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Middle Tennessee’s Primary Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

David Penson, MD, MPH

ON ROUNDS The High Cost of Failing to Comply with HIPAA The Health Insurance Portability and Accountability Act (HIPAA) has been around since 1996, and the compliance required under HIPAA’s Privacy and Security Rules are not new news.

Nevertheless, some healthcare practices are still slow to adopt the measures required to comply with these rules ... 10

The Trust Factor Nashville firm reveals results of 7th annual payor survey; trust represents greater factor than rates NASHVILLE – In the wake of national health reform, the trust factor between hospitals and health insurance companies is perilously low.

That’s the consensus of 373 hospital and health system administrators responsible for negotiating contracts with major health plans in the seventh annual National Payor Study ... 19

ONLINE: NASHVILLE MEDICAL NEWS.COM

Patient Safety Takes Flight in Tennessee

TCPS, LifeWings Partner to Implement TeamSTEPPS

By CINDy SANDERS

The Tennessee Center for Patient Safety (TCPS) recently announced a collaborative agreement with LifeWings Partners LLC, a West Tennessee company that has adapted the best practices of high reliability organizations to create safer patient environments for hospitals across the nation.

Headquartered in Collierville, Tenn., LifeWings has brought together a team of physicians, nurses, and healthcare risk managers … along with former NASA astronauts, military flight surgeons, officers, pilots, and flight crew … to train healthcare professionals in the communications and teamwork skills used by pilots to ensure safety. TCPS and LifeWings are partnering on a program to enable Tennessee hospitals to adopt the healthcare version of crew resource (CONTINUED ON PAGE 18)

Vanderbilt Set to Overhaul Medical Curriculum In the Running for AMA Grant

By SHARON H. FITZGERALD

Are U.S. medical schools training physicians to treat patients using today’s delivery systems? The answer to that question, most experts agree, is no. That’s one reason the Vanderbilt University School of Medicine is in the throes of a groundbreaking curriculum redevelopment called Curriculum 2.0.

The curriculum overhaul was sketched out during a 2010 retreat, working on the premise

Coming Soon!

that medical students must learn how to do their jobs in settings where they will work, said Bonnie M. Miller, MD, Vanderbilt’s senior associate dean for Health Sciences Education. “Healthcare education needs to be situated in the real workplace so you can learn and practice the skills that you’re going to need to use when you’re on your own in practice,” she said.

The mantra for Curriculum 2.0 is: “All workers learn, and all learners work.”

(CONTINUED ON PAGE 19)

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PhysicianSpotlight

David Penson, MD, MPH

Urologist’s Input Impacts Outcomes on a Local, National Basis

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that’s what we did,” he said. “It’s been everything I thought it was going to be and more.”

Perhaps the ‘more’ part comes from the many hats he wears at Vanderbilt since his dream job is really dream jobs.

With a focus on prostate cancer, he still sees patients and does surgery a couple of days a week, he mentors young faculty surgeons interested in public health and outcomes research, and he is active in the larger policy arena. He also helped create and continues to run the Center for

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David Penson, MD, MPH, has numerous titles and responsibilities at Vanderbilt University Medical Center and in the national arenas of public health and research. Despite his hectic schedule, he loves the variety his work affords and relishes the opportunity to collaborate with young physician-scientists to address issues impacting patient outcomes. The job he enjoys the most, however, is that of unpaid taxi driver … which comes with the territory when you are the father of three.

“At home I’m just dad, which is the best title,” he said with a laugh.

Growing up in New York, Penson earned his undergraduate degree from the University of Pennsylvania, where he met his wife Jennifer. After graduating from Boston University School of Medicine, he headed west to the University of California, Los Angeles for internship and residencies at the UCLA Center for Health Sciences.

Penson’s enthusiasm for his field is evident. Part of what attracted him to urology was the combination of being able to perform surgery while retaining elements of internal medicine. He was also drawn to the field’s emphasis not just on a patient’s quantity of life but also the quality of life. “For the most part, we do a lot more good than we do bad,” he said with a smile.

During residency, Penson was influenced to pursue his master’s in part because of Mark Litwin, MD, MPH, who is now chair of Urology at UCLA. “He was doing a lot of work in public health, and specifically in outcomes research/health services research, and it struck me that it was a really impactful way to make a difference beyond just being in the operating room,” Penson recalled.

Accepted into the Robert Wood Johnson Foundation Clinical Scholars

Program, Penson returned east to do his training and complete a master’s in public health at Yale University. Another crosscountry trek saw the young family settled near family members on the West Coast where they thought they would remain … until Vanderbilt offered Penson “the best job in the whole world” in Nashville in 2009.

“If you told me, ‘Dave, write yourself your perfect job description,’ then this is it.

When someone shows you a job like that, you pack up the house and move … and

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Hamilton and Howd Chair in Urologic Oncology, Vanderbilt-Ingram Cancer Center Professor of Urologic Surgery, Vanderbilt University Director, Center for Surgical Quality and Outcomes Research, Vanderbilt Institute for Medicine & Public Health, VUMC Chair, Tennessee Men’s Health Report Card Advisory Panel Chair, Health Policy Council, American Urological Association Member, National Advisory Council, U.S. Agency for Healthcare Research & Quality (AHRQ) Staff Physician, VA Tennessee Health Care System Researcher, Urologist, Mentor Taxi Driver

Surgical Quality and Outcomes Research within the Vanderbilt Institute for Medicine & Public Health.

“When I was brought here, I saw a world-class institution that was looking to grow in the area of surgical outcomes research,” he said. “All the resources were here, they just needed to be aligned in the right way.” Penson added, “It’s grown pretty quickly because we brought in good people, there were good people already here, and it’s a supportive environment.”

In fact, it’s the support system, commitment to the community and unique collegial atmosphere that Penson believes sets Vanderbilt apart from many other major academic institutions. “This is unlike any other place I’ve ever been,” he said. “People want to work together. The silos just don’t exist at this place.”

It will take that type of approach to move forward with new care delivery models. “If you’re not prepared to practice real team medicine, you’re not going to succeed in the new world order that is the Accountable Care Act,” he stated.

“The whole idea is to take care of people before they are patients,” Penson continued. “Vandy is in a really good position for that because we have that sort of team mentality already.”

In addition to his work in Nashville, which includes spearheading the Tennes-

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HealthcareEnterprise

CareAll Provides In-Home Care for Many as Need for Home Healthcare Grows

By KELLY PRICE

The ancient poet Pliny the Elder coined the phrase “Home is where the heart is.”

Increasingly, as the delivery of medicine changes, it’s become clear that home is also where the healthcare is.

Increased Demand, Home Health Solution

By 2020, it is estimated that the more than 50 million Americans who are 65 or older will represent 17 percent of the entire population ... a statistic that continues to grow.

Predictions are that as those numbers increase, they will be exacerbated by a decreasing number of physicians and nurses, and a hospital system whose resources will fall short of the demand led by a tsunami of aging baby boomers.

To manage increasing demand and limited inpatient resources, the scientists and futurists at The Rand Corporation, a nonprofit institution that helps improve policy and decision-making through research and analysis, have said, “Advances in home healthcare products and services

are attractive, promising, and perhaps even necessary, solutions to mitigate the current pressure on the healthcare system while improving the patients’ well-being beyond the physiological parameters of disease control.”

The Rand study showed home health

technology isn’t limited to self-monitoring devices, such as glucose meters. “Home healthcare and self management devices and services span a broad spectrum. Depending on the interpretation of the terminology, they can include everything from mobility support tools to basic diagnostic and therapeutic tools to telemedicine solutions and care delivered by home healthcare professions,” the study stated.

