions … and the best approach to health reform remains a topic of heated debate … everyone does seem to agree on certain key principles: • Healthcare is in the midst of major transformation to address the unsustainability of the current system.

• Working collaboratively will be essential to delivering care going forward.

• Quality, outcomes, and cost efficiency must work hand-in-hand.

• It will take strong leadership across the broad healthcare spectrum to effectively align the many moving parts within the industry.

Enter the Nashville Health Care Council Fellows Initiative, an innovative program to empower the leadership of healthcare companies to develop strategic competencies and knowledge to carry the industry forward.

Judith Byrd, executive director of the Council Fellows program, said discussions concerning an executive educational offering have been on the table for several Judith Byrd

(CONTINUED ON PAGE 12)

Belmont Expands Simulation Program, Adds Fellow

By CINDy SANDERS

The partnership between Saint Thomas Health and the University of Tennessee Health Science Center is rapidly growing.

Plans are well underway to greatly expand the number of training slots in Middle Tennessee for the state’s future physicians ... 15

ONLINE: NASHVILLE MEDICAL NEWS.COM

Council Fellows Adam Feinstein, Chris Taylor & Bill Rutherford collaborate on a project during one of the class sessions.

Through a $300,000 grant from the Memorial Foundation this spring, Belmont University has been able to upgrade high-fidelity simulation equipment, fund a post-graduate fellowship position, and expand interprofessional training in the Healthcare Simulation Center at the Gordon E. Inman College of Health Sciences & Nursing.

Dean Cathy R. Taylor, DrPH, MSN, RN, said the gift is enabling Belmont to increase the impact of their clinical simulation program and to stay on the leading edge of a rapidly evolving discipline. “In addition to creating exciting new clinical experiences for both students and community providers, with this funding we will create new ways of educating future leaders in this emerging field,” she said.

Taylor continued, “This is an area of emerging science for training healthcare professionals that is still so new there are essentially very few experts in how to manage and execute this kind of opportunity.”

(CONTINUED ON PAGE 15)

PHOTO COURTESY OF BELMONT UNIVERSITY

Baptist Hospital is offering new birthing options LEARN MORE ON PAGE 7

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Best Practices Evidence-Based Standards of Care

Level 1 trauma centers lead the country in saving lives

By Richard S. Miller, M.D. FACS, Professor of Surgery and Chief, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center

Each year, trauma accounts for roughly 42 million emergency department visits and 2 million hospital admissions across the country.

Traumatic injury accounts for about 30% of all life years lost in the U.S. The economic burden is more than $400 billion a year from trauma; this figure includes both health care costs and lost productivity. In 2009, there were almost 172,000 deaths due to injury. Trauma was the leading cause of death in people 44 and under, and the number three cause of death across all age groups.

The most common causes of trauma are motor vehicle collisions, falls and violence (most often penetrating trauma from stab and gunshot wounds). Other forms of trauma include drowning, fires and burns. Trauma can be intentional or accidental, but it is usually preventable.

The care of the acutely injured is a public health issue that involves the community, health care professionals and health care systems. It encompasses pre-hospital EMS, emergency department assessment, treatment and stabilization as well as in-hospital care, surgery and complex medical management.

Trauma centers are classified from Level I to Level IV. The Level I facility is the regional resource trauma center. The facility must provide leadership and total care for every aspect of injury from prevention through rehabilitation. A nationwide study conducted by the researchers at Johns Hopkins School of Public Health and the University Of Washington School of Medicine found that the care at designated Level I trauma centers lowers the risk of death for injured patients by 25% compared to treatment received at a non-designated trauma center.

The Level I trauma center also has the major responsibility of providing leadership in education, research and system planning.

Medical education programs within the Level I trauma center include residency program support and post-graduate fellowship training in trauma for physicians as well as continuing education for nurses and pre-hospital providers.

Since its inception in 1984, Vanderbilt University Medical Center’s trauma center has served as the region’s first and only trauma center.

Vanderbilt’s Level 1 trauma center responds to the highest level of critical injury and has been recognized nationally for its research and education endeavors. Equipped with specialized facilities, advanced technology and highly trained personnel, the trauma center operates around the clock and admits more than 3,000 patients who have experienced significant injuries each year. Vanderbilt serves an area of 65,000 square miles around Nashville that covers communities in Tennessee, Kentucky and Alabama.

An essential component of trauma care is the expeditious transport of critically injured patients to the trauma center. Vanderbilt’s LifeFlight critical care transport program is Tennessee’s largest accredited notfor-profit air medical transport program. It serves the patients of our area with helicopters, fixed-wing aircraft and ground ambulances.

Vanderbilt’s facilities and personnel are essential to the quality of care it provides. Vanderbilt provides immediate, comprehensive and continuous care for trauma patients from initial evaluation in one of four trauma resuscitation bays to the Trauma Critical Care Unit through progressive care and extended care at Vanderbilt Stallworth Rehabilitation Center. The Division of Trauma and Surgical Critical Care is composed of eight board-certified trauma and acute care surgeons working closely with six orthopedic trauma surgeons as well as subspecialists in neurosurgery, facial trauma, vascular and spine surgery. A dedicated trauma operating room is available around the clock.

The trauma unit includes a 31-bed integrated acute and sub-acute care unit that contains a 14-bed ICU, a seven-bed acute admission area and a 10-bed sub-acute unit. Renovations for an additional 16-bed extension of the trauma Unit on the same floor are near completion. The trauma unit is served by specially trained trauma nurses and advanced trauma nurse practitioners. The trauma team follows evidence-based guidelines and protocols to ensure a unified management practice.

Vanderbilt also has a 20-bed burn unit and serves as the region’s only burn center.

As a part of our commitment to function as a top tier trauma center, Vanderbilt University Medical Center offers prevention programs throughout Nashville and the surrounding region. Additionally, our comprehensive approach to trauma and surgical critical care provides powerful research and educational opportunities for residents and fellows interested in a career in trauma surgery and surgical critical care.

Vanderbilt has the nation’s largest trauma and acute care surgery fellowship, training the most talented surgeons in the country in this challenging surgical subspecialty. Since 1990, the fellowship program has trained more than 50 trauma and acute care surgeons, most of whom are leaders in academic and community trauma centers across the country.

Our ongoing mission is to provide optimal care for our community through injury prevention and high quality patient care, leading the way in medical education, research and the health of our trauma system in Tennessee.

SOURCES: 1) Trauma Statistics: nationaltraumainstitute.org 2) Resources for Optimal Care of the Injured Patient:2006, published by the American College of Surgeons Committee on Trauma 3) MacKenzie EJ et al. A National evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006, 354: 366-378 4) Sasser SM et al. Guidelines for field triage of Injured Patients, MMWR- Center for Disease Control and Prevention 2011, 61: 1-20

All source data for this article has been provided by

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PhysicianSpotlight

Passport to Care

Dr. Kristina Kokubun McCain’s Service Abroad … colposcopies, gymoney for care once the diagnosis was necological surgery, made,” she said.

With more bright stamps than the and annual exams Musing on the most recent changes most active jet setter, Kristina McCain, with blood pressure that have affected the practice of medicine MD, has a U.S. passport that reveals her measurements and stateside, McCain commented, “I see pafrequent-flyer lifestyle. Rather than jetblood glucose screentients who want to be healthy, and who setting, however, the stamps coloring ings combined with are looking for ways to maximize their her passport pages are from her medical health, diet, and exhealth, and with whom I want to work adventures in remote areas of far-flung ercise seminars and on these goals … but it is very difficult to countries including Vietnam, Cambodia, consultations. carve out the time when you’re paid by Guatemala, Haiti, Kathmandu, Belize, and “We have set the the diagnosis code instead of treatment.

Mumbai. clinics up in every There aren’t the hours in the day.”

She travels to bring her valuable medikind of place … rural Her many experiences at home and cal training and healthcare services to local Buddhist temples, abroad, said McCain, have “taught me women in countries around the world who schools … wherever so much about what is really important are living … and dying … without adwe could find a place in life.” equate care. to see and treat paWhen she isn’t working, McCain (L-R) Dr. Kris McCain, Sam Webb and translator in Cambodia this past February. Webb, who was then a fourth year medical student at the James H. On a medical mission to Guatemala tients,” she observed. enjoys family, healthy cooking, crafting Quillen College of Medicine at East Tennessee State University, accompanied several years ago, McCain realized that McCain has jewelry, going to the beach, hiking, and McCain as part of a rural medicine elective. Dr. Webb, who recently graduated, rural women in the country were not getworked in the redmembership in a new women’s book will do his OB/GYN residency at Parkland Hospital in Texas. ting screenings and treatment that are roulight district of Kuala club. She is also … along her husband tine in this country. She made the decision Lumpur, Malaysia, … a new convert to the game of golf and admits to some “culture shock” adjusting to return as often as possible to work with doing VIA colposcopies at a safe house proudly admits to making a recent threefrom her West Coast background. the medical personnel in the countries she for women who were forced into the sex par. Another source of joy and pride is After medical school, she undertook has visited. trafficking trade. There she identified a the couple’s son, a student at Washington an internship in obstetrics and gynecology “I saw that rural women in the counmedical focus on screening women rescued University in St. Louis, who has decided at Vanderbilt and completed her residency try were not getting screened for cervical from trafficking for cervical cancer. to stray from the medical field into the in that field. While at Vanderbilt, she also cancer so I decided to work with some of “The problem was lack of diagnosis, world of computers and is working this married her classmate, Robert McCain, the doctors there to train them to try to not lack of care — the organization had summer as an intern for Google.

MD, now a pulmonologist at Tri-Star catch medical abnormalities before they Southern Hills Medical Center. progress to cancer,” she said.

Kristina McCain has served on the OB/GYN staff at Vander$5 OFF bilt University Medical Center and code Williamson County Medical Center.

“SCOMM” She currently works with Women’s Health Specialists of Middle Tennessee, which is affiliated with Saint Thomas Health, and she also has medical privileges with Baptist HosSaturday pital.

“I joined Saint Thomas PhysiAugust 17, 2013 cian Services because they encour8:30 am aged my continued work in medical Walk of Fame Park missions. Their support has allowed me to resume the care of hundreds of Nashville, TN previous patients — women who saw Dr. Kris chats with patients and other providers in a clinic set up me over the last 20 years. I am very in Buddhist temple. grateful for that,” she said.

In 2006, McCain started traveling McCain, who grew up the daughter on medical mission trips with Birmingof a minister and a teacher in Southern ham, Ala.-based Health Talents InternaCalifornia, said she liked biology and the tional on gynecological surgery missions sciences in general. However, she continto Guatemala and has returned often to ued, she was “pretty interested in psycholthat country to offer colposcopy training ogy and spiritual growth early on. This Professionally Timed 5K • 1 Mile Fun Run/Walk • Undy Costume Contest to local physicians. She also has worked made me want to be a child psychologist with the Medical Benevolence Founda… the reason I became interested in pretion (affiliated with Duke’s Family Health med.”

Ministries) in Guatemala and Malawi. In McCain added, “My mother said I addition, McCain volunteers for Global could leave the state for college but not fly Outreach Clinics that provide travel mediBENEFITING around to visit campuses. I was interested cine for missionaries and families adopting in what I had read about Johns Hopkins overseas.

University in Baltimore … so sight unseen, Throw on your most outrageous underwear McClain spent weeks with the FamI applied, was accepted, and packed up my and grab your friends for this 5K event to ily Health Ministries in Haiti, Nepal and seven suitcases and headed east.” expose the truth about colon cancer.

Kathmandu. She has participated on mediAfter graduation, McCain decided cal mission trips to Belize, where she visited on a career in medicine and enrolled in REGISTER NOW www.undy5000.org local hospitals to help determine the need Vanderbilt University Medical School. for … and assist in training on performing Arriving in Nashville in the late ‘80s, she

By KELLY PRICE

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HealthcareEnterprise

Foundations Recovery Network Opens Nashville Facility One More Step in Aggressive Growth Strategy

By SHARON H. FITZGERALD

Foundations Recovery Network cut the ribbon on its newest behavioral health facility in June, but what makes this one special is that it’s right at home. Headquartered in Brentwood, Foundations owns inpatient and outpatient centers in California, Georgia and Memphis, but Foundations Nashville is in the company’s own backyard.

“We are excited to have services here,” said Richard Rodgers, Foundations chief operating officer and a Nashville native. The company renovated a twocentury-old Victorian-style manse on Lea Avenue that offers a comfortable, noninstitutional environment for patients.