CareAll

Nashville-based CareAll, whose motto is “Where being home is feeling better,’ has stepped up to the challenge of providing onsite healthcare by offering service in three primary areas: home health, private duty nursing and personal services.

CareAll employs a wide range of trained and credentialed staff with prior hands-on experience in a variety of healthcare settings. Whether the case requires the skilled services of a nurse, either RN or LPN, the evaluation and treatment of a therapist, personal care services, or housekeeping skills from a caregiver or aid, CareAll works to meet patient needs in the home.

To ensure confidence in clients, all employees working through CareAll have been thoroughly screened before being employed. Through mandatory background checks and random drug screenings, CareAll ensures that the safety and care of patients remains at the highest levels.

J.W. Carell, chairman and founder of CareAll Home, has been in the home healthcare arena since 1985. Through those years he has seen significant changes in patient health and everyday living.

“When it comes to healthcare, people want to feel comfortable. Home is the place where they really want to be,” he said in a recent television interview.

You might recognize the CareAll 4

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name from their television advertisements featuring cheerful octogenarian twins, Pinky and Bluey, who are satisfied CareAll clients and proud to tell it. Pinky calls Bluey the “little energizer Bunny” … or is it the other way around?

“At CareAll, we’ve been serving patients for more than 20 years — and you can be sure that we’ll always be here, offering patients the ability to heal in the comfort of their own home,” Carell continued.

The company has obviously met a need. Since opening, they have doubled their revenue every two years and currently have 1,000 employees working from their 29 locations across the state.

“We are always recruiting and training future employees,” Carell said, “I expect that we will have 2,000 employees in the next three years.”

He pointed out, “Through the years, I have seen significant changes in our patient health needs every day. We have learned how to deal with the needs of each one — from ‘crack babies’ who need care 24-hours-a-day to elderly patients recovering from a fall or surgery — and everyone in between.”

He continued, “What we are looking for in our employee family are caring people who bond with their patients and their patients’ families and almost become part of the family.”

Carell added, “We have been willing to provide education and train our employees because we realize that the market is not going to give us enough staff who meet our standards, and to meet those standards, we will need to train employees ourselves.”

The company offers online training programs and in some cases pays for LPN/RN graduates to get their master’s degrees in their field.

The CareAll program provides nurses, who coordinate all services ordered by a patient’s physician and communicate regularly with the physician. They are expected to keep informed with current technologies, procedures and skills. Often these skills include competency in complete physical assessments, disease management and education, lab work, enteral feedings care and instructions, IV therapy, catheters, injections, wound care, diabetic care and instructions, pain management, diet instructions, ostomy care, and comprehensive medication management and education.

CareAll also offers a range of assistance programs from free tax preparation advice to fall prevention interventions.

With more than 1,000 home visits each day, CareAll provides a viable solution to meet the needs of their clients, all while allowing those patients to stay home where their heart is.

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Understanding Alzheimer’s rare, early onset Alzheimer’s is believed to be genetic in nature.

But unlike heredity, which is beyond our control, diet and lifestyle are choices that can play a significant role in determining risk factors.

“The biggest change we’re promoting is activity as you age, even if it’s just walking for a few minutes every day,” Buechel said. “We’re also seeing connections between Alzheimer’s and higher caloric intake, smoking and vascular disease.”

By MELANIE KILGORE-HILL

Forgetting a name, losing the keys or not finding the right words are agerelated challenges faced by most. But for the 5.2 million Americans with Alzheimer’s, memory loss that disrupts daily life is a constant and frightening occurrence. By 2025, that statistic is expected to jump some 40 percent … and triple by the year 2050 … begging researchers to take a harder look at finding answers.

What is Alzheimer’s?

Alzheimer’s is a form of dementia that occurs when segments of the brain’s 100 billion neurons become damaged and fail to form communication networks.

For reasons still unknown, damaged cells spread and eventually become destroyed, causing irreversible brain damage.

While no cure is on the horizon, science is bringing researchers one step closer to understanding the disease. Franklin neurologist Paul Buechel, MD, said Alzheimer’s is no longer brushed off as a

“normal” part of aging as in years past.

“Thanks to increased awareness and understanding of Alzheimer’s, today’s physicians are identifying symptoms and treating patients earlier on,” Buechel said.

Who’s at Risk?

Age continues to be the greatest risk factor for Alzheimer’s disease. It affects 10 percent of adults over 65, 30 percent over 80 and some 50 percent of adults 90 and older. Only four percent of cases are diagnosed in individuals under 65. Although

Heart Health & Alzheimer’s

That’s because smoking, like artery disease, limits the body’s ability to send blood and oxygen to the brain. In fact, Buechel suggests if patients have vascular disease in the heart, they likely have it in the brain. In another mind-heart connection, patients who undergo cardiac bypass surgery often experience short-term memory loss and could be increasing their risk for dementia, as well. NIH research over the past two decades has produced significant data suggesting, “neuropsychological deficits after routine cardiopulmonary by-

pass are related to the number of microemboli delivered during surgery.”

Healthy Lifestyle, Healthy Brain

In May, European researchers reported a link between obesity and Alzheimer’s, noting the importance of regular exercise and healthy weight for reducing risk. And according to a recent Swedish study, those who were clinically overweight — a BMI between 25 and 30 — were 71 percent more likely to develop dementia.

Catherine Stallworth, MD, medical director of LifeTherapies Inpatient Rehabilitation Unit Catherine at Baptist Hospital, Dr. Stallworth said diet and exercise are imperative but often dismissed in today’s quick-fix era of healthcare.

“Nutrition, exercise and spirituality are all really important but neglected in our culture, driving up healthcare expenses,” Stallworth said. “We know for a fact that seniors who are active are in and out of the hospital quicker, experience less co-morbidities and just tend to do a lot better than those who are sedentary.”

NIH guidelines recommend seniors exercise at least 150 minutes each week (CONTINUED ON PAGE 8)

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Nashville Universities Redefining Senior Care

By MELANIE KILGORE-HILL

Today, 10,000 Americans will turn 65 … just as they will tomorrow, and every day for the next 17 years. So what’s being done to ensure care of America’s record-setting senior population?

Lipscomb School of TransformAging In 2011, the School of TransformAging at Lipscomb University opened to provide academic classes for students and individuals seeking career development and to serve the industry and community through outreach and research. The school is designed to address issues facing seniors and those who serve them by finding lasting and meaningful solutions to the nation’s aging crisis.

Their innovative aging simulation, for example, allows professionals and caregivers the chance to experience firsthand daily challenges faced by the elderly.

In August, the school will add two new graduate certificates, Pastoral Care and Aging and Serving the Aging Consumer, to complement their existing Aging Services Leadership graduate program.

“The questions facing people who are older is who will care for them, and what is the quality of those caregivers?” said Beverly S. Patnaik, director of academics for the School for TransformAging.

“The state doesn’t have consistent requirements of what skills are needed for paid caregivers, much less family members. It’s imperative that we look at those needs, and we at Lipscomb are qualified and willing to help address issues that result from inconsistency in training.”

According to Patnaik, today’s aging boomer Beverly S. Patnaik population is savvier and more demanding than generations past.

That change in mindset will impact how society addresses senior services including healthcare, how the faith community will minister to adults, educational opportunities, and how retailers will respond to the growing senior market.

“With this demographic coming up, everything we think we know about senior services will be completely different,” Patnaik said.

Vanderbilt-Reynolds Geriatrics Education Center Another champion in the fight for senior care is the Vanderbilt-Reynolds Geriatrics Education Center. The team works to design, implement, evaluate and improve geriatric education by integrating geriatrics into curriculum and by working closely with residency programs,

faculty and regional training programs.