At the ribbon-cutting, Foundations CEO Rob Waggener said, “We are grateful to return to our roots where the company was started and look forward to bringing back the exemplary integratedtreatment model for addiction and mental health disorders that first began in Nashville. We have enjoyed broad success and great clinical outcomes around the country using the compassionate care that we first developed here.”

Foundations was founded in Nashville in 1995 as a nonprofit, treating patients who had been dually diagnosed and conducting federally-funded research studies on integrated treatment. “It became a well-known player in the industry on treating people who have both mental health and substance abuse disorders,” Rodgers explained. Foundations was sold and became a for-profit enterprise in 2007. However, Rodgers continued, “We have kept that research department and continue to focus on our outcomes and focus on fidelity to the evidence-based methods of integrated treatment. That’s an

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important part of our mission. We believe that the majority of patients who deal with substance abuse issues also have a co-occurring mental health issue; and if you don’t treat the whole person, you’re not giving that person the best chance for success.”

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“It’s been a long time coming, but it is very revolutionary,” said Snipes, referring to the comprehensive treatment of co-occurring conditions. In fact, the industry is moving away from the term dual diagnosis in favor of the term co-occurring, she said, since patients may face more than two challenges. Someone suffering from depression and substance abuse, for example, might also face physical issues such as hypothyroidism or chronic pain, or even

JULY 2013

legal issues that might seem insurmountable. “We ferret out how they’re impacting one another and address all of those in a concurrent fashion,” she said.

Foundations’ research team follows up with patients at increments after treatment to assess treatment effectiveness.

“We have found that we have a much higher, long-term sobriety rate than with just the standard approaches to treatment,” Snipes said.

As part of Foundations’ mission, the company shares that knowledge. “We don’t want to keep what we know just to ourselves,” Snipes said. “We want other clinicians who are working with patients to be able to have the skills and tools they need and provide their patients with quality care.” Twice a year, the company hosts major conferences, as well as “lunch and learn” workshops and regular training sessions. The next conference is Sept. 23-26 in Palm Beach, Fla., with the theme Moments of Change, featuring innovations in integrated treatment.

Foundations Nashville is strictly an outpatient facility, offering a range of options, including evening sessions and daytime sessions that begin and end during school hours so parents don’t need to retain childcare. Each Tuesday evening is a family program for “those people a patient would rely on, not just necessarily blood relatives,” Snipes said.

Accessibility is a “mantra,” she added. “We want to get people in when they need to get in, so we make it a point to get people in for an assessment within 24 business hours of when they contact the facility. We really want to make treatment accessible for them.”

In addition to Snipes, the Nashville center employs two therapists and an office manager. Siri Moturi, MD, provides the available psychiatric services.

Foundations Nashville isn’t the only iron in fire for Foundations Recovery Network. The company opens a San Francisco facility this month. “We are working right now both for locations for new facilities to open, as well as existing programs to acquire,” Rodgers said. At this point, Foundations employs about 600 people nationwide.

Chicago private-equity firm Sterling Partners held majority ownership in Foundations until September 2012. That’s when Foundations was acquired by an investor group led by Nick Pritzker, a billionaire thanks to his family’s founding of the Hyatt hotel chain. Pritzker brings hospitality expertise to the company, as well as an infusion of capital to add new facilities.

“They don’t have a ticking clock, so to speak, like a private equity firm,” Rodgers said of the new owners. “The adequate source of capital and the desire to grow a meaningful business for a long time gives us the chance to be patient. We are going to be thoughtful, but aggressive.” nashvillemedicalnews

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Recruiting in an Era of Reform

New Landscape Requires Different Leadership Skills

By CINDY SANDERS

As healthcare continues to transform and evolve, the skill sets needed to be an effective leader and provider are changing, too. From HIPAA and HITECH to the Affordable Care Act, the regulatory and reimbursement environments have impacted the recruiting process by demanding that physicians, nurses and management teams be able to provide the best outcomes in the most efficient manner possible.

“The hospital model is changing so those leaders don’t look the same anymore,” said Brian Kelley, a partner with The Buffkin Group, LLC. “You better have a deep bench,” he continued of the need to have an executive team with different areas of expertise.

Brian Kelley Just as the ideal applicant is changing, the most effective way to recruit that candidate is also undergoing a transformation. “We’re doing a lot of things differently than we did five or six years ago,” noted Susan Masterson, national vice president of provider recruitment for TeamHealth. “The day of placing an ad and waiting for the right candidate Susan to appear is long gone.”

Masterson As for the true impact of health reform on job recruitment, the experts all agreed that has yet to fully play out. “We’re building the plane engine as we fly it,” Masterson said wryly.

So how are recruiting and management firms attracting and retaining the right people in a period of great transition, and what skills should candidates hone to answer new challenges posed by the nation’s complex healthcare system? Medical News asked a number of recruiters to share their insights.

Physicians In addition to her national provider recruitment duties with Knoxville-based TeamHealth, Masterson is a past board member and committee chair for the National Association of Physician Recruiters and a current committee member for the Association of Staff Physician Recruiters.

On the national front, she said the need for primary care physicians is anticipated to rise dramatically. Yet, she continued, only about a quarter of the applicants coming out of training are headed that direction. “We need more family practice and internal medicine physicians,” she said.

“The government is going to have to make more slots for internship and residency, and they’re going to have to incentivize physicians to be primary care doctors,” Masterson added of anticipated demand in the wake of ACA. “Regardless of the specialty,” she con-

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tinued, “I think there are different competencies for doctors that are a ‘must have’ today than (were necessary) years ago.” A focus on quality, prevention and evidencebased medicine were included on her list.

Masterson also noted the need to be comfortable with technology and said two of the biggest skills were to be team-oriented and effective in mentoring and working alongside advanced practice clinicians (APCs).

“Another thing I think we’ll see is there will be a lot of physicians that are in small, private practices that will choose to join larger companies or hospitals,” Masterson said. She added that her company is recruiting many physicians who are ready to hang up their shingle because of heavy workload, decreasing reimbursements, increased regulation and uncertainty over how healthcare reform will impact their practice. Another factor driving this trend, she added, is that the ‘new millennials’ (born between the early 1980s and 2000s) are very focused on a work-life balance and value personal time as much as career … which often translates into a willingness to be hospital employees rather than taking on the stress of owning their own practices.

In her own company, Masterson said they have taken a much more proactive strategy to recruit residents for their key focus areas of emergency medicine, anesthesiology, urgent care and the ‘ists’ — hospitalists, laborists, surgicalists. TeamHealth has created a number of support services … from online resources to shadowing oppor-

tunities to hosting discipline-specific boot camps … to help the young recruits settle into their new roles.

“We’re also signing many more APCs … probably three or four times more than we did just four or five years ago,” she noted of the increased demand for physician assistants, nurse practitioners, nurse anesthetists and other mid-level providers.

As demand increases for providers, it has become increasingly competitive to fill open spots. Locum tenens companies have been springing up, said Masterson. Where those temporary providers had been filling in for short periods during vacation or maternity leave, Masterson said it is increasingly common to see them in place for months at a time while the search continues for a permanent hire. TeamHealth has their own internal group known as Special Ops physicians to answer this need.

Hiring, however, is only one part of the puzzle. “It’s one thing to recruit the doctors, but then we have to retain them so there is a tremendous focus on retention,” Masterson said.

Advanced Practice Providers MedPlacer, a national recruitment and operational process improvement firm headquartered in Nashville, places healthcare providers and executives in a variety of positions. However, said Jeff E. McCracken, founder and managing director, the company’s core business is on emergency, surgical and cardiovascular service

placement. “When we originally founded our company, we had a broader approach,” he noted. Over time, he continued, “We’ve really focused in more on a couple of key niche areas, and it’s really driven by the market.” McCracken added, “About 90 percent of the professionals Jeff we place have a nursing McCracken background of some sort.”

The company, he explained, has three main divisions — permanent nursing leadership recruitment, staff nursing recruitment, and interim departmental leadership.

Although MedPlacer doesn’t always put an interim director on site, when the company does have a leader on the ground, that person helps clients assess operations, identify weaknesses, outline process improvements, set departmental objectives and align staff appropriately to achieve those goals.

McCracken said the strategy has been to not only glean the technical needs of a department but to understand the culture to recruit the right person. “The retention rate has been much higher because we’ve had an on-the-ground experience within the hospital,” he noted.

Like physicians, McCracken said nurses are now recruited nationally. As the housing market has improved, he has found an increased willingness among nurses to consider positions in other parts of the (CONTINUED ON PAGE 6)

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country. An area of rapid growth has been placing staff level nurses in departments to help alleviate dependence on travel nurses.

He was quick to add that travel nurses play an important role in helping a facility staff up for seasonal peaks or to meet the needs of increased patient populations for short periods of time. However, he added, hospitals ultimately want staff members who are engrained in their community.

Kipper Latham, RN, chief clinical officer for MedPlacer, is the person on the inside.

“It helps the nurse understand that hospital before they pick up and move from Pittsburgh to Texas,” he said of being embedded in the hospital while assessing a department’s operations, staffing and processes.

Additionally, he spends his time learning about the area … schools, activities, the housing market, and quality of life … to best match a job candidate with both the hospital and community. He added finding the right match is more than just aligning skill sets. “You have to look not only on paper but also understand that professional’s longrange goals and motivation,” he said.

Like McCracken, Latham said travel nurses play an important role in staffing solutions but likened them to renters vs. owners. “Travelers are needed, but it’s not the same as if 80-90 percent of your nurses are part of the community,” he explained.

During a seven-month stint in the emergency department at a Texas hospital, Latham saw the number of travel nurses decrease from 25 to two, and the Press Ganey hospital scores rise from the bottom 25th percentile to the top 15 percent.

“Patient satisfaction scores went through the roof because now you had ownership in the community,” Latham noted.

As with physician recruitment, retention is a key to success. McCracken reiterated turnover not only hurts the bottom line, but it takes a heavy toll on key areas impacting quality and efficiency including morale, institutional knowledge, cultural sensitivity, and patient and employee satisfaction.

He added there is no crystal ball to know exactly how ACA will impact hospital staffing, but McCracken pointed out increased volumes are often seen in the Emergency Department first and then have a domino effect in other areas of operation.

He said MedPlacer is working collaboratively with colleagues in other firms to try to prepare for increased demand. “We’re continuing our strategic alliance with other recruitment companies nationally. That way we can scale appropriately,” he concluded.

The Executive Suite The Buffkin Group — headquartered in Brentwood with offices in Connecticut, New York and Virginia — focuses primarily on placements at the C-suite level for service providers and end payers. The landscape … and the skills needed to successfully navigate the new terrain … are definitely changing.

“When you’re in the Craig Buffkin heat of your business, it’s sometimes difficult to take a strategic look at your executive team and ask, ‘Do we

have the team in place to meet the regulatory demands that take place in 2014?’” said Craig Buffkin, managing partner and founder of the firm.

For non-profit hospitals, he added, that could mean a shift in attention. Previously, these facilities were much more focused on outcomes than on cost factors.

Now, both must be equally weighed. “It’s put a lot of pressure on having a different type of leader in different parts of their organizations that didn’t exist five years ago because not only do they have to worry about outcomes but also on driving costs and efficiencies,” Buffkin said.

The new regulatory environment and shifts in reimbursement models have brought about some consolidation of acute care facilities and hospitals taking over physician practices. In the short run, said Buffkin, consolidation shrinks the leadership market. However, he continued, “In the long term, it typically increases the need as companies get bigger.”

In fact, he continued, “We’ve doubled the number of searches we’ve been completing on an annual basis in the last several years, and the majority of that demand has come from our healthcare clients because of regulatory pressures.”

Brian Kelley, a partner based in the firm’s Connecticut office, added the complex delivery and regulatory environment has made it nearly impossible for one person to have all the skills necessary to meet the hospital’s or practice’s needs. Three areas he identified as ‘critical in any management setting’ are knowledge and experience of healthcare services, profit and loss expertise to understand reimbursement challenges and a robust understanding of IT from both a quality and efficiency perspective.

“You have to have a team … it’s not one person,” he said. “For one person to have all three of those skill sets is few and far between.” That, however, has opened the door for others to break into healthcare.

In hospitals, Kelley said, “The old world was to build from within … not so much anymore. They are willing to recruit from outside the hospital’s four walls,” he continued, noting this is particularly true in terms of technology positions.

Buffkin added it has also opened a greater need for marketing professionals … both to draw patients and to reach healthcare professionals as demand begins to exceed supply. “We work with academic medical centers, and one of the areas we’re seeing an increase is in chief marketing officers. They are increasing their marketing departments as they try to attract more applicants to medical school and nursing school to meet the rising demand.”

On the flip side, the push for quality has also opened the door for more physicians to take on leadership roles. Kelley said he is seeing more doctors return to school to get a graduate degree in business.

Ultimately, he noted, you have to look at the leadership in place at any given facility and fill in the gaps.

“We all are seeing more candidates who are taking the time to be better educated,” he added. “Healthcare has a lot of complexities, and I think people are preparing themselves better for the changes.” nashvillemedicalnews

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new birthing options now available

Baptist Hospital offers new menu of birth options The advantage to “walking” the baby out allows the fluid to be squeezed from the lungs, similar to what happens during a vaginal delivery. Waiting to clamp the umbilical cord is considered beneficial because it allows more blood and nutrients to be transferred to the newborn.

Mother, baby and family are the focus of bringing a new life into the world. Baptist Hospital is excited to be offering a menu of options that keep that in mind. From tub labor to family-centered cesareans, mothers can work with their physicians to choose which birthing method is right for them.

“As providers we need to understand that every delivery is unique to that family,” said Dr. Doug Brown, Chief of Obstetrics and Gynecology at Baptist Hospital. “By offering personalized options for each situation we can help create the best experience possible for mom, dad and baby.”

Baptist Hospital is now proud to offer: • Tub Labor – The water environment of a tub is a relaxing way for mothers to labor.

While immersed in water covering the abdomen, relaxation is enhanced allowing mothers to cope with contractions and may even decrease pain. The water provides relief from aching muscles and joints. The mother can move in and out of the tub during the process and, ultimately, delivers the baby out of the tub. Baptist has four tubs currently installed.

• Family-Centered Cesarean – You wouldn’t expect to hear the words ‘natural’ and ‘cesarean’ used together, but at Baptist Hospital you do. For mothers who have their heart set on experiencing a natural childbirth, but ultimately require a cesarean section, they no longer have to completely forego all of the natural birthing methods.

The family-centered cesarean differs from the normal cesarean in many ways. In a family-center cesarean, the medical team puts the ECG dots on the mother’s back so her chest is free for skin-to-skin contact with the newborn upon delivery. Also, the family can choose to drop the curtain once the baby’s head emerges in order to watch the baby being delivered. Another change to the standard cesarean includes the “walking” of the baby out of the womb slowly and waiting for the umbilical cord to stop pulsing before clamping it.

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• Skin-to-Skin – Skin-to-Skin is another amenity Baptist Hospital is offering mothers. This involves the baby being placed on the mother’s chest bare-bodied directly following the birth. Along with many other benefits, it is said to improve breastfeeding, maintain body temperature better than an incubator and reduce crying.

• Doula – Baptist Hospital is also proud to offer doula services for new mothers.

A doula’s role is to nurture the mother, her partner and the birthing team. She is with the mother before and after labor for emotional and physical support. A doula is a nonmedical professional trained to assist at childbirth. The experienced doula uses techniques to comfort and reassure the mother and help make every delivery a positive one.

“Every baby, every mother, every labor has their own sacred story. With the new birth options, mothers can customize their experience to what works for them at each moment in time” said Dr. Donna Crowe, labor and delivery physician leader at Baptist Hospital. “In addition, mothers still have access to a state-of-theart neonatal intensive care unit and access to the latest in advanced, urgent care should they require it.”

Baptist Hospital provides these amenities to make the special day enjoyable, comfortable and safe for both mother and baby. In addition, they also have a highly skilled staff that supports high risk pregnancies to ensure that their patients have access to aroundthe-clock urgent care while still enjoying the comfort and security for which the program is renowned.

For more information, visit Baptist Hospital’s website at www.sths.com/baptisthospital or call 615-284-BABY (2229).

Along with the above methods, Baptist Hospital offers many other amenities including: • • • • • • • • • • • • • • • •

Nitrous Oxide available for childbirth pain OB dedicated anesthesiologist 24/7 Experienced OB Hospitalist available 24/7 Maternal Fetal Medicine (high-risk OB specialist) Neonatal Intensive Care Unit Level III Limited separation between mom and baby One dedicated nurse for both mom and baby Cuddle Time (quiet time) Breastfeeding support 7 days a week Lactation Boutique Nursery available at mom’s request Child birth preparation classes Breastfeeding Support Group Sibling Classes Safe Sleep Education Outpatient Lactation Services

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Norman Named New Dean of VUSN Veteran Educator Takes the Helm at the Graduate School fall to step down as dean at the end of the 2012/13 academic year.

Last month, Linda Norman, DSN, In announcing the new dean, Jeff RN, FAAN, was announced as the new Balser, MD, PhD, vice chancellor for dean of the Vanderbilt University School Health Affairs and dean of the School of of Nursing effective July Medicine, said, “I am de1. The veteran educator lighted Linda is assuming and administrator has this highly visible and straspearheaded curricular tegically significant role. innovations for 22 years Having worked closely at VUSN, which recently with her for many years, ranked number 15 on the I know she will be an outU.S. News & World Report standing dean, bringing to list of the nation’s ‘Best this new opportunity exGraduate Schools – Nurstensive experience along ing.’ with the respect of the Norman, who joined School of Nursing’s faculty the Vanderbilt faculty on and students.”

July 1, 1991, recalled with Balser thanked Cona laugh, “I came to stay way-Welch for her work to five years.” When asked build the school into a naDr. Linda Norman what kept her at Vandertionally recognized leader bilt despite being asked to consider posiin nurse education. “She steps down at a tions at other academic institutions, she time when the School of Nursing is in an said simply, “It is the most exciting place enviable position with a stable faculty and I’ve been. We do more at VUSN than alleading academic programs in practice, most any school in the country.” research and informatics,” he said.

Recognized as a national and inter“What Colleen Conway-Welch has national leader in nursing and health procreated has just been amazing,” echoed fession education, Norman, the Valere Norman. “We have a very solid foundaPotter Menefee Professor of Nursing, retion … building on that foundation is places Colleen Conway-Welch, PhD, RN, what we need to do to really focus on this CNM, FAAN, FACNM, who decided last renewed healthcare mandate for interproBy CINDy SANDERS

fessional education.”

To achieve the real promise of teamwork in both the academic and practice settings, Norman said one of the first steps has to be to make sure nursing is properly aligned with other divisions of the university and medical center. “One of our first initiatives will be to look at the linkages we have to contribute to knowledge generation and to the application of knowledge in practice,” she said. Norman added that often means looking at connections with non-traditional partners. For example, she noted, a VUSN faculty member is currently working with Vanderbilt’s Engineering Department on caring for the elderly via robotics. “You don’t typically think of nursing and engineering,” she said.

She has been heavily involved both locally and nationally in establishing interprofessional academic programs. In 1993, she first began serving on the national advisory committee for the Institute for Health Care Improvements. The committee coordinated a national, multi-site project involving nursing, medicine and health administration programs to integrate quality improvement and patient safety into heath professions education.

“When we were looking at really being able to improve healthcare delivery, one single discipline wasn’t going to be able to do that alone,” she said. “We

Study Finds Disagreement on Role of Primary Care Nurse Practitioners In the face of an increasing demand for primary care services and a worsening shortage of primary care physicians, one broadly recommended strategy to combat the problem has been to increase the number and the responsibilities of nurse practitioners. However, primary care physicians and nurse practitioners significantly disagree on some proposed changes to the scope of nurse practitioners’ responsibilities, according to a New England Journal of Medicine study released in May. Led by investigators from the Vanderbilt University School of Nursing (VUSN), Vanderbilt Institute for Medicine and Public Health and Massachusetts General Hospital (MGH), the study was supported by grants from the Gordon and Betty Moore Foundation, the Johnson & Johnson Campaign for Nursing’s Future, and the Robert Wood Johnson Foundation.

“It is unsettling that primary care physicians and nurse practitioners, who have been practicing together for several decades, seem so far apart in their perceptions of each other’s contributions,” said co-author Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies and the Valere Potter Professor of Nursing at VUSN. The study survey was mailed to a national random sample of nearly 2,000 primary care clinicians — evenly divided between physicians and nurse practitioners — and responses were received from 467 nurse Dr. Peter Buerhaus practitioners and 505 physicians.

The majority of both groups — 96 percent of nurse practitioners and 76 percent of physicians — agreed with the Institute of Medicine recommendation that nurse practitioners “be able to practice to the full extent of their education and training.” However, the two groups disagreed significantly on whether an increase in the supply of nurse practitioners would improve patient safety and the effectiveness of care and health costs. One-third of physicians responded that such an increase might have a negative effect on safety and effectiveness.

“We were surprised by the level of disagreement reported between these two groups of professionals,” said Karen Donelan, ScD, EdM, of the Mongan Institute for Health at MGH, lead author of the report. “We had hypothesized that, since primary care physicians and nurse practitioners had been working together for many years, collaboration would lead to more common views about their roles in clinical practice. The data reveal disagreements about fundamental questions of professional roles that need to be resolved for teams to function effectively.”

A strong majority (82 percent) of nurse practitioners believed they should be able to lead medical homes but only 17 percent of physicians agreed. Additionally, 64 percent of nurse practitioners agreed they should be paid equally for providing the same services, compared with only 4 percent of physicians. Interestingly, 60 percent of nurse practitioners in collaborative practices indicated they provided services to complex patients with multiple conditions, but only 23 percent of physicians in such practices responded that those services were provided by nurse practitioners.

The two groups did agree that increasing the supply of primary care nurse practitioners would improve the timeliness of and access to care, and respondents working in collaborative practices indicated that both professions provide a wide range of services in their practices.

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have to be able to learn how to work in teams together.”

‘Outside the box’ thinking is second nature to Norman. In addition to interprofessional education, she led numerous innovations during her years as senior associate dean for academics in blended learning, quality improvement and doctoral distance learning, as well as implementing the strategic direction for all VUSN academic programs.

A proponent of flexibility and blended distance learning, Norman said offering such programs enables nurses to further their education without having to completely uproot their lives, which is a win/ win for both nurses and for the patients and communities they serve. At last count, she noted, VUSN has students represent about 40 states. While Vanderbilt faculty delivers the entire curriculum, nurses are allowed to do their clinical work within their own communities, assuming there is a suitable site. They also take classes on campus in Nashville several times a semester with the balance being presented online.

“You can live almost anywhere that is flight-suitable to Nashville,” Norman noted. “Over 50 percent of the coursework is delivered on campus by our faculty, face-to-face in a very concentrated period of time.”

Vanderbilt has close to 1,000 students pursuing graduate nursing degrees. Norman said a little more than 750 are pursuing master’s degrees with the balance working toward either the research or clinical doctorate. She also noted VUSN has an RN to MSN pathway for students who do not have a BSN. The pre-specialty entry program, which has close to 150 students enrolled, requires a six-semester sequence to receive the master’s degree, rather than the three semesters it takes for BSN students.

Norman earned her bachelor’s and master’s degrees from the University of Virginia and her doctorate from the University of Alabama – Birmingham. She was inducted as a fellow into the American Academy of Nursing in 2004 and currently serves as director of evaluation at the Robert Wood Johnson Foundation/ Northwest Health Foundations Partners Investing in Nursing initiative. Norman is widely published and a popular presenter on numerous topics within the field of nursing.

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Access to Care & Physician Extenders

By ANNE SUMPTER ARNEY

No matter what your political leaning, almost everyone agrees on the importance of access to quality healthcare. Healthcare reform has and will put increased pressure on the primary care physicians who historically have been the gatekeepers for a patient’s healthcare.

Increasingly, either nurse practitioners or physician assistants are delivering some of the care traditionally provided by primary care physicians. In some ways, the professions of nurse practitioners and physician assistants are different; however, both provide patient care that is both independent from and under the supervision of a physician.

As an advanced practice nurse (APN), a nurse practitioner is licensed and governed by the Board of Nursing. An APN is exactly that — a nurse with advanced training and responsibilities: a master’s degree or higher in a nursing specialty and national specialty certification as a nurse practitioner, nurse anesthetist, nurse midwife or clinical nurse specialist. Where a nurse’s work is usually limited to carrying out the orders of a physician and does not include the diagnosis or prescription of treatment for a patient, this is not true of an advanced practice nurse. An APN may conduct physical exams and often diagnoses and treats common acute illnesses and

injuries. Upon certification by the Board, an APN can also prescribe medications.

Although their services and role in the healthcare system are similar, a physician assistant (PA) is not an APN. A PA is licensed and governed by a committee of the Board of Medical Examiners rather than the Board of Nursing. A PA may provide selected medical/surgical services and like an APN, a physician assistant may diagnose and prescribe certain medications.