“In order to have a geriatric workforce for the future, we have to look at how we’re preparing our medical workforce today,” said James Powers, MD, principal investigator and center director. “That includes addressing clinical programs and outpatient clinics where we provide assessment and chronic disease management, inpatient geriatric units for hospitalized patients and geriatric consults and palliative care.”

New quality measures enacted by the Affordable Care Act mean it’s more

Brain Boosters

By MELANIE KILGORE-HILL

The Next Generation of Gamers

A recent University of Iowa study found seniors could prevent natural aging of the mind by playing … video games. According to researchers, “Elderly people who played just 10 hours of a game priming their mental processing speed and skills delayed declines by as many as seven years in a range of cognitive skills.”

“We know that we can stop this decline and actually restore cognitive processing speed to people,” said Fredric Wolinsky, professor in the UI College of Public Health and lead author on the paper published May 1 in the journal PLOS One. “So, if we know that, shouldn’t we be helping people? It’s fairly easy, and older folks can go get the training game and play it.”

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important than ever for providers to improve quality while reducing costs.

Patient centered medical homes and disease management programs are examples of newer models designed to minimize hospital readmission rates.

“The main goal in treating elderly patients is to manage their expectations,” Powers said. “That means choosing tests and programs that aren’t wasteful or inappropriate for older patients, and learning what patients want and what is safe for them.”

Cheers to Your Health … and Mind

Another study by the University of Reading in the U.K. has shown that the phenolic compounds found in champagne can improve spatial memory. The compounds, which are more concentrated in champagne than in white wine, alter proteins linked to the brain’s ability to store memories — the same proteins that seem to deteriorate with age.

Non-drinkers can get some of the same results by eating other polyphenol-rich foods, such as blueberries and cocoa.

Fatty Acids Linked to Stronger Memory Abilities An April report from the American Academy of Neurology found that foods rich in omega-3 fatty acids found in fish, chicken and salad dressing might be linked to preserving memory and thinking abilities. However, the same association was not found in people with diabetes. The research was published in the April 30 print issue of Neurology®, the medical journal of the American Academy of Neurology.

“Since there are no definitive treatments for most dementing illnesses, modifiable activities, such as diet, that may delay the onset of symptoms of dementia are very important,” said Georgios Tsivgoulis, MD, with the University of Alabama at Birmingham and the University of Athens, Greece.

Data came from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of the general population. For the study, dietary information from 17,478 African-American and Caucasian people with an average age of 64 was reviewed to see how closely they adhered to a Mediterranean diet. They were also given tests that measured memory and thinking abilities over an average of four years. A total of 17 percent of the participants had diabetes. Seven percent of the participants developed impairments in their thinking and memory skills during the study.

The study found that in healthy people, those who more closely followed the Mediterranean diet were 19 percent less likely to develop problems with their thinking and memory skills. There was not a significant difference in declines between African-Americans and Caucasians. However, the Mediterranean diet was not associated with a lower risk of thinking and memory problems in people with diabetes.

“Diet is an important modifiable activity that could help in preserving cognitive functioning in late life,” said Tsivgoulis. “However, it is only one of several important lifestyle activities that might play a role in late-life mental functioning. Exercise, avoiding obesity, not smoking cigarettes and taking medications for conditions like diabetes and hypertension are also important.”

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Vanderbilt Forms Strategic Affiliation with MSHA, Expands WTH Agreement Last month, the leadership of Vanderbilt University Medical Center (VUMC) and Mountain States Health Alliance (MSHA) announced an affiliation agreement. With 13 hospitals and numerous outpatient care sites, MSHA covers 29 counties in Tennessee, Virginia, Kentucky and North Carolina with a predominant service area in northeast Tennessee and southwest Virginia.

The announcement represented the culmination of a three-year search process

by MSHA leadership. “As part of our 10year strategic plan, we have been diligently seeking a partner outside of our region who shares our vision for the future as well as our culture of quality and cost effectiveness,” Dennis Vonderfecht, MSHA president and CEO. Vanderbilt will help with the recruitment of hard-to-find specialists and subspecialists to serve in MSHA’s coverage area and will also assist with implementing evidence-based care models to enhance patient care and manage chronic conditions including asthma, diabetes and heart disease. Additionally, MSHA patients will benefit from Vanderbilt’s robust research engine by having access to a number of VUMC clinical trials in their home region.

C. Wright Pinson, MD, MBA, deputy vice chancellor of Health Affairs for Vanderbilt University and CEO of the Vanderbilt Health System, was quick to point out the affiliation is mutually beneficial as Vanderbilt seeks to improve and extend services Dr. C. Wright Pinson while reducing costs as part of healthcare reform. He added that MSHA is a leader in healthcare delivery in their coverage region.

“Our affiliation with Mountain States Health Alliance creates greater opportunity for both institutions to fulfill important objectives for those we serve, forming the framework for Vanderbilt to collaborate with like-minded colleagues to bring patients greater access to a diverse array of clinical and research initiatives,” Pinson said. “As nonprofit organizations, we share a common mission to provide the highest quality care for broad and diverse patient populations.”

Although anticipated to grow over time, the two organizations set forth the following parameters for collaboration at the outset: • Share best practices in the areas of evidence-based care models; • Collaborate in the areas of medical research and clinical trials; nashvillemedicalnews

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• Develop consultative relationships among specialists and subspecialists; • Work together in the area of physician recruitment to facilitate access, especially to specialty services; • Collaborate clinically, with particular emphasis on cardiovascular and oncology services; and • Work together to develop a statewide clinically-integrated network to contract with payers for high-quality, efficientlyprovided healthcare services.

Also announced at the end of May, VUMC has expanded its relationship with West Tennessee Healthcare (WTH).

The academic affiliation agreement further establishes a collaborative relationship between the two institutions. The new agreement creates a framework for the future development of cooperative programs between Vanderbilt-Ingram Cancer Center (VICC) and WTH’s new Kirkland Cancer Center in Jackson, which is scheduled to open in the fall of 2013.

Although specific goals are still being hammered out, the affiliation agreement was anticipated to include educational program support, opportunities to enhance the delivery of oncology support programs for physicians and patients, consultative services, and joint clinical research trials.

Under this agreement, all parties will remain independent, but they will be able to pursue joint projects and design new initiatives that are more efficient for the delivery of cancer care.

“This new affiliation with West Tennessee Healthcare is an extension of our mission to provide outstanding and compassionate care to cancer patients in the region by enhancing access to clinical care,” said Jennifer Pietenpol, PhD, director of VICC. “We are committed to scientific excellence and as a leader in genomic medicine, we are delighted to Jennifer extend our assistance to Dr. Pietenpol more physicians and patients through this collaboration.”

Vanderbilt has signed a number of affiliation agreements over the past few years to grow a network of nonprofit medical centers that geographically covers much of Tennessee. In addition to MSHA and WTH, other affiliate centers include Cookeville Regional Medical Center, Maury Regional Medical Center, NorthCrest Medical Center and Williamson Medical Center. Additionally, an academic affiliation is in place between Baptist Memorial Health Care of Memphis and VICC.

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Understanding Alzheimer’s, continued from page 5 combining strength, balance, flexibility and cardio exercises. Stallworth also encourages a Mediterranean diet, proven to decrease cardiac risks and inflammation.

For years, scientists have speculated about a link between possible brain inflammation and Alzheimer’s.

“We believe patients have a much lower risk of Alzheimer’s if they’ve been taking anti-inflammatory medications for a long period of time,” Buechel said. “It adds to the hypothesis that there might be inflammation going on in the brain, although we don’t yet know the details at a chemical and physiologic level.”