The practices of both PAs and APNs are closely linked to their supervising physician. The services of both must be provided under the supervision, direction and ultimate responsibility of a licensed physician accountable to the Board of Medical Examiners or the Board of Osteopathic Examination. A PA or APN must notify the appropriate Board of the name and contact information of their supervising physician, and the range of services that may be provided by both PAs and APNs is limited to those within the usual scope of practice of the supervising physician.

A PA or an APN often practices as part of the staff of a physician’s office, serving as an extension of the care provided by the physician. In the context of a physician’s office, an important distinction stands between the potential role of a PA and an APN. Tennessee law allows a PA to be a part owner in a medical practice together with a medical or osteopathic

doctor. A nurse, even an APN, may not jointly own a medical practice with a physician and may not provide medical services as the owner of any professional corporation or limited liability company.

An APN can only be either employee or an independent contractor of the physician’s practice.

Both APNs and PAs may be seen in two other types of primary care settings — they can be employed by urgent care clinics, or they may own their own practices.

In whatever setting they provide care, PAs and APNs must have a supervising physician. When they are practicing outside of any physician’s office, the role of supervising physician is provided by a physician who has entered into an agreement to undertake the responsibility of supervision for a fee.

Since Tennessee law prohibits a physician from being an employee of a nonphysician-owned practice, the PA or APN supervising physician must provide the supervision as an independent contractor to the clinic or practice. Direct supervision by a physician is not required by the rules, and the physician does not have to be present in the office of the PA or APN. However, in all settings, the physician’s role is still essential to the delivery of care by the PA or APN, and the physician must carry out all of the supervisory responsibilities required by both Tennessee law and the applicable licensing board.

These responsibilities include working with the PA or APN to adopt practice protocols and monitor the PA or APN’s adherence to them. The protocols must include, among other things, the applicable standard of care and should be specific to the population seen. The supervising physician must personally review the medical charts for the patients of both PAs and APNs (at least 20 percent of charts monitored or written by the certified nurse practitioner or a physician assistant every 30 days) and visit any remote site at least once every 30 days. In addition, the supervising physician must make a personal review of the historical, physical and therapeutic data gathered on patients when medically indicated, if requested by the patient, or when the prescriptions written fall outside the protocols or a controlled drug has been prescribed.

Anne Sumpter Arney, a partner with Nashville’s Bone McAllester Norton PLLC, has more than 30 years experience working with many of Nashville’s healthcare companies and medical professionals. She advises clients on business law and transactional issues, as well as assisting them in navigating ever changing healthcare laws and regulations. She also publishes a newsletter entitled “Physicians’ Legal Update” and a blog, OnCall. In addition to her health law practice, she advises both healthcare and non-healthcare entrepreneurs on how to start, grow, operate and sell their businesses. She can be reached at asarney@bonelaw.com.

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The Move to DNP

Nurses Embrace Advanced Degree Program to Address the Increasingly Complex Healthcare Practice Environment

By CINDy SANDERS

In October 2004, member schools of the American Association of Colleges of Nursing (AACN) voted to endorse the organization’s position statement calling for the transition of the level of preparation needed for advance practice nursing from the master’s degree to the doctorate level by 2015 through the addition of the DNP — Doctor of Nursing Practice.

“Will we have all of our APRN programs transition to DNP by the 2015 deadline? Probably not … but we will have a critical mass that are,” said Jane Kirschling, PhD, RN, FAAN, dean of the School of Nursing for the University of Maryland who serves as 2012-2014 board president for AACN. “I feel like we’ve reached the tipping point,” she added.

Indeed, the growth of DNP programs nationwide has been remarkable. By spring Dr. Jane 2013, programs existed Kirschling in 40 states and the District of Columbia. “We are extremely pleased that we currently have 217 Doctor of Nursing Practice programs up and run-

ning in the United States. If you go back to 2004, we only had seven programs,” Kirschling noted. “In addition, we have 97 new programs under development.”

She added enrollment has jumped from 170 DNP students in 2004 to 11,575 last year.

Rooted in the desire to deliver the highest quality of care in the practice setting, Kirschling said the addition of the DNP was consistent with what is happening in other healthcare disciplines including pharmacy, audiology and physical therapy. Grounded in evidence-based practice, she said the hope is that these doctoral-prepared nurses will take existing discoveries and more rapidly drive that knowledge to the bedside. Additionally, she said the degree is anticipated to prepare these nurses to provide leadership in an increasingly multifaceted healthcare environment.

“What I project we’ll see with time as we graduate more from the DNP program is they will actually partner with PhD nurses to create some really interesting synergy to solve really difficult clinical issues and to solve them in a quicker timeline that directly impacts patient care,” stated Kirschling.

The reason for the DNP movement is

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multifactorial. In addition to aligning with other health profession disciplines that offer a clinical doctorate, Kirschling said the degree also recognizes the complexity of the nation’s evolving healthcare delivery system.

The number of hours and amount of academic work required to become an advanced practice registered nurse provided another impetus behind the DNP movement, Kirschling noted. Nursing had already moved to increase and expand practical knowledge in APRN master’s programming. Where many master’s degrees in other fields require 30-36 credit hours, the four recognized APRN master’s programs — Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Midwife — already required a minimum of 40-55 credit hours. With the newer doctoral degree, students need, on average, 80 credit hours in the baccalaureate to DNP program and an additional 39 credits in the master’s to DNP path.

“Healthcare in the county has changed dramatically,” Kirschling concluded. “The depths of knowledge and the skill set any provider needs have just increased over time. We, as a discipline, felt it was critical that our graduates be prepared to meet the demands of the future.”

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PhD vs. DNP Jane Kirschling, PhD, RN, FAAN, president of the American Association of Colleges of Nursing, said the addition of the Doctor of Nursing Practice (DNP) degree was the clinical complement to the long-standing Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc) degrees, which prepare students for scientific research.

The PhD, she noted, “is really intended to prepare the next generation of scientists for new discovery so they are generating new knowledge for the discipline.” In addition to an interest in a nursing faculty career with a research component, Kirschling said it was fairly common for nurse executives to obtain a PhD as they sought to increase leadership roles. With the addition of the DNP, nurses now have two terminal degree tracks from which to choose — research and practice.

The newer DNP quickly overtook PhD and DNSc programs in terms of the number being offered across the country. Currently, there are 131 researchfocused programs in the U.S. The number of research doctoral programs grew from 103 to 131 between 2006 and 2012. During that same time period, DNP programs grew from 20 to 217.

As the field looks to increase the number of doctoral-prepared nurses, the good news is enrollment is up in both research-based and practice-based doctorate programs, although the newer DNP degree has seen much more rapid growth as more academic institutions have begun offering the option. Between 2004 and 2012, the number of students enrolled in DNP programs increased from 170 to 11,575. The number of students seeking a PhD in nursing grew from 3,439 to 5,110 during the same timeframe.

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Local Deans Weigh in on DNP

By CINDY SANDERS

Graduate nursing programs at Vanderbilt University School of Nursing, Belmont University School of Nursing, and Middle Tennessee School of Anesthesia have all added DNP/ DNAP tracks to their graduate offerings with VUSN debuting the program in 2008, Belmont adding the degree last year and MTSA adding a track this fall.

“The DNP, when it was first envisioned, was to deepen the knowledge of advance practice nurses to accelerate the application of evidence-to-practice, to inform research, and for leadership and management of healthcare,” said VUSN Dean Linda Norman, DSN, RN, FAAN. She added it has traditionally taken about 15 years for evidence-based practices to truly become part of bedside care. “That time frame needs to shorten, but you need people who really understand how to evaluate evidence and apply it to practice,” she noted.

Equally, Norman continued, when you have people who know how to change practice effectively, they are in a position to help create a feedback loop to inform

Chaquetta Thomas Johnson, VUSN’s 2013 Founder’s Medalist, received her Doctor of Nursing Practice degree this past May.

PHOTO BY SUSAN URMY

new research. Nurses with these coveted skills also make for good managers and executive leaders in the complex, multifaceted healthcare delivery system.

At Vanderbilt, Norman said they offer the DNP as a post-master’s degree.

“We have a program that seamlessly moves from BSN to DNP, but we award the master’s along the way,” she said, adding the School of Nursing doesn’t plan to eliminate the master’s degree as long as certifying bodies continue to accept it as the standard for advance practice. Since nurses can be certified in their specialty at the master’s level, awarding the degree in between the BSN and DNP allows those nurses to go ahead and practice at the APN level while completing their doctorate, she explained.

Belmont launched their DNP program in 2012. “We admitted our first DNP students last fall. The admission requirement was a master’s,” said Cathy Taylor, DrPH, MSN, RN, dean of the College of Health Sciences & Nursing. “This fall, we will admit the first BSN to DNP

students.”

She said Belmont’s post-MSN to DNP program is 40 credit hours, and the BSN to DNP program will be 71 hours. Taylor noted research shows the more education a nurse has, the less likely a patient is to die and the more likely that patient is to see improved outcomes and stay healthy. “It’s just a pragmatic approach for us,” she said of launching the terminal degree program.

For both nurses and patients, she added, “It’s the right thing to do.”

Having just undergone an expansion of their simulation program, Taylor said, “Simulation is going to play a much bigger role in developing those advance practice competencies, as well as basic nursing skills.”

MTSA became the first school in Tennessee to receive approval to offer

the Doctor of Nurse Anesthesia Practice (DNAP) last fall and will welcome its first classes in September 2013. The inaugural class is expected to have 12 students with plans to grow in subsequent years.

The accredited DNAP program came on the heels of a major campus expansion and renovation, which included the addition of a second simulation lab and new resources for distance education. Future plans call for building a new lecture hall, atrium and learning resource center.

“The DNAP program will produce higher-quality graduates with a deeper understanding of anesthesia … not simply more graduates,” said MTSA President Kenneth Schwab, EdD. “MTSA has always put our students ahead of the curve with a rigorous education and clinical experience that prepares them to provide anesthesia,” added Chris Hulin, CRNA, MSN, MBA, MS, DNP, dean and program administrator.

The DNAP program at MTSA will be the terminal degree for nurse anesthesia. Only current certified registered nurse anesthetists (CRNAs) can apply. A major aspect of the new program is the distance learning component. MTSA officials said they have prepared with a new teleconferencing center designed for professors to give virtual lectures featuring a classroom with built-in cameras, audio systems and noise-reducing walls.

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The Inaugural Class of Council Fellows Merrick Axel: Partner, Cressey & Company Bo Bartholomew: Founder and President, PharmMD Laura Beth Brown: Vice President, Vanderbilt Health Services Molly Cate: Partner & Co-founder, Jarrard Phillips Cate & Hancock Chris Cigarran: Market President, Employer Division, Healthways John Doulis, MD: CIO, MedCare Investment Group Todd Falk: Division Vice President, DaVita Adam Feinstein: Senior Vice President, Strategy & Corporate Development, LabCorp Stephen Flatt: President, National HealthCare Corporation Darin Gordon: Director, Health Care Finance & Administration, State of Tennessee Michael Hill: Attorney & Shareholder, Harwell Howard Hyne Gabbert & Manner Grant Jackson: General Partner, Council Capital Hans Kestler: Vice President, Orthopedics & Sports Medicine, BioMimetic Therapeutics James Lakes: Director, Business Strategy & Operations, Microsoft Corporation Fletcher Lance: Global Healthcare Leader, North Highland Ted Lomicka: Vice President & Assistant Treasurer, Community Health Systems Evans Looney: President, Tennessee & North Mississippi, Humana J.L. Osei Mevs: Senior Associate Vice President, External Affairs, Meharry Medical College Shawn Morris: President, Development & Innovation, CignaHealthSpring Frank Moser: President, Aegis Sciences Corporation Miriam Paramore: Executive Vice President, Strategy & Product, Emdeon

Nashville Health Care Council Fellows continued from page 1 years, but the impetus to put the plan in motion really came from the members of the Health Care Council Board, who reaffirmed the importance of fostering and expanding Nashville’s legacy of innovation and entrepreneurship in the face of transformation.

“From the industry perspective, it was very important for the Council Board to be proactive as the industry comes upon this unprecedented era of change,” said Byrd.

“Nashville has a legacy of innovation, success, management expertise, new ideas, and strategy development, and we want to stay at the forefront and drive the future,” she continued.

Former U.S. Senate Majority Leader Bill Frist, MD, readily stepped up to push the idea forward and reached out to health policy expert Larry Van Horn, PhD, to execute the vision. Van Horn, associate professor of Economics and Management and executive director of Health Affairs at Vanderbilt University Dr. Larry Van Owen Graduate School Horn of Management, is nationally recognized as a leading expert and researcher on healthcare management.