Support for Alzheimer’s Patients

For dementia patients, a support network of family and friends is essential. Programs like Healthways’ Silver Sneakers provide outlets to connect seniors with Dr. James an active group of peers, Powers providing both physical and emotional support.

James Powers, MD, associate clinical director of the Geriatric Research, Educa-

tion and Clinical Center at Vanderbilt and chief of geriatrics at Nashville’s VA Medical Center, said focusing on and building support for caregivers also should be a primary focus for physicians and families.

“More disease and illness in the population increases caregiver stress,” Powers said. “The U.S. spends less than any other developed nation on social support services. If an elderly woman needs help during the night for her husband, she calls 911. There’s not a 24-hour hotline for agitated dementia patients.”

While family practitioners often diagnose and treat patients, neurologists also pro-

THE WHEELS

OF PROGRESS

ARE TURNING AGAIN.

vide extensive, ongoing support for patients and their families.

“These cases usually take a lot of time, including lengthy meetings with everyone involved in the patient’s care,” Buechel said. “There’s a lot to address including home safety, driving concerns and guns in the home. It’s not uncommon to meet with the entire family for an hour or more to address these concerns.”

Treatment Options

While no treatment is available to stop Alzheimer’s, medications can be highly effective in slowing progression of the disease. Cholinesterase inhibitors are currently approved for patients in early to moderate stages of the disease to treat symptoms related to memory, thinking, language, judgment and other thought processes. Drug therapies can significantly improve a patient’s quality of life by delaying progression of Alzheimer’s by as much as 10 years – welcome odds considering most patients aren’t diagnosed until their 70s or 80s. Buechel said it’s easy for physicians to get discouraged by the limited amount of progress they sometimes see in patients on medications. However, he encouraged them to stay the course and be open to trying different prescriptions or a combination of therapies.

“While there’s no cure for Alzheimer’s, there’s an awful lot of agents that can help forestall progression of memory loss,” Buechel said. “Eighty percent of patients have some improvement on medications, which can actually improve

Symptoms of Alzheimer’s • Memory loss that disrupts daily life • Challenges in planning or solving problems • Difficulty completing familiar tasks at home, at work or at leisure • Confusion with time or place • Trouble understanding visual images and spatial relationships • New problems with words in speaking or writing • Misplacing things and losing the ability to retrace steps • Decreased or poor judgment • Withdrawal from work or social activities • Changes in mood and personality

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Source: Alzheimer’s Association

5/17/13 2:04 PM

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Getting the Deal Done

Health Care Council Hosts Annual ‘Financing the Deal’ Panel Last month area executives gathered for the Nashville Health Care Council’s annual “Financing the Deal” panel discussion, bringing together financial experts to provide insight on access to capital, trends in mergers and acquisitions, and the outlook for funding future growth of Nashville’s $70 billion healthcare industry.

Moderated by Wayne Smith, chairman, president & CEO of Community Health Systems, the panel consisted of Ralph Davis, partner with Cressey & Company; Brian McCarthy, vice chairman of Health Care Investment Banking for Bank of America Merrill Lynch; James McLain, senior vice president for Brown Brothers Harriman; and Jonathan Morphett, managing director of Avondale Partners.

Although the industry is undergoing dramatic shifts due to healthcare reform, the panelists said chances for growth exist, particularly in innovative, more efficient business models. “Despite the trials of a new regulatory structure, there is a current wave of ideas and entrepreneurship that is making healthcare a very dynamic place to be investing right now,” Davis said. He added that companies with solid ideas and strong management were ripe dealmaking.

Morphett and Davis pointed out Nash-

Financial experts shared their insights and predictions regarding the healthcare M&A landscape during the Nashville Health Care Council’s annual “Financing the Deal” panel discussion.

ville has a number of engaged, nimble, innovative companies that have both the resources and supportive environment to test new products, service models and strategies. “Because they’re nimble and because they’re young, they can move a lot more quickly than some of the established companies out there,” noted Morphett.

Davis added many of these companies fall in the “sweet spot” where they are small enough to be closely in touch with their customers, community and referral sources but large enough to have seasoned management teams, good IT platforms and the tools to be successful. “Those sorts of disruptive actors are well positioned, in our view, to take advantage of the change that comes from

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McCarthy continued, “When the uncertainty of health reform is behind us, I am convinced we will see an uptick in acquisition activity, and it will include some previously unlikely alliances among different industry sectors.”

Morphett added, “Nashville healthcare companies are well poPHOTO BY DONN JONES sitioned right now for dealmaking, especially the investor-owned hospitals. We reform … and in some cases to even lead see this group particularly interested in acreform.” quisitions that provide them a larger piece The group also predicted an uptick of the healthcare delivery system.” in M&A activity for the remainder of the In light of the Affordable Care Act, year. McCarthy said that although strategic most healthcare companies have made buyers are still getting their arms wrapped increasing quality and decreasing cost a around all the implications of reform, it has major focus of operations. “The industry is become clear to him that scale, along with changing as it reacts to price pressure and product or service line expansion and diverpayment reform. With these shifts, mergers sification, would be the key to success. “Scale and acquisitions are going to be driven by is going to be absolutely critical in the postdeals that create efficiency and high-quality reform world,” he said. “In order to survive outcomes,” said McLain. “The most comlong term, you’re going to have to have real pelling businesses that we see are the ones scale. You’re going to have to be able to that are really focused on solutions for the drive efficiencies. You’re going to have to be patients, physicians and payers … preferably strong enough in your local markets to hold in that order.” your own when it comes to contracting.”

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JUNE 2013

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The High Cost of Failing to Comply with HIPAA

By ANNE ARNEY

The Health Insurance Portability and Accountability Act (HIPAA) has been around since 1996, and the compliance required under HIPAA’s Privacy and Security Rules are not new news. Nevertheless, some healthcare practices are still slow to adopt the measures required to comply with these rules.

Ignoring or failing to take the requirements of HIPAA seriously was always potentially expensive. Originally, civil monetary penalties for HIPAA violations were $100 per violation with a maximum aggregate penalty of $25,000 per year for each violation. With publication of the Omnibus Final Rule implementing provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the cost of a HIPAA violation will be even greater. The final rule, which was adopted in January and becomes effective this September, increases the maximum amount of fines for civil penalties to $1.5 million and adds an assessed penalty based on the level of culpability characterizing the violation. The assessed penalty is a tiered structure in which the amount of the sanction is determined by the nature and circumstances of the HIPAA violation. If multiple HIPAA violations occur, penalties could surpass $1.5 million.

Not only are the penalties high, but enforcement is increased. The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) is the government agency responsible for enforcing the HIPAA Privacy and Security Rules.

As of March, OCR had received 79,920 HIPAA complaints and investigated and resolved more than 19,306 cases. OCR resolves a complaint in one of several ways: by obtaining voluntary compliance, requiring corrective action or issuing a formal finding of violation.

Even before the adoption of the new rule, the results of an enforcement action against physician practice Phoenix Cardiac Surgery, P.C. (“PCS”) made it very clear that failing to comply with HIPAA can, indeed, be very costly. As a result of the investigation, PCS was required to pay a penalty of $100,000 to resolve the disputed claims. It was alleged that PCS had been posting clinical appointments for its patients on a publicly accessible Internet–based calendar. OCR found that PCS had failed to have in place adequate HIPAA policies, procedures or training. PCS had failed to have a clearly designated security officer, as required by the Security Rule, and PCS did not have business associate agreements in place with some of its outside contractors who had access to patient information.

The enforcement action against PCS is just one of many examples of providers who have been subject to penalties as result of OCR’s HIPAA enforcement.

Other examples of enforcement actions in which private practices failed to adequately comply with HIPAA rules are 10

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JUNE 2013

listed on the OCR’s website and include the following types of violations: • Upon requesting a copy of his medical records, a patient was billed a $100.00 “records review fee,” along with an added administrative fee. Although the Privacy Rule permits the imposition of a reasonable, cost-based fee that includes the cost of copies, postage charges and, with patient consent, the cost of preparing an explanation or summary, the practice was required to refund the $100.00 “records review fee.”

• A physician practice requested that, in exchange for the physician’s compliance with the Privacy Rule, patients sign an agreement that prohibited the patient from directly or indirectly publishing or airing commentary about the physician, his expertise and/or treatment. OCR required the covered entity to cease using the patient agreement that conditioned the entity’s compliance with the Privacy Rule and to revise its Notice of Privacy Practices.

• A private practice physician denied a patient access to medical records citing an outstanding balance for physician services. The Privacy Rule requires that a covered entity provide an individual access to their medical records within 30 days of a request, regardless of whether or not the individual has a balance due.

• At the direction of an insurance

company that had requested an independent medical examination of an individual, a private medical practice denied the individual a copy of the medical record.

OCR found that the patient had right to access all of her medical records and required that the practice revise its policies and procedures regarding access requests to reflect the individual's right of access regardless of payment source.

There is no private right of action for a HIPAA violation so a private litigant cannot file a suit based on a HIPAA violation. However, in addition to the enforcement authority of the OCR, the Tennessee Attorney General has the authority to bring civil actions and to obtain damages on behalf of state residents for violations of the HIPAA Privacy and Security Rules or to enjoin further violations of the HIPAA Privacy and Security Rules.

In order to avoid substantial penalties as a result of HIPAA violations, practitioners and their practices are well advised to monitor, assess and update their HIPAA policies and procedures regularly. According to OCR, the potential HIPAA violations that they most commonly investigate in order of frequency are: • Impermissible uses and disclosures of protected health information, • Lack of safeguards of protected health information, • Lack of patient access to their pro-

tected health information, • Uses or disclosures of more than the minimum necessary protected health information, and • Lack of administrative safeguards of electronic protected health information.

Effective HIPAA compliance can be time-consuming and usually begins with a written compliance plan, an audit of your practice to identify potential issues, training employees, and ensuring that written business associate agreements are in place for those relationships that require them.

Keep mind that HIPAA compliance is an ongoing process. To meet the requirements of HIPAA’ s Privacy and Security Rule, a provider must often and periodically monitor the procedures, policies and systems in place to mitigate the risk of a violation.

Despite the time and cost of HIPAA compliance, in the current enforcement atmosphere, it is money well spent.

Anne Arney, a partner with Nashville’s Bone McAllester Norton PLLC, has more than 30 years of experience working with many of Nashville’s healthcare companies and medical professionals. She advises her healthcare clients on business law and transactional issues, as well as assisting them in navigating ever-changing healthcare laws and regulations. In order to help medical professionals stay informed on a variety of legal concerns, Anne publishes a newsletter entitled “Physicians’ Legal Update” and a blog, OnCall. She can be reached at asarney@ bonelaw.com.

2013 Women’s Health Report Card Some Improvement, Much More Needed After years of Ds and Fs, an overall grade of C for the state of women’s health in Tennessee is clearly a move in the right direction, but preventive health experts also stressed there is much room for improvement.

Last month, health officials gathered in Nashville to unveil the 2013 Tennessee Women’s Health Report Card, a biennial project assigning letter grades of A-F on various indicators and outcomes to provide a comprehensive picture of the health status of the state’s more than 3 million women. The report card looks at a five-year span of data covering a wide range of topics from reproductive health and leading causes of death to modifiable risk behaviors, preventive health practices and barriers to good health. The project is a collaborative effort of the Vanderbilt Institute for Medicine and Public Health, Meharry Medical College, East Tennessee State University, the University of Tennessee Health Science Center and the Tennessee Department of Health.

To download the report card, go to: www.tnwomenshealthreportcard.com.

The Good: Infant mortality rates decreased 25 percent in the most recent

five-year period with an overall grade of B given for infant deaths per 1,000 live births. State health officials, Tennessee hospitals and individual providers have focused attention on this issue for the past several years. “The decline is real, persistent and likely to continue,” said Katherine Hartmann, MD, PhD, professor of Obstetrics and Gynecology at Vanderbilt and deputy director of Vanderbilt’s Institute Dr. Katherine Hartmann of Public Health. “This improvement reflects concerted community, public health and prenatal efforts around the state,” she continued.

However, the report also showed infant mortality rates still garner an F for African-American women. Hartmann noted that although the infant mortality rate is still too high, the numbers are “headed briskly in the right direction.”

Other encouraging news showed a continued decline in diabetes and motor vehicle death rates, a decrease in the number of hospitalizations for hip fractures, and the lowest colorectal cancer death rate since 2002. Another positive, more than 80 percent of Tennessee women over

age 50 have gotten a mammogram in the past two years.

The Bad: There were still plenty of Fs on the 2013 report card. Tennessee women received failing marks for the percentage of women who smoke during pregnancy, the number of breast and cervical cancer deaths in African-American women, the number of overall heart disease and stroke deaths, and the rate of sexually transmitted infections. In fact, the number of Chlamydia and Syphilis cases has jumped considerably since 2004. Obesity continues to plague Tennessee women (and men) with 1 in 3 of the state’s women currently being classified as obese. Also of concern are persisting social barriers, including increases in poverty and unemployment, that are closely linked to health.

Looking to 2015: The health experts involved in the report card said women could expect to see more positive change before the 2015 edition if they would focus on preventive behaviors. Tobacco cessation, exercise, improving healthy eating habits and decreasing alcohol use, along with staying up-to-date on preventive care, should keep the needle moving in the right direction for Tennessee women.

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VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R N E W S - I N - B R I E F Information and Regional News for Refer ring Physicians

SPECIAL INSERT TO THE NASHVILLE MEDICAL NEWS

JUNE 2013

Articles excerpted courtesy of the VUMC Reporter

Cochlear implant patients enjoy better hearing with new Vanderbilt process BY: NAN CY WISE

Longtime cochlear implant users are reporting dramatic improvements in their hearing, thanks to new image-guided programming methods developed by Vanderbilt University researchers.

Using Vanderbilt’s patent-pending nonsurgical process, audiologists are able to fine-tune and customize cochlear implant programming, providing improved sound quality and clarity.

“Our automated image-guided programming method can dramatically improve a person’s hearing with a cochlear implant, even if implantation happened a long time ago. Study subjects have called it life-changing,” said Benoit Dawant, director of the Vanderbilt Initiative in Surgery and Engineering (ViSE).

“This is an excellent example of collaborative effort between engineering and medicine that ViSE promotes.”

More than 200,000 people worldwide have cochlear implants and the number of newly implanted recipients is increasing dramatically each year. Anyone with a cochlear implant could experience better hearing with Vanderbilt’s new

programming process.

Cochlear implants use 12 to 22 electrodes, depending on the device manufacturer. Although the implanted electrodes can be seen on a CT scan, the nerve cells they stimulate are not easily identified due to their locations and micro-

scopic size.

Traditionally, all the electrodes are turned on and programmed to stimulate any surrounding nerve cells. This one-size-fits-all approach can result in less-than-clear hearing when adjacent electrodes stimulate the same region of nerve cells.

Furthermore, each person’s anatomical structure varies and every implant must be mapped in a timeconsuming process after surgery.

The new automatic technique uses patients’ pre- and postoperative CT scans to determine the location of the implanted electrodes and where overlap is occurring, possibly causing interference in the transmission of signals. The image-guided strategy and software then pinpoint which electrodes can be turned off to improve hearing fidelity. An audiologist uses this programming plan to create a revised custom map for the patient’s needs. The process is completely noninvasive and can be done in one office visit.