Together, the two served as co-directors of the Council Fellows program, which launched in February with an orientation meeting and concluded with the graduation of the 33 Fellows on June 28.

In crafting the curriculum, Van Horn said the thought process was to address three key objectives — 1) to ignite a burning platform for system wide change; 2) to foster new ways of thinking by developing strategies and business approaches to create value in healthcare; and 3) to help hone the leadership skills to take organizations from where they are today to where they need to be in the future.

The outcome was a mix of classic MBA programming, including the utilization of case studies and guest lecturers, combined with emersion activities not

Dr. Bill Frist, former U.S. Senate Majority Leader and co-director of the Council Fellows program, shares insights during a classroom session.

typically found in an academic setting, interactive discussions within the class, and small group meetings centered on leadership development.

“We brought in Nashville’s storied leaders to talk very candidly in small groups to the Fellows specifically about leadership and career development,” explained Byrd, who added that each member of the 2013 class went through a leadership assessment. Tom Cigarran, Bill Carpenter, Herb Fritch, George Lazenby, Jim Lackey, Dee Anna Smith, David Black, Joey Jacobs and Harry Jacobson, MD, met with groups of six-eight for lively, two-way discussions.

In fact, Van Horn said the interactive dialogue … in the small groups, larger class setting, and informal conversations during breaks … might have been one of the most valuable tools.

“I’m an economist so I view the healthcare challenges through a particular lens,” he said. “Senator Frist is a physician, former politician and investor … so he views the system through those lenses. It’s the discussion though, from multiple perspectives, that develops a broader perspective for the Fellows, and what their place will be in developing the business solutions of the future.”

Van Horn stressed the participants accepted to the inaugural class were already

Jim Parrott: Partner, Ernst & Young Clay Phillips: Director, Provider Relations & Communications, BlueCross BlueShield of Tennessee

Applying for the 2014 Fellow Class

Alan Poenitske: Senior Vice President, Financial Operations, MedSolutions

Applications for the second Council Fellows initiative are expected to open in September. While tweaks in the program could be made following the debriefing process, Executive Director Judith Byrd believes the general format will mirror this first successful outing.

One change she does anticipate is moving the schedule up a month with orientation in January 2014 and graduation in May. Council Fellows is open to executives of Nashville Health Care Council member organizations, as well as to those working for government agencies on a local, state or federal level. However, there is no geographic limit for qualified candidates. In fact, Byrd noted there were applicants from as far away as California, and at least two members of the inaugural group traveled to Nashville for class. “I think that does speak to it being a nationally unique offering,” she said of the broad candidate pool.

Byrd also stressed that the original group of applicants held enough Fellows-level candidates to fill several classes. “There were incredibly talented people turned away just because of the sheer volume of applicants,” she said. Byrd strongly encouraged those still interested to consider reapplying for the 2014 class.

For more details or to apply this fall, go online to www.healthcarecouncilfellows.com.

Bill Rutherford: COO, Clinical and Physician Services Group, HCA Michael Ryan: Managing Director, Avondale Partners Jeff Seraphine: President, Delta Division, LifePoint Hospitals Andrew Smith: Executive Vice President, General Counsel & Secretary, Brookdale Senior Living Bryanie Swilley: Eastern Division President, IASIS Healthcare Chris Taylor: Executive Vice President & CFO, Parallon Business Solutions Brent Turner: President, Acadia Healthcare Mark Wainner: Vice President, Financial Operations, AmSurg Paul Wallace: Managing Director, Heritage Group

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executives with a tremendous amount of experience and insight into the industry.

During the eight daylong sessions, these leaders from different sectors of the healthcare industry had the opportunity to share their varied perspectives on transforming the system.

“We’ve built relationships amongst 33 executives who are leading healthcare organizations, which will allow them to use that network to enact new business models,” Van Horn said.

“Collaboration is the key to fostering dialogue and change,” added Byrd. The Council Fellows program was, itself, a collaborative effort. Partner organizations BlueCross BlueShield of Tennessee, Community Health Systems, HCA, Healthways, LifePoint Hospitals and Vanderbilt University Owen Graduate School of Management joined forces with the Nashville Health Care Council to turn the Fellows concept into reality.

In the end, Van Horn said the goal was to encourage the Fellows to embrace change and shift their mindsets to power innovation. “The changing customer … the purchaser of healthcare … coupled with implementation of the Affordable Care Act will shift the determinants of success for healthcare organizations of the future,” he noted.

Although the unknown undoubtedly can be frightening, it can also be exhilarating. “The healthcare system is evolving, and there’s never been a more exciting time to be in healthcare as now,” said Byrd. “The change is coming at a rapid pace. There are a lot of things we can do as these opportunities present if you unleash the talent to find solutions and work towards value and improved patient care.”

As of June 28, there are 33 newlyminted Council Fellows who feel well equipped to work together to meet those challenges. “I’ve gotten letters from Fellows in the program expressing how this has changed and shaped the way they think about problems in their industry and how this has changed the way they work,” said Van Horn.

Byrd concluded, “We’re confident Nashville will be stronger and better from this annual experience. Its impact will be felt in the boardrooms and C-suites of healthcare organizations throughout the nation.” nashvillemedicalnews

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From the Fellows Perspective Laura Beth Brown, MSN, RN, Vice President Vanderbilt Health Services: Having just completed a fellowship with the Centers for Medicare and Medicaid Services, Brown said she experienced a moment of hesitation when Vanderbilt Health System CEO Wright Pinson, MD, asked her to apply for the Council Fellows. The interactive structure of the Nashville Health Care Council program quickly replaced any qualms about diving into another intensive Fellows program.

“It has totally exceeded any expectation I had,” Brown said. “Everything I’ve learned in this experience I have been able to apply or to look at my work with a different lens and a different way of problem-solving.”

She added, “I definitely think Nashville is a great place to have this Fellows program because of the resources and access to healthcare.”

The city’s robust healthcare industry enabled the Council Fellows program to select senior leaders from across the broad spectrum of healthcare services and management companies. “A lot of us in the room are competitors so you don’t naturally gravitate to your competitors to talk about work,” Brown said with a laugh.

However, she continued, the unbiased setting created an instant network that encouraged sharing and developing new ways to problem-solve. “It put us in a position to discuss solutions in a collaborative way regarding the challenges in healthcare rather than working, as we typically do in healthcare, in a very siloed, independent way.”

As the landscape changes, Brown said collaborative approaches are becoming the norm. “There are people now who I feel like I could just pick up the phone to call to solve a problem. I know the right people now.”

She continued, “I think it’s created a great framework to build on … I’m really interested in seeing what we do post-Fellows. I think this alumni class will continue to meet and to collaborate.”

Ted Lomicka, Vice President & Assistant Treasurer, Community Health Systems: Lomicka first learned about the Council Fellows Initiative through his involvement with Leadership Health Care. The more he learned, the more he liked. Knowing Judith Byrd’s organizational skills, and Sen. Bill Frist’s medical and political background, he was excited to apply for the inaugural class. Working with Larry Van Horn at Owen Graduate School was icing on the cake. “His ability to harness vast amounts of data and make sense of it really lends itself to a thorough study of healthcare reform,” he said. “Those three individuals make for a pretty powerful combination.”

As he dove into the program, Lonashvillemedicalnews

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Emersion experiences, such as onsite clinical visits, provided added perspective to the coursework.

micka found his early enthusiasm wasn’t misplaced. He particularly enjoyed the timely, topical policy updates at the beginning of each session. “Having a forum where we’re able to discuss and debate healthcare policy as it is emerging is imminently valuable,” he said.

As co-directors, Frist and Van Horn contacted their network of colleagues to bring in renowned speakers to address the participants. “In particular, Harvard Professor Michael Porter taught us to define value as patient outcomes per dollar spent.

This approach facilitates greater collaboration between clinicians and managers, allows for the fundamental restructuring of healthcare delivery, and initiates the use of an array of delivery system outcome tracking metrics,” he explained. “Following this approach will facilitate dramatic advancements in patient care.”

He added that Robert Kaplan, also a professor at Harvard, taught the group time-driven, activity-based costing. “It’s brilliant in its simplicity; and using this approach, you can easily discern the cost to provide healthcare services,” he said, adding, “That was a neat take-away. I’ve done that on several projects already.”

With his focus at CHS on improving the financial performance of hospitals and health systems, evaluating strategic transactions, and supervising corporate cash management functions, Lomicka said he is already putting the lessons learned to good use.

Shawn Morris, President – Development & Innovation, CignaHealthSpring: Working with one of the nation’s largest Medicare Advantage Plans, Morris is keenly aware the current healthcare system is unsustainable. “For the health of our country long term, we have to figure out healthcare,” he said.

Being a part of the solution attracted him to the Council Fellows Initiative. “I like change, and I think change makes things better,” he noted. The Fellows, he continued, has given him access to others from across the spectrum of healthcare who feel the same way. “It’s a very bright

nity to see healthcare from different lenses.

“Traditionally healthcare is very siloed, and that leads to a lot of the fragmentation we see. I think we will all have to think differently … with a collaborative mindset. Is that going to happen overnight? Absolutely not. But this type of class is a step towards that,” he said.

Like many of his colleagues, Morris gained a lot from the policy updates at each session. One he particularly enjoyed featured a Skype session with United States Chief Technology Officer Todd Park, who shared information about ‘Health Datapalooza.’ Morris said he hadn’t known about the event before Fellows but looked into it and ended up sending two of his staff members to D.C. to participate.

For Morris, though, the very best take-away might be the lasting connections with legacy CEOs and the coming generation of health leaders as they work together as change agents.

group of people,” Morris said. “Business begins with relationships. I think this environment really allows for that.”

While Morris noted HealthSpring was built on a collaborative business model, he recognizes more teamwork will be required in the future and will extend beyond payers and providers. Being exposed to Fellows with a background in technology, marketing, investment, research and other disciplines has been intriguing. “You kind of understand where the world is going from their shoes,” he said, adding the simulation and hands-on emersion elements also gave participants the opportu-

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Vanderbilt Wins AMA Education Grant Med School One of Few in Nation to Receive ‘Accelerating Change in Medical Education’ Funding Editor’s Note: We began covering this story in the spring as thought leaders in medical education and healthcare societies look to evolve provider training to better match the nation’s transforming healthcare delivery needs. In April, “Educating Tomorrow’s Doctors Today,” included an interview with Jeremy A. Lazarus, MD, president of the American Medical Association, regarding the association’s campaign to transform medical education. Last month, Sharon Fitzgerald spoke with Bonnie M. Miller, MD, senior associate dean for Health Sciences Education at Vanderbilt University School of Medicine, about innovative plans to fundamentally redevelop the way med students are taught. Both the April article and June’s “Vanderbilt Set to Overhaul Medical Curriculum” are available online at www.

NashvilleMedicalNews.com. Typing “Accelerating Change” in quote marks into the search box will bring up previous articles or find them in PDF format in our archives section.

First there were 115, then 31, and now 11.

Of the 119 proposals from 115 U.S. medical schools, the American Medical Association has selected just 11 to fund through the organization’s “Accelerating Change in Medical Education” initiative.

It was announced on June 14 that Vanderbilt University School of Medicine is one of the finalists that will receive a share of the $11 million in AMA grant money.

“We are thrilled to award funding to 11 medical schools for their bold, transformative proposals designed to close the gaps between how medical students are trained and how healthcare is delivered,” said AMA President Jeremy A. Lazarus, MD, in announcing the finalists.

“This AMA initiative will identify specific changes in medical education that can be

applied in medical schools throughout the nation to enable students to thrive in a changing healthcare environment and improve the health of our nation’s patients.”

Vanderbilt’s proposal, known as Curriculum 2.0, calls for embedding students in Dr. Jeremy A. Lazarus the healthcare workplace based on the premise that students must learn to do their jobs in the types of settings where they will ultimately work. The well-supervised students will become team members at a single clinical site for their entire undergraduate medical education.

The purpose of the weekly clinical experience is to help students learn system-based practice skills.

The students also will use their own competency-based performance data to complete self-assessments. From that data, the med students will form personalized learning goals and objectives, which will be linked to a learning management system in Vanderbilt’s electronic health record. As students achieve competencybased progression benchmarks, they will move forward in their education, allowing those who grasp a concept quickly to continue onward without waiting for their peers and those who need extra time on a particular skill to master it before going to the next level.

“This is a validation that Curriculum 2.0 represents some of the most exciting and innovative ideas for medical education,” said Bonnie Miller, MD, senior associate dean for Health Sciences Education at Vanderbilt. “Through this grant, the AMA hopes to disseminate best prac-

tice to medical educators throughout the nation. We believe this funding and collaboration will allow us to accelerate the changes we hope to bring about with Curriculum 2.0, and to rigorously evaluate the curriculum’s effectiveness.”