Participant Kelly Harris said the reprogramming improved her hearing so much, it was almost as great as getting the implant in the first place. “I love it. When I left the clinic, I immediately knew I could hear better,” Harris said.

The project continues to enroll new adult study participants.

VANDERBILT AUDIOLOGY CLINIC (615) 322-4327 vanderbilt.edu/CAOS/research-projects

Surgical first treats LVAD patient’s arrhythmia

BY KATH Y WHITNE Y

Michael Stanbery’s internal defibrillator was delivering painful shocks weekly in an attempt to correct his arrhythmia, known as ventricular tachycardia (VT).

“It felt like a horse kicking me in the chest every time,” said Stanbery, 48, of Morristown, Tenn.

In addition to his internal defibrillator, Stanbery, who was diagnosed with cardiomyopathy 12 years ago, has a left ventricular assist device (LVAD) to help support his failing heart while he waits for a transplant.

Typically, VT can be cured through ablation, which uses radio

frequency to heat the muscle fibers in the left ventricle. However, the presence of an LVAD makes this procedure very difficult because the physician has to manipulate the ablation catheter around the LVAD, an implantable mechanical pump that helps pump blood from the ventricles to the body.

“About 35 percent of patients with LVADs have sustained VT requiring their internal device to deliver therapy,” said Christopher Ellis, M.D., of the Vanderbilt Heart and Vascular Institute. “It’s vital that we prevent these patients from getting recurrent defibrillator shocks. They are painful and asso-

ciated with shortened survival.”

Recently, Ellis performed ablation on Stanbery, the first LVAD patient to undergo the procedure at Vanderbilt.

Ellis inserted a platinum-tipped catheter in Stanbery’s femoral vein, manipulated it through the right atrium, into the left atrium, and down through the mitral valve into the left ventricle.

The catheter delivered an electrical current that vibrated ions in the heart muscle, heating the tissue and killing the muscle responsible for the VT. All the while, Ellis was keeping an eye on the LVAD via imaging

guidance to make sure the catheter did not interfere with the device.

“As soon as we converted Mr. Stanbery to normal rhythm, his pump flows went up and he felt great the next day,” Ellis said. “He should have a very high success rate. He should live without any more VT or defibrillator shocks until his transplant.”

Children’s after-hours clinic debuts in Mt. Juliet BY: CHRIST INA ECHEGARA Y

Bumps, bruises and sore throats don’t keep regular business hours, and that’s why the Monroe Carell Jr. Children’s Hospital at Vanderbilt has opened an afterhours clinic in Mt. Juliet, Tenn.

The clinic will allow parents to take their children to get care when their pediatricians’ offices have closed for the day or the weekend. To keep care consistent and current, the child’s regular pediatrician will be sent a report about the visit the same evening. Appointments will not be necessary.

Vanderbilt board-certified pediatricians will staff the clinic space and offer primary care for issues such as ear infections, sore throats and scrapes. Services such as flu shots or other vaccines and X-rays will not be available.

“Because we will be staffing the after-hours clinic with pediatricians, we will have a higher level of expertise as well as full understanding of the importance of partnering with the primary pediatrician as care plans are developed,” said Meg Rush, M.D., chief of staff and executive medical director of Children’s Hospital.

“This ensures better integration and greater continuity of care for patients.”

Vanderbilt Children’s After-Hours Clinic 2025 North Mt. Juliet Rd. Suite 200 Mt. Juliet, TN 37122 (615) 754-7337 6–9:30 p.m.

Monday-Friday

VANDERBILT HEART (615) 322-2318 VanderbiltHealth.com/heart

3–9:30 p.m.

Saturday-Sunday

VANDERBILT UNIVERSITY MEDICAL CENTER NEWS-IN-BRIEF * JUNE 2013

CONTINUING MEDICAL EDUCATION For more information on these courses and to register, please go to www.cme.vanderbilt.edu.

TIPQC Summer Regional Learning Session – Johnson City June 12 Niswonger Children’s Hospital, Johnson City Maintaining Proper Boundaries June 12-14 Center for Professional Health, Nashville TIPQC Summer Regional Learning Session Knoxville June 13 UT Medical Center, Knoxville TIPQC Summer Regional Learning Session Chattanooga June 14 Children’s Hospital at Erlanger, Chattanooga Autism Diagnostic Observation Schedule (ADOS-2) Clinical Training June 25-26 Vanderbilt Kennedy Center, Nashville TIPQC Summer Regional Learning Session Nashville June 27 Monroe Carell Jr. Children’s Hospital at Vanderbilt Clinical Genetics for the Pediatric Health Care Professional June 29 One Magnolia Circle, Vanderbilt Prescribing Controlled Drugs July 10-12 Center for Professional Health, Nashville 37th Annual Diagnostic Sonography Symposium July 13-14 Embassy Suites Cool Springs, Franklin

To make a referral call (800) 288-5000

Vanderbilt University Medical Center News-in-Brief, Design and Layout: VUMC Design

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VUMC named among nation’s top 100 hospitals BY: DOUG C AMPBELL

Vanderbilt University Medical Center has once again been named among the “100 Great Hospitals in America” by Becker’s Hospital Review.

To create the list, the Becker’s Hospital Review editorial team analyzed data from numerous sources,

including U.S. News & World Report, Truven Health Analytics’ 100 Top Hospitals, HealthGrades, Magnet Recognition by the American Nurses Credentialing Center, the Studer Group and the Baldrige Performance Excellence Program. Hospital nominations were also accepted and evaluated by the editorial team.

According to Becker’s, “hospitals included in this list have proven to be innovators for medical treatments, research, technology and care delivery.

These hospitals are home to medical breakthroughs and act as anchors of health within their respective communities.”

Patients, surgeons benefit from neurological outcomes registry BY: MIMI ECKHARD

When 55-year-old Neader Williams first learned that she might need spine surgery to treat her excruciating back and leg pain, she was scared and unsure that surgery was the answer.

But after answering a few simple questions about her health history, Vanderbilt neurosurgeon Matthew McGirt, M.D., calculated that she had a 95 to 98 percent likelihood of a successful surgery.

“By looking at previous surgical outcomes of patients with similar age and weight, and also risk factors such as history of smoking or depression, we can more confidently recommend surgical treatment or even advise against it,” said McGirt, director of Clinical Spine Research at Vanderbilt and vice director of the National Neurosurgery Quality and Outcomes Database (N2QOD).

McGirt is leading a national effort, established by Neuropoint Alliance and the American Association of Neurological Surgeons, to better predict who will respond to surgery based on previous results and individual risk factors.

The new registry already includes surgical outcomes data from 175 surgeons representing 43 hospitals in 23 states, with information spanning the continuum of care from pre-operative, inpatient and oneyear postoperative outpatient care.

In its first year, the group analyzed more than 3,500 lumbar surgery patients to determine the safety and cost effectiveness of such procedures. Cervical spine data will be collected this year, expanding enrollment to 10,000 patients per year.

“Before we had access to this information, spine surgery was rec-

ommended based on symptoms and what an MRI showed,” McGirt said. “But now, for the first time, we can know with greater certainty if surgery really is the best treatment option for each patient’s unique circumstance.”

Vanderbilt is the coordinating center for the national database and registry, which is expected to reduce health care costs by preventing ineffective or unnecessary surgeries. It also aims to standardize treatment in hospital and outpatient settings.

“This is the evolution of care,” said Vanderbilt’s Clint Devin, M.D. “There are plenty of registries that look at surgical safety data, but no other registry in the world incorporates patient-reported quality of life experiences that make it possible for patients to make more informed decisions about their own health care.”

McGirt believes the patient-centered approach will also change the way medical schools teach future surgeons.

“We now know with certainty that one pill or one surgery does not benefit all patients the same, even if patients have the same disease,” he said.

“So, teaching procedures is no longer enough. By teaching comparative effectiveness of actual patient experiences, our residents are learning how to analyze, interpret and predict patient treatment and care at the individual level.”

VANDERBILT SPINE CENTER (615) 875-5100 VanderbiltHealth.com/spinecenter

Therapy helps regenerate child’s undeveloped bones BY: CHRIST INA ECHEGARA Y

Janelly Martinez-Amador has a rare genetic disorder called hypophosphatasia (HPP), a metabolic disease that affects the development of bone and teeth. Initially, doctors weren’t sure she would survive her first birthday. In May, Janelly turned 7 and is growing bone with the help of an experimental drug therapy and her care team at the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

HPP affects about one in 100,000 babies born in the United States.

While there are varying degrees of severity, the most severe forms of HPP occur before birth and early infancy. More than half of babies born with the disease don’t survive beyond their first birthday.

Janelly has the more severe form of the disease, which was diagnosed when she was 3 months old after failing to grow and gain weight.

“If you saw her in 2009 and see

her now, it’s not the same Janelly,” said her mother, Janet Amador.

“She used a ventilator, an oxygen mask – many machines to help her breathe.”

Janelly is one of 11 children, age 3 years and younger, to participate in a clinical trial to receive an enzyme-replacement drug therapy, asfotase alfa, for the life-threatening form of HPP. About eight months into the treatment, Janelly’s parents felt her

Aetna Institutes of Excellence honors VUMC quality of care BY: CHRIST INA ECHEGARA Y

Vanderbilt University Medical Center has been recognized by Aetna Institutes of Excellence for its expertise in consistently delivering evidence-based, quality care for pedi-

atric congenital heart surgery services.

An Institutes of Excellence designation is for health care facilities that offer safe, highly specialized and evidence-based care to members with complex or rare conditions.

Aetna makes information about the quality and cost of health care services available to its members to help them make informed decisions about their health care needs.

VUMC Neurodiagnostic Program gains accreditation BY: LESLIE HILL

The Vanderbilt University Medical Center Neurodiagnostic Program has been accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

Neurodiagnostics is the allied health care profession that records,

monitors and analyzes nervous system function to promote the effective treatment of pathologic conditions. Technologists record electrical activity arising from the brain, spinal cord, peripheral nerves, somatosensory or motor nerve systems using a variety of techniques and instruments.

The neurodiagnostics team at Vanderbilt is an integral part of clinical care for epilepsy and other neurological conditions.

VANDERBILT NEURODIAGNOSTICS LAB (615) 322-0959 VanderbiltHealth.com/clinicalneurosciences

Clinic helps foster recovery from psychotic disorders BY: PA UL A JONES

Vanderbilt Psychiatric Hospital’s Psychotic Disorders Clinic has become a leader in the region for the initial assessment and treatment of young adults suffering from their first psychotic break.

These episodes are characterized by notable changes in behavior or thinking such as erratic or impulsive actions, delusional thinking, or hallucinations, according to Jeffrey Stovall, M.D., part of the clinic’s treatment team.

Stovall said many of the patients they treat are referred from other hospitals, though some are brought in by family members or are self-referred.

The majority of patients the clinic sees suffer from schizophrenia or bipolar disorder, and most of them are between the ages of 18 and 21— the most common age of onset for these types of disorders.

“Many people who are struggling with a psychotic disorder distance themselves from their loved ones, and many families don’t know how to respond to the challenges of the disease. Good treatment includes the right balance of anti-psychotic medications as well as helping the patient realize that there is support for them,” Stovall said.

“We want to help them realize that their lives are not over and

that they can still achieve much of what they want for themselves.

We don’t stigmatize them and they shouldn’t stigmatize themselves.”

Stephan Heckers, M.D., M.Sc., chair of the Department of Psychiatry, said Vanderbilt’s expertise with these patients is enhancing care and furthering research.

“This clinic allows us to have access to the patients and follow them over time, improving outcomes both research-wise and clinically,” he said.

fingers — which had been completely soft and boneless — and they could feel traces of developing bone. Her head also began to develop bone. At 18 months into therapy, X-rays showed, for the first time, the visible development of her rib cage.

Improvement continues each day, each week for Janelly.

“This is why we get into medicine in the first place: to truly make a difference in the life of a child,” said

Jill Simmons, M.D., her physician.

“My goodness, to go from no bones to bones. That’s the most impressive thing I have seen as a physician. It’s incredible.”

MONROE CARELL JR. CHILDREN’S HOSPITAL AT VANDERBILT (615) 936-1000 ChildrensHospital.Vanderbilt.org

New clinic links pediatric sarcoma treatment services BY: CHRIST INA ECHEGARA Y

To improve the care experience for osteosarcoma patients and their families, Children’s Hospital launched the Multidisciplinary Pediatric Sarcoma Clinic in April as a one-stop location for patients with sarcoma to receive expedited therapy and more unified, convenient care.

Jennifer Halpern, M.D., and Scott Borinstein, M.D., Ph.D., will offer joint clinic hours once a month. As the program gets under way, they hope to expand days and hours to patients being treated for sarcomas, including osteosarcoma, Ewing sarcoma, rhabdomyosarcoma and synovial sarcoma.

“I couldn’t imagine having a better experience or greater care, but the new clinic does make it easier having it all under one roof,” said Rebecca Smith, the mother of a patient.

Fewer than 1,000 children and young adults (age 20 and younger) are diagnosed each year in the United States with sarcomas.

Currently, Children’s Hospital serves as a large referral center for the region, seeing about 40 active patients. Treatment lasts about six months to one year, with follow-up care for 10 years.

Jennifer Simpson, 24, an osteosarcoma survivor, was diagnosed

“I couldn’t imagine having a better experience or

greater care, but the new

clinic does make it easier having it all under one roof.”

REBECCA SMITH

at 19, and similar to Smith, went to multiple locations for her care.

Now as a survivor for follow-up surveillance, she will be able to be seen at the new joint clinic.

“It’s a lot easier. Especially now that I have a job, I would have to schedule a whole day off to go to different places and have to wait hours in between. It’s a lot easier, a lot faster,” Simpson said.

The clinic is in the Hematology and Oncology Clinic on the sixth floor of the Doctors’ Office Tower at Children’s Hospital.

MONROE CARELL JR. CHILDREN’S HOSPITAL AT VANDERBILT (615) 936-1000 ChildrensHospital.Vanderbilt.org

VANDERBILT PSYCHIATRIC HOSPITAL (615) 320-7770 VanderbiltHealth.com/PsychiatricHospital

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VANDERBILT UNIVERSITY MEDICAL CENTER NEWS-IN-BRIEF * JUNE 2013

Epilepsy Program again receives key quality recognition BY: LESLIE HILL

The Vanderbilt Epilepsy Program has maintained its designation as a Level 4 center by the National Association of Epilepsy Centers (NAEC) for the ninth consecutive year.

The program has received the designation since it was implemented in 2005.

According to NAEC, Level 4 centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

“It is gratifying to again be recognized at the highest level,” said Bassel Abou-Khalil, M.D., professor of neurology. “This designation is a recognition of the quality care we offer epilepsy patients every

“This designation is a

recognition of the quality care

we offer epilepsy patients every day. Our staff understand how to work together and use our

considerable resources to provide patients thoughtful evaluations and personalized treatment.”