Each of the 11 schools will receive $1 million over five years to fund their proposed educational innovations.

In addition to Vanderbilt, the AMA selected proposals from Indiana University School of Medicine, Mayo MediDr. Bonnie cal School, NYU School Miller of Medicine, Oregon Health & Science University School of Medicine, Penn State College of Medicine, The Brody School of Medicine at East Carolina University, The Warren Alpert Medical School of Brown University, University of California – Davis School of Medicine, University of California – San Francisco School of Medicine, and University of Michigan Medical School.

Miller noted one of the most exciting parts of being chosen for the grant is the opportunity for collaboration with other top medical educators. “Over the next five years we will have the incredible honor of sharing a curriculum we have worked on so hard for the last several years and will have the opportunity to learn more about what works for other programs. It will be fun, helpful and interesting, but most of all it establishes Vanderbilt as a leader in transformational change in healthcare education,” she said.

For more information, go online to www.changemeded.org.

Introducing Health Ed at the High School Level Last month, Lipscomb University Nursing and Health Sciences Center and HCA TriStar introduced rising high school sophomores, juniors and seniors to a variety of health science professions during a weeklong camp through Lipscomb-HCA/TriStar Health Care Academy.

This year’s camp — with 31 participants from Tennessee to Texas — featured experiences related to pharmacy, nursing, nutrition and exercise science. The camp provided students with hands-on activities, laboratory science experiences, and instruction in CPR, EKG, AED, non-invasive measurements including blood pressure and pulse, and basic first aid.

In addition to touring TriStar Summit Medical Center, the students worked with Lipscomb’s cutting-edge patient simulators, which display symptoms and respond to treatments, in the school’s 16-bed Health Science Simulation Center. The students worked with ‘Harvey,’ the university’s cardiac simulator, to identify abnormal heart rhythms and breath sounds. Harvey has numerous heart arrhythmias and heart murmurs that can be detected and comes with various heart disease scenarios including x-rays and EKG monitor strips for students to evaluate.

On the last day, the students carried out a simulated healthcare event in a high-tech lab where they portrayed healthcare professionals in scripted exercises to treat ‘patients’ (Lipscomb nursing students and faculty). The final exercise allowed students to bring together all the skills they learned throughout the week.

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Centerstone Expands Mental Health First Aid USA Training Youth Curriculum Focuses on Behavioral Health Issues in Adolescents Last month, Centerstone, one of the nation’s leading notfor-profit providers of communitybased mental health and addiction services, announced plans to expand the Mental Health First Aid USA training to include curriculum to identify unique behavioral issues in adolescents and young adults ages 12-25.

The original program, launched in 2011, focused on adult mental health issues, but the expanded program teaches participants risk factors and warning signs of mental health problems in a younger population, builds an understanding of the importance of early intervention and provides information on techniques and resources to help an adolescent in crisis. The certification course is intended for adults who regularly interact with adolescents or young adults. Training using a five-step action plan — assess risk of suicide or harm, listen nonjudgmentally, provide reassurance and information, encourage appropriate professional help, encourage self-help and other support strategies.

Susan Gillpatrick, MEd, LPC, CTS, a Centerstone crisis management specialist certified as an instructor, teaches the eight-hour course. “Teachers, employers and adults who regularly interact with young people can learn to recognize the signs and symptoms of mental illness and know how to respond in a crisis through this training,” said Gillpatrick. “Historically there has been no routine training for adults to know how to identify or handle mental disorders.

We are pleased to be able to offer this service and hope that through this course we can help others be aware of mental illness symptoms in youth and help them find appropriate professional treatment.”

For more information or to schedule a training session, contact Gillpatrick at (615) 202-2580 or susan.gillpatrick@centerstone.org.

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Major Expansion Plans Underway for Saint Thomas Health, UT Residency Program

By CINDY SANDERS

The partnership between Saint Thomas Health and the University of Tennessee Health Science Center is rapidly growing. Plans are well underway to greatly expand the number of training slots in Middle Tennessee for the state’s future physicians.

Although UT Health Science has had a residency program at Baptist Hospital since 1982, an announcement by the health system and university in April 2012 outlined a plan to ultimately grow the number of medical residents from the current 17 to more than 100 in the coming years with future plans to add up to 50 Fellows to the program, as well. In addition to Baptist, the expanded residency program also will utilize Middle Tennessee Medical Center and Saint Thomas Hospital as home clinical sites.

“UT really plans to have a large presence here in Nashville by partnering with Saint Thomas Health,” said incoming UT Medical School Assistant Dean of Operations Jordan Dr. Jordan Asher Asher, MD, MS. Asher, who graduated from medical school and did his training at Vanderbilt, joined Saint Thomas Health as physician network executive seven years ago from private practice. He now serves as the chief medical officer and chief integration officer of Mis-

sionPoint Health Partners, in addition to his role with the expanded medical training program. Although he has focused on the residency program since March 2012, Asher noted the work around graduate medical education at Saint Thomas Health goes back to his days as physician network executive when he and colleagues began assessing the feasibility of expanding GME, thinking strategically about partnership options and envisioning the model for increasing the primary care physician pipeline.

Over the next four years, the Internal Medicine program based at Baptist Hospital and Saint Thomas Hospital is anticipated to expand from its current 17 residents to closer to 30. Baptist Hospital will add an OB/GYN track, and Saint Thomas Hospital will serve as home base for a General Surgery program with 15 residents. At MTMC, plans call for an Emergency Medicine program with 24 residents and a Family Medicine program with an additional 15 residents. Program directors are in place for three of the four new training tracks (see box) with the hope of accepting the first physician residents into the new programs starting next July.

“We truly believe to create the healthcare of the future, you have to train the doctors of the future,” Asher said. “The UT/Saint Thomas Health partnership is very interested in training physicians in holistic and reverent care, as well as in population-based models, to remain in the Middle Tennessee community.”

In addition to rotations throughout

the Saint Thomas Health network, Asher said residents will have access to other sites affiliated with the University of Tennessee Health Science Center. “We’re leveraging the vastness of the UT system,” he noted.

In contemplating the right GME track, he said individuals have to evaluate what type of medicine they wish to practice … community health, academic, research, specialty care … which, in turn, drives the type of residency program chosen.

“Vanderbilt has an incredibly important role in training not only community physicians but also those who have an interest in going into academics and research,” Asher noted. However, with the anticipated increased demand for more primary care practitioners, he said additional training slots are needed. “We’re really trying to fill what we see as a perceived gap in training physicians that will remain in local communities.”

Directors of New Joint Residency Program Named Last month, Saint Thomas Health announced three new directors for the growing medical residency program. Douglas Brown, MD, will serve as residency director of Obstetrics, Christopher Dunlap, MD, will oversee Family Medicine; and Mark Reiter, MD, has been named director of the new Emergency Medicine residency program. Tracey Doering, MD, is already in place as program director for the long-established Internal Medicine program at Baptist, and the search is still in process for the final program director to oversee General Surgery.

Brown graduated from the University of Alabama School of Medicine in Birmingham and completed his residency in obstetrics and gynecology at Vanderbilt. The board-certified OB/GYN practices at Heritage Medical Associates.

Dunlap is currently a faculty member of the Family Medicine Residency Program of Tallahassee Memorial HealthCare (TMH) and also serves as family medicine clerkship director at Florida State University College of Medicine. A graduate from UT Health Science Center, he completed his residency at TMH. The board-certified family physician previously ran a family practice in Coffee County, Tenn.

Reiter is a board-certified emergency physician with Middle Tennessee Emergency Physicians in Murfreesboro and is the founder and CEO of Emergency Excellence, LLC, an organization dedicated to improving emergency medicine performance. He graduated from Robert Wood Johnson Medical School and holds a master’s degree from Rutgers Business School. Reiter completed his residency in emergency medicine at the University of North Carolina. He currently serves as vice president of the American Academy of Emergency Medicine.

Belmont Expands Simulation Program, Adds Fellow, continued from page 1 Luckily for Belmont, one of those internationally recognized experts, Beth Hallmark, PhD, leads their simulation program. Her expertise was one of the draws for Gwenn Randall, who was appointed the school’s first sim fellow.

“This post-doctoral fellowship in Simulation Laboratory Management is a very unique opportunity where the intricacies of simulation and the simulation environment are being explored. I view my role at Belmont as a learner, educator, motivator, evaluator, deDr. Gwenn veloper, publisher and Randall researcher,” Randall noted.

She joined Belmont with extensive clinical and administrative nursing experience. She received her undergraduate degree from Howard University, a master’s in nurse anesthesia from St. Joseph’s University, a master’s in nursing from Temple University, and a doctorate in nursing from Barry University. Randall completed post-doctoral simulation training at Mayo

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Clinic. Additionally, she engages in foreign mission trips each year to provide anesthesia services in medically underserved areas, and Randall helped develop the practicum for a nurse anesthesia graduate program in Addis Adaba, Ethiopia, where she returns annually for didactic and clinical instruction.

While some fellowship programs exist for physicians in simulation, Randall said the Belmont opportunity is unique for nursing. During her fellowship, she is focusing on all aspects of simulation lab management — faculty development, bridging simulation across interprofessional teams, standardization of simulation practices, and finding the most effective means of conducting a post mortem on the experience. “Simulation without proper debriefing is really null and void,” she stressed.

Randall added that simulation is an excellent way to demonstrate core competencies and noted some states now allow up to 25 percent of a nursing student’s clinical time to be in the sim lab. “Simulation is going to play a major part in education,” she said, particularly in light of an increasing need for clinical experience and a limited

number of community spots. Randall continued, “Simulation is much more than just the mannequins … simulation is about the realism of the experience.” She added that when done properly, a simulated scenario creates the sense of urgency and adrenaline rush found in an emergency situation.

Taylor noted simulation gives both student nurses and those already in practice the opportunity to work on techniques and practice scenarios in a controlled environment. It also provides the opportunity to practice teamwork and communications skills and opens access to situations, such as an end-oflife scenario, that might not be readily available during training. “We get letters from former Cathy R. students who say they Dr.Taylor wouldn’t have known how to handle a situation in their practice if they hadn’t hat the simulated experience during training,” Taylor said.

The university’s simulation center has 28 mannequins ranging from newborns to adults. The advanced patient simula-

tors exhibit a broad spectrum of symptoms and responses to treatment based on programmed scenarios. The Memorial Foundation grant helped the school purchase its newest addition … “SimMom.” “In addition to funding the fellowship for Dr. Randall, which we think is incredibly important to move the science forward, we were able to purchase a very expensive, high fidelity SimMom, which is an incredible training tool for obstetrics,” Taylor said.

A full-body, interactive birthing simulator, SimMom has the functionality to train students in a range of midwifery and obstetric skills, including different delivery positions and maneuvers. High-risk, lowfrequency birthing event scenarios also help providers prepare for emergencies, such as umbilical cord prolapse or postpartum hemorrhage, in a risk-free environment.

“This is a big part of the future for training healthcare professionals at every level,” said Taylor. With a tip of the hat to the Memorial Foundation, she concluded, “We are so grateful for someone believing in this idea. It was a dream, and they helped make it come true.”

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State Pharmacy Board Strengthens Oversight of Drug Compounding

By CINDY SANDERS

In the wake of another suspect drug case with reports of adverse patient events, the Tennessee Board of Pharmacy has announced actions to better assure the safe, sterile compounding of drugs by state-licensed entities.

The latest incident found officials with the Tennessee Department of Health (TDH) and other state and federal agencies working through the Memorial Day weekend to investigate problems with methylprednisolone acetate (MPA) products produced

by Main Street Family Pharmacy, LLC, in Newbern, Tenn.

Reports of adverse events first surfaced in Illinois and North Carolina from patients who received injections of preservative-free MPA (80 mg/mL) after Dec. 6, 2012. By May 24, seven reports of illness had been logged with no report of meningitis or other life-threatening infection. The suspect MPA was shipped to physicians and clinics in 14 states. In Tennessee, seven facilities received the questionable drug — Quality Care, Jackson; Pinnacle Pain Management Clinic, Union City; Getwell Family Clinic, Jackson; Walker Pain Management Center, Jackson; First Choice Clinic, Dyersburg; Christian Care Clinic, Newbern: and Axis Medical Clinic, White House.

The Tennessee Board of Pharmacy first licensed Main Street Family Pharmacy in 1985, with a license as a manufacturer/wholesaler/distributor being added in 2010. State officials reported the staff of Main Street Family Pharmacy had fully cooperated with the investigation and launched a voluntary recall of all its sterile products even though no known adverse effects have occurred from any other product. The pharmacy is currently on probation as a result of this investigation.

The new measures adopted by the Tennessee Board of Pharmacy collectively address the need for safe, effective medicines while preserving access for patients.

“The board is working cooperatively to identify solutions to improve safeguards for public health while not placing unnecessary barriers on sterile compounding pharmacies that would hamper production of much-needed drugs already in short supply,” said Charles E. “Buddy” Stephens, DPh, president of the Board of Pharmacy. “We believe our actions enhance existing safeguards and offer new steps to ensure safe and effective medications are there when needed.”

The board has taken action to: • Expedite suspension of sterile compounding by a pharmacy or manufacturer when a serious problem is discovered.

With cause, a sterile compounder’s license can be suspended jointly by an officer of the Board of Pharmacy, its authorized 16

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executive director, and the commissioner of the Tennessee Department of Health without having to wait for a full Board of Pharmacy meeting.

• Enhance oversight and regulation of drug manufacturing operations in the state. The license for manufacturers will be a separate category. Prior to this move, manufacturers were included in a combined classification with wholesalers and distributors.

• Work more closely with the U.S.

Food and Drug Administration. The new requirements call for drug manufacturers in Tennessee to show proof their operations are registered with the FDA. • Add a sterile compounding registration to the regular pharmacy license, to the manufacturer license, and to the wholesaler/distributor license.

These initial actions are not expected to be the last. A workgroup from the Board of Pharmacy is collaborating with staff at the TDH to identify additional measures and improvements to address the manufacturing and distribution process. Items under consideration include more proactive inspection with additional emphasis on critical reviews of maintenance and quality control records, interim self-assessment and applicable reporting by the licensed entities, and adoption of applicable U.S. Pharmacopeia Standards. Additionally, three more

licensed pharmacists are being recruited by the Board of Pharmacy to serve as inspectors and another administrative staff person will be added to facilitate the new self-assessment and reporting responsibilities.

“It’s a great challenge to strike a thoughtful, protective balance between addressing the daily drug shortages faced by patients and healthcare providers across Tennessee with the absolute need to assure safety and effectiveness in the compounded product,” said TDH Commissioner John Dreyzehner, MD, MPH. “While we wish the current situation associated with a Tennessee pharmacy had not happened and that patients had not been affected, the actions Dr. John taken by the board, along Dreyzehner with legislation passed recently, are moving us forward in assuring the safety and availability of important medications.”

Global Alliance for Arts & Health Under Nashvillebased Leadership

By MELANIE KILGORE-HILL

Two Nashville women are leading international efforts to bridge arts and healthcare.

Misty Chambers, MSN, RN, recently was installed as president of the Board of Directors of the Global Alliance for Arts & Health, while Donna Glassford is serving as interim executive director of the Alliance.

The Washington, D.C.Misty based nonprofit is dediChambers cated to advancing the arts as integral to healthcare and assisting in the professional development and management of arts programming for healthcare populations; providing resources and education to healthcare and arts professionals; and encouraging and supporting research and investigation into the beneficial effects of the arts in healthcare.

“I want to focus on growing membership and helping everyone continue to understand the importance of arts in healing and healthcare and how they can get involved,” Chambers said of her new role.

“We also want to focus on how a global alliance can support those efforts locally and in the international community, as well.”

A clinical operations/design specialist with Nashville architectural firm Earl Sw-

ensson Associates, Inc., Chambers serves in a healthcare planning, design and research capacity for ESa and is a licensed registered nurse. She joined ESa in 2006 after serving as director of facilities planning at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, where she first met Glassford more than 18 years ago.

Now president of Donna Glassford Arts in Health Consulting, Glassford develops and coordinates artistic programming for healthcare clients across the country. Glassford also is past secretary of the Global Alliance board, which was formerly Donna called the Society for Glassford Arts in Healthcare.

“The group started 24 years ago at the beginning of the arts and health movement with a handful of professionals doing similar jobs in healthcare,” said Glassford, an Alliance member since 1997. Today, the 1,400-member organization represents performing and visual arts and includes members from healthcare and community institutions, design and architecture firms, physicians and nurses.

Alliance partners also have expanded.

The Joint Commission now provides input on a variety of initiatives along with the American Hospital Association, the National Institute on Aging,

Americans for the Arts and other groups.

“The organization really brings together people and organizations from across all spectrums who understand the impact art can have on both individuals and communities,” Chambers said. “The broad membership base comes together with one purpose. It’s a very unique interest group and helps us serve patients and communities in a different way.”

Areas of focus for the Global Alliance’s Arts and Health Program include patient care, healing environments, caring for caregivers, community well being and education. In Nashville, programs like Musicians on Call and the children’s theatre and healing garden at Monroe Carell Jr. Children’s Hospital are examples of successful mergers of arts and healthcare.

“We’re treating the whole person when introducing arts in healthcare,” Glassford said. “It’s an invaluable tool that treats the spirit, as well as the body. This organization helps people find those opportunities, or we connect them with people who can.”

Other officers installed from around the country include Helen Currier, director of nursing at Texas Children’s Hospital, as vice president; Pauline Daniels, creative arts programming manager of Goodwin House Alexandria, as treasurer; and Johanna Rian, coordinator, Center for Humanities in Medicine at Mayo Clinic, as secretary. nashvillemedicalnews

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Vanderbilt University a Leading Site for Blood-based Autism Clinical Study

By MELANIE KILGORE-HILL

Vanderbilt University is among a handful of world-class institutions participating in a clinical study to help identify children with autism through genetic testing. The study is the largest prospective, multi-site autism clinical study to date.

Earlier Diagnosis

In April, Massachusetts-based SynapDx Corp., an early-stage lab services company, launched a 660-child, 20-site study to focus on the evaluation of its proprietary blood-based test. The goal, according to researchers, is to diagnose children around 18 months when symptoms first appear and behavioral therapy can be optimized. Currently, most children are diagnosed between the ages of four and five.

“Our best evidence for improvement in core symptoms of autism is for intensive behavioral intervention during the preschool years,” said Jeremy Veenstra-VanderWeele, MD, Vanderbilt’s site investigator. “We have little evidence for Dr. Jeremy treatments that occur past Veenstrafirst or second grade.”

VanderWeele

Identifying Autism

Veenstra-VanderWeele, medical director of the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Kennedy Center, said parents often are unsure what is considered a normal part of development and what represents a sign of autism.

Often the first symptoms are a lack of social engagement and lack of non-verbal communication, like pointing, he noted.

Usually, children also exhibit repetitive behaviors or repetitive play, like lining objects up in a certain pattern instead of playing with toys actively.

“I think that many families, and in fact, many clinicians, may be concerned about delays or differences in development but are not sure when to be worried enough to seek an expert evaluation,” VeenstraVanderWeele said. SynapDx would be the first genetic test to indicate an autism diagnosis. Currently the spectrum disorder is determined by a costly and time-consuming process based on course of development, behavioral symptoms and direct observation.

Science Behind SynapDx

According to a SynapDx press release, the lab test measures the amount of RNA copied from many different genes.

Those amounts of RNA are influenced by a person’s genes and environment. For each gene, the amount of RNA copied determines how much protein is made. The RNA and resulting proteins dictate many functions in the body including how the nashvillemedicalnews

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brain develops, affecting speech, behavioral and social skill development.

Theresa Tribble, vice president of Commercial Strategy for SynapDx, said enrollment for the trial is still underway. Researchers are looking for children ages 18 months to 60 months suspected of autism or another type of developmental delay but without a diagnosis.

Theresa “SynapDx received Tribble funding May 2010 after a number of prominent researchers at Boston Children’s Hospital began looking at gene expression as a differentiator between children with autism and those with other kinds of delays,” Tribble said. “Our scientific collaborators are very focused on figuring out a way for earlier identification in the pediatrician’s office so they can get clinical diagnoses sooner.”

The test would accelerate a referral in cases of atypical development but is not expected to become a standard test for every child.

“The important thing is that this study is designed to clearly answer the question of whether this will be a useful test for screening children prior to referral for autism evaluation,” Veenstra-VanderWeele said.

“This test will never be used diagnostically but could potentially be useful to pediatricians who are trying to figure out whether a child needs to be referred for an expert assessment for autism.”

More Cases or More Awareness?

According to the U.S. Centers for Disease Control and Prevention, around 1 in 88 American children are on the autism spectrum — a tenfold increase in prevalence in 40 years. Studies also show that autism is four to five times more common among boys than girls.

“It isn’t clear that there is a true increase in autism, as we currently think about it,” Veenstra-VanderWeele said. “It is very clear that more children are diagnosed today than would have been diagnosed 20 years ago. A well done study in the United Kingdom found an autism rate of about 1 percent in adults using our current criteria, which is very similar to the rate that we see in children. Almost none of those adults had been diagnosed with autism prior to the study. This suggests that the true rate of autism has not changed dramatically, but we don’t know as much about the true rate of autism as we would like.”

Additional study locations include Boston Children’s Hospital, Children’s Hospital of Philadelphia, Mount Sinai Medical Center, Nationwide Children’s Hospital and the UC Davis MIND Institute. For more information on Vanderbilt’s clinical study, call (615) 936-3288.

GrandRounds Wishes Granted Faith Family Medical Center was awarded a $220,000 grant by the BlueCross BlueShield of Tennessee Health Foundation to further wellness services and education for the working uninsured and their families in Middle Tennessee. Funding will benefit Faith Family’s Journey to Health program, which provides affordable access to wellness activities designed to reduce health risk factors.

Saint Thomas Health recently received two grants totaling $137,000 to help women access mammography services from the Greater Nashville Affiliate of Susan G. Komen®.

A third-year grant of $102,500 was awarded to provide mammography services for underserved populations in 11 Middle Tennessee counties through the Our Mission in Motion mobile mammography coach. In addition, a little over $34,500 was awarded for the Multi-Ethnic Breast Health Outreach project to bring breast health education and lowcost screenings to at-risk populations in medically underserved communities in Davidson and Rutherford Counties. This initiative brings culturally sensitive and language-specific breast health materials to African American, Hispanic and Kurdish women in their own communities.

Centerstone recently received a $2,000 grant from the Nashville Predators Foundation for its Intensive In-Home Treatment Program serving children who exhibit a mental or emotional disturbance, often as a result of traumatic experiences. The funds will be used to train staff in Eye Movement Desensitization and Reprocessing (EMDR), recognized by the American Psychiatric Association as a highly effective, first-line treatment Presenting and receiving the check at the grant distribution ceremony technique for children whose lives have in Bridgestone Arena’s Nissan Atrium are (L to R) Centerstone Director been seriously impacted by trauma. of Intensive In-Home Treatment Kathy Ballinger, Nashville Predators starting goaltender Pekka Rinne, Centerstone Referral and Outreach Coordinator for Intensive In-Home Treatment Elliot Pinsly, and Nashville Predators team mascot Gnash.

Spanish for

Health Care Professionals Wednesdays 7–9 p.m.

September– November 2013 A custom-designed program—for intermediate to advanced Spanish speakers—that offers a solid foundation in Spanish conversation, comprehension, and culturally appropriate communication in medical situations.

Topics will include anatomy, common and chronic illnesses and health risks in the Latino patient population, protocol for obtaining a medical history, prevention, diagnosis, treatment, follow-up, and patient cultural belief systems related to illness and health.

For complete details, call 343-3140 or visit vanderbilt.edu/healthcarespanish

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GrandRounds McGee Named CNO for Saint Thomas Hospital Saint Thomas Hospital recently named Kathy McGee, RN as chief nursing officer for the hospital.

The 28-year Saint Thomas Hospital veteran had been serving as interim CNO since October 2012.

Since joining the hospital as a staff nurse in 1985, Kathy McGee McGee has held many positions within the hospital including inpatient and outpatient oncology patient care manager, director of medical surgical areas and director of the Outpatient Infusion Center. In 2008, she became director of Nursing for Critical Care and in 2011 accepted the role of executive director of Cardiac Services. McGee earned her undergraduate nursing degree from the University of Tennessee – Knoxville and her master’s from Vanderbilt University.

Interventional Cardiologist Joins TriStar Summit Interventional Cardiologist Taral Patel, MD, recently joined the medical staff at TriStar Summit Medical Center. Patel received his medical degree from Mount Sinai School of Medicine in New York City and completed his residency in internal medicine at Duke Dr. Taral Patel University Medical Center in Durham, NC. He completed his cardiology fellowship at Cleveland Clinic Foundation and his interventional cardiology fellowship at St. Luke’s Hospital/Mid-America Heart Institute in Kansas City, Mo. He is board certified in the specialties of Internal Medicine, Cardiovascular Disease and Interventional Cardiology.

Let’s Give Them Something to Talk About!

Awards, Honors, Recognitions

The Monroe Carell Jr. Children’s Hospital at Vanderbilt has again been named among the top pediatric hospitals in U.S. News & World Report magazine’s annual “Best Children’s Hospitals” rankings released last month. Children’s Hospital achieved national rankings for 9 out of 10 of its pediatric specialty programs. Urology moved up four spots to rank 4th this year. Pulmonology moved up one spot to 19th. Gastroenterology & GI Surgery also moved up this year, improving from 33rd to 32nd. Other specialties ranked this year include: Cancer (36), Cardiology and Heart Surgery (23), Neonatology (16), Neurology and Neurosurgery (43), and Orthopaedics (34).

Gregory R. Weaver, MD, has been inducted as a Fellow in the American College of Radiology (ACR). The induction took place at a formal convocation ceremony during the recent ACR Annual Meeting and Chapter Leadership conference in Washington, DC. Weaver is a diagnostic radiologist at Radiology Alliance and Centennial Medical Center.

Former U.S. Senate Majority Leader Bill Frist, MD, has joined the board of Brentwood-based MDSave, a web-based company that allows patients to research, compare and purchase services directly from physicians at a discounted rate.

Allen Anderson, MD, of Tennessee Orthopaedic Alliance has been elected by his peers to the 2013 ISAKOS (International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine) Board of Directors.

The appointment was made during the recent ISAKOS Congress held in Toronto, Canada.

Healthways has received the 2013 Best Employers for Healthy LifeDr. Allen styles® Platinum Award for its Be Well employee engagement program Anderson at the Leadership Summit sponsored by the National Business Group on Health’s Institute on Innovation in Workforce Well-Being. The local company was honored for its ongoing commitment and dedication to promoting a healthy workplace and encouraging workers and their families to pursue and maintain healthy lifestyles.

First Call Ambulance Expands, Relocates Nashville HQ First Call Ambulance Service, a Nashvillebased provider of clinical patient transport, recently relocated and expanded its corporate headquarters to 1930 Air Lane Drive.

The renovated facility features approximately 62,000 square feet of space the company will use for office operations and indoor vehicle storage and maintenance. First call started in Nashville with two ambulances and a handful of employees and is now among the largest private ambulance companies the U.S., operating nearly 250 vehicles in 17 locations across Tennessee, Ohio, and Mississippi. The company expects to service more than 250,000 patient transports this year.

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TriStar Centennial Offering New Treatment for Tendinopathies TriStar Centennial Medical Center recently began providing a new outpatient occupational therapy treatment for tendinopathies and post-operational or -injury scar tissue.

Andy Detwiler, OTR, CEAS, an occupational therapist with rehabilitation services at TriStar Centennial recently achieved Astym® certification. One of only a few therapists in the Nashville area providing this treatment, he joins a nationwide network of rehabilitation professionals quailed to perform this treatment.

Astym treatment is an evidenced-based rehabilitation program that has proven effective in treating conditions including tennis elbow, golfer’s elbow, carpal tunnel syndrome, plantar fasciitis, chronic ankle sprains, shin splints, and scar tissue that can interfere with recovery after surgery.

Cox Named On-Site Physician at Life Care – Old Hickory Village Mitch Cox, MD, has been named the on-site physician at Life Care Center of Old Hickory Village. Cox was hired as part of Life Care’s initiative to place physicians in each of its 26 buildings in Tennessee. In his new position, Cox will work with the facility’s interdisciplinary team, facility medical director and other attending physicians in caring for each patient. His presence in the nursing home will enhance physician accessibility to patients and families, and he will aid in hospital transitions and pharmacy communications.

Cox most recently served as a hospitalist and nocturnist at SkyRidge Medical Center in Cleveland, Tenn. Board certified in internal medicine, Cox earned his medical degree from the American University of the Caribbean School of Medicine in St. Maarten and completed his residency at Memorial Medical Center in Savannah, Ga.

CAQH Selects Passport to Develop National COB Registry Franklin-based Passport has been selected by CAQH to develop a national coordination of benefits (COB) solution that will improve the sharing of patient coverage data between healthcare providers and payers. Providers and participating payers will be able to access the CAQH COB information to identify primary and secondary insurance coverage and better coordinate patient benefits for episodes of care.

Twelve major insurers – covering more than 165 million lives – are already working together in this industry collaboration and CAQH plans to expand participation in the coming months. The technology Passport is building for the COB solution will enable providers to reduce paperwork, streamline claims processes, and increase payment accuracy.

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GrandRounds Recent Certifications, Accreditations & Commendations The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) has granted its Outstanding Achievement Award to the Sarah Cannon Cancer Centers located on the campuses of TriStar Skyline Medical Center and TriStar Centennial Medical as a result of surveys performed during 2012.

The EHR from Franklin-Tenn.-based Healthcare Management Systems (HMS) has been tested and certified as a Complete Inpatient EHR under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Certification Body (ONC-ACB) program. The EHR includes HMS’ physician documentation application, patient portal and business intelligence solutions. As one of the first EHRs to receive the 2014 Edition Complete Inpatient EHR certification, the EHR from HMS helps put providers on the path to attestation for the 2014 Edition of Meaningful Use and helps them comply with the federal government’s healthcare IT guidelines.

TriStar Skyline Medical Center was recently named the state’s first Comprehensive Stroke Center. TriStar Skyline, part of the TriStar Stroke Network, is the first hospital in the state to be recognized by The Joint Commission and the American Heart Association/American Stroke Association as meeting The Joint Commission’s standards for Comprehensive Stroke Center Certification.

BlueCross BlueShield of Tennessee has named TriStar StoneCrest Medical Center and TriStar Skyline Medical Center as a Blue Distinction Center in Spine Surgery.

HCA MRSA Study Shows Effective Means to Lower Bloodstream Infections A comprehensive infection prevention study conducted exclusively at 43 HCA-affiliated hospitals found “universal decolonization” of ICU patients reduces bloodstream infections by 44 percent.

Published in the New England Journal of Medicine, the Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA, was conducted in conjunction with investigators at Harvard and several other academic institutions, and research programs at two U.S. Department of Health and Human Services agencies — the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC). The use of antimicrobial agents on an entire patient population is referred to as universal decolonization.

The study found that using antimicrobial soap and ointment to decolonize all intensive care unit patients reduced all bloodstream infections, including MRSA, by 44 percent. The study, which involved nearly 75,000 patients in 74 adult ICUs across 16 states, compared three approaches to reduce bloodstream infections — screen

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all patients and isolate MRSA carriers, targeted decolonization after screening, and universal decolonization with no screening.

“The REDUCE MRSA study proved that universal decolonization is the best practice to prevent infection from MRSA and other dangerous bacteria in high risk ICU patients,” said Jonathan B. Perlin, MD, president, Clinical and Physician Services Group and CMO of HCA. “These compelling results convinced us to implement this protocol in HCA hospital adult ICUs. Universal decolonization should be a new part of a comprehensive infection prevention effort that begins with hand hygiene and includes a number of proven practices.”

Aegis Sciences Corp. Adds to Leadership Team Aegis Sciences Corporation, a forensic toxicology and healthcare sciences laboratory, recently announced the addition of three new senior leaders to its team.

Sheila Dawling, PhD, has joined the company as vice president of laboratory operations. Previously the associate director of clinical chemistry at Vanderbilt University Medical Center, Dawling has been involved in the maintenance and monitoring of quality Dr. Sheila Dawling standards and indicators, instrument maintenance and the writing of standard operating procedures for the past 13 years. In her new role, she will oversee and direct all of Aegis’ laboratory operations and workflow. A London native, Dawling received her undergraduate degree in biochemistry from University of Surrey in Guildford and her doctorate in pharmacology from University of London.

Rebecca Heltsley, PhD, a six year Aegis veteran, has been promoted to vice president of research and development. Previously a senior scientist and assistant vice president for R&D operations, she will manage all aspects of R&D in Dr. Rebecca her new role including the Heltsley development, implementation and assessment of new technologies.

Heltsley received her master’s in chemistry from Western Kentucky University and her doctorate in environmental toxicology from North Carolina State University.

David Hill joins the company as vice president of managed care and will lead all national managed care operations for Aegis. Hill’s 15 years of experience includes serving as director of managed care for Simplex Healthcare and as area vice president of CADavid Hill RECENTRIX in Connecticut and e+CancerCare in Nashville. He received his undergraduate degree from Samford University and his MBA from Belmont.

Centerstone Teams with Unity Physician Partners Centerstone Health Partners, a subsidiary of Nashville-based nonprofit mental health services provider Centerstone, recently announced a partnership with primary care provider Unity Physician Partners. The joint venture will allow physicians to care for medically underserved patients with physical and behavioral healthcare needs by establishing integrated care clinics.

Franklin-based Unity’s executive team is led by veteran Nashville healthcare execs, including Mike Bailey, chairman and CEO, the former head of Windsor Health Group. Co-founders James Geraughty and Jeff Bogle previously held executive positions with HealthSpring and Surgis, respectively.

The partnership will begin by establishing Unity primary care physician offices in six existing Centerstone locations — four in Tennessee and two in Indiana. The clinics will open in the third quarter of this year. Moving forward, Centerstone and Unity expect to open five or six integrated care locations every six months. Clinics will be located at existing Centerstone offices in Tennessee and Indiana, as well as new sites in both states. The joint venture also will seek to partner with providers in other states to expand into communities across the country.

Payment America Names New CEO, Reports Performance Metrics Nashville-based Payment America Systems, Inc. — a provider of healthcare revenue cycle services focused on patient payments, collections, and revenue data — has named Phil Christianson president and CEO. Christianson brings Phil Christianson more than 25 years of experience growing Fortune 500 and mid-sized healthcare businesses. Previously, he served as CEO of disease management company Focused Health Solutions and of RealMed, the top developer of SaaS revenue cycle management solutions for physicians. He also ran Corporate Benefit Services of America and divisions of The Walt Disney Company and United health Group. He received his undergraduate degree from Cal Poly-San Luis Obispo, a law degree from Loyola Law School, and an MBA from the University of Southern California.

Payment America, a portfolio company of Council Capital that already serves more than 1,000 facilities nationwide, developed a data warehouse around how certain patients interact and pay for services based on factors such as patient type, financial scoring, employer groups and health plans. By utilizing the data warehouse, the company has seen a 49% increase in payments in 2013 from 2012 and is now using business intelligence insights to increase revenue before it ever reaches the collections stage.

Wood Joins Saint Thomas Health in Top Human Resources Post Saint Thomas Health officials recently announced that Marvin ‘Bud’ Wood has assumed the role of chief human resources officer for the nine-hospital network.

As former senior director of Human Resources for Bud Wood Franklin-based Community Health Systems, where he provided leadership for 29 hospitals with 22,000 employees, Wood brings 25 years of experience to his new role. Wood received his bachelor’s degree in political science and a master’s in human relations from the University of Oklahoma.

Ryan Search & Consulting Expands Healthcare Division

Franklin-based Ryan Search & Consulting recently expanded its healthcare division and named Marianne Blackwell as market leader for the firm’s healthcare practice.

A 25-year veteran of the human resources and healthcare fields, Blackwell’s focus will be to partner with companies to betMarianne Blackwell ter identify their leadership needs and the right candidates that can fill them. She has served her entire career in recruitment and leadership positions with Vanderbilt University, Rehability Health Services and Vanderbilt University Medical Center. Blackwell received her undergraduate degree from Rhodes College in Memphis and her master’s in human resource development from Vanderbilt University.

Avondale Adds NYC, CignaHealthSpring Moves into Chicago Nashville-based independent investment banking and wealth management firm Avondale Partners announced last month the firm is expanding to New York City and adding two seasoned capital markets executives to oversee the new office.

Dana Lambert has a combined 19 years experience on both the buy and sell sides. He has served as an assistant portfolio manager at Royce & Associates, New York since 2007. He earned his degree in economics from Dana Lambert Brandeis University.

John Cuddeback comes to Avondale from the New York office of BMO Capital Markets where he served as a director in institutional equity sales for 11 John years. Cuddeback earned his Cuddeback degree in international business from Lehigh University.

In a similar move, Cigna-HealthSpring announced it is opening an office in downtown Chicago. The new office, which is expected to open by September, will hire 120 employees as the company expands its Medicare Advantage plans in Illinois.

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