BASSEL ABOU-KHALIL, M.D.

day. Our staff understand how to work together and use our considerable resources to provide patients thoughtful evaluations and personalized treatment.”

Vanderbilt’s Epilepsy Program includes adult and pediatric epilepsy clinics, adult and pediatric EEG

laboratories, an eight-bed adult monitoring unit and a four-bed pediatric monitoring unit, making it the largest in Tennessee.

The program is active with presurgical evaluation and epilepsy surgery for children and adults and is also involved with both basic science and clinical investigations, including drug trials, genetics and fMRI imaging.

Vanderbilt is one of only two epilepsy centers in Tennessee with NAEC recognition.

VANDERBILT EPILEPSY (615) 322-7246

VanderbiltEpilepsy.com

The Middle Tennessee Chapter of the Juvenile Diabetes Research Foundation ( JDRF) has awarded Vanderbilt’s William Russell, M.D., director of the division of Pediatric Endocrinology and Diabetes, its highest honor: the Living and Giving Award for support of people diagnosed with type 1 diabetes (T1D).

Russell was honored at the JDRF Promise Gala April 20 at the Loews Vanderbilt Hotel.

“Dr. Russell has done so much to improve the lives of those living

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with T1D and we are grateful to have him as a part of the JDRF family,” said Mary Lyn Schuh, executive director of the Middle Tennessee JDRF chapter.

Russell is the principal Investigator for the Type 1 Diabetes TrialNet research program and was instrumental in Vanderbilt gaining the designation as a TrialNet Clinical Center. TrialNet is funded by the National Institutes of Health, JDRF and the American Diabetes Association.

An active supporter and advocate of families touched by T1D,

Welcomes These Providers

CARDIOLOGY

Kimberli Taylor Clarke, M.D. Specialty: Cardiology Medical School: Meharry Medical College School of Medicine Residency: University of Maryland School of Medicine Fellowship: Vanderbilt University School of Medicine Practice Location: Vanderbilt Heart & Vascular Institute at One Hundred Oaks Appointments: (615) 322-2318

Richard Gumina, M.D., Ph.D.

Russell’s diabetes treatment efforts honored BY: C AROLE BART OO

Vanderbilt University Medical Center

Russell and the Children’s Diabetes Program team support multiple community outreach programs, including Diabetes Family Day. The annual event at Vanderbilt brings together several hundred children, young adults and their families to share experiences on living life well with T1D.

VANDERBILT DIABETES (615) 343-8332 • Adult (615) 322-7842 • Pediatric VanderbiltHealth.com/diabetes

Specialty: Interventional Cardiology Medical School: Medical College of Wisconsin Residency: Mayo Clinic Fellowship: Medical College of Wisconsin; Mayo Clinic Practice Location: Vanderbilt Heart & Vascular Institute Appointments: (615) 322-2318

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Financing the Future

Planning for the Transition from Earner to Spender Editor’s Note: For this year’s retirement focus, we really wanted to look at proactive measures that take a ‘whole person’ approach to retirement. Financial aspects, of course, loom large, but retirement also impacts an individual’s emotional health and those around the retiree as roles change within the household. Equally important, proactive retirees must consider residential options as health and abilities shift with time.

By CINDy SANDERS

How much do you need, and how long do you need it to last? Realistically assessing those two questions is the first step in preparing for the transition from wage earner to living well in retirement.

Steven Glasgow, senior vice president and financial advisor in the Wealth & Asset Management group for Nashvillebased Avondale Partners, has more than 20 years experience working with individuals and institutional investors with a focus on defined contribution and benefit

Accelerating Savings Steven Glasgow, senior vice president of Avondale Partners, said there are options to help high-earners accelerate their taxdeferred savings in preparation for retirement. One of the most sophisticated options is a crosstested cash balance plan that allows higher wage earners to contribute signifi cantly more to their retirement plans.

Glasgow said this type of strategy works particularly well for physicians in a group or specialty practice or for healthcare executives where the principal owners and executives are highly compensated in comparison to the rest of the employees. “The traditional profi t-sharing or 401K plan doesn’t usually get them the amount of tax deferral and accumulation that they would like to meet their retirement needs,” he said. “We actually help them set up what is a hybrid-defi ned plan where they can legally contribute signifi cantly larger amounts to their own retirement accounts than for the other employees.”

Glasgow noted the key to this type of plan working is that the higher earners must have a relatively consistent stream of earnings (so this isn’t a viable option for commission-based sales reps, for example), and the disparity of earnings between principals and other employees must be pretty signifi cant.

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plans. Widely recognized for Good investments can do good his expertise, Glasgow is one of five finalists nationwide for things, but they can’t work the 2013 PLANSPONSOR magic. They can’t turn $100,000 Retirement Plan Advisor of the Year Award, which will be aninto $100,000 a year.” nounced in September. He also — Steven Glasgow, Avondale Partners was recently recognized among the nation’s “Top 100 Retirement Plan Advisers” for 2013

by PLANADVISER magazine.

For individual clients, he helps evaluTiming the Gold Watch ate where they currently stand from a fiThe traditional retirement age of 65, nancial perspective, where they hope to be Glasgow explained, was really based on by the time they retire, and what measures the mortality history of the railroad inare needed to bridge that gap. While it is dustry. Years ago, age 65 was set as the wonderful for a young physician or executime when railroad workers could begin tive to begin planning for retirement in accessing their pensions … of course, their late 20’s or early 30’s, Glasgow said they typically only lived a few years after that is pretty unusual outside of contributthat. ing to a corporate retirement plan. Active Today, life expectancy has changed planning, he noted, usually starts later. quite dramatically. “You plan to about “In my experience, I think most age 90 or 92,” Glasgow said, noting that people start to get sensitive to it in their once a person passes the threshold of 65, early 50’s.” Glasgow added that by the then every year thereafter significantly mid-50’s, those who are going to actively adds to the chances that person will reach plan for retirement will begin getting seritheir 90th birthday. Realistically, retiring ous about the task. For many, a decade or at 65 means most people are working 45 more of determined investing still allows years to finance close to 25 years of adenough time for them to be able to retire ditional living expenditures. on their own terms.

Despite that, Glasgow noted, “We

haven’t changed our expectations of when you should walk out with the gold watch.”

However, he continued, the landscape is beginning to shift. Increased lifespans have helped fuel the desire to continue utilizing skills and expertise on at least a part-time basis. “It keeps you feeling like you are contributing and relevant,” he said of the emotional and psychological aspect of working.

And then there’s the financial reality that the recession has forced many wouldbe retirees to earn income longer. “If ‘have’ and ‘need’ are too far apart, then something’s got to change,” Glasgow said, adding the two options are working longer or lowering expectations.

“Sometimes, a couple of years can make a substantial difference,” he added.

By working just a few extra years, Glasgow said an individual sees the double bonus of accumulating more savings while deferring the need to tap into the nest egg, which can make all the difference when it comes to enjoying retirement.

Begin with the End in Mind

Glasgow said that often the focus of investments is purely on how an individual’s portfolio has performed relative to the market instead of really thinking about what is trying to be accomplished with those investments.

In planning for retirement, he said individuals must assess their hopes, dreams and goals for what they want their life to look like once they dramatically cut back on or stop working. “Then the question becomes how much do I have to have socked away to make that happen? From there, we can do the math.”

He continued, “From a financial perspective, I’m always fascinated at the number of high earners who have never sat down and thought about a budget. If someone accumulates a million dollar balance in their retirement plan, the assumption is they’re safe.” However, Glasgow added, when you start looking at that individual’s expenditures — multiple mortgages, children still in college, elaborate vacations — you might find they will be spending $200,000 a year. In that case, he noted of the savings, “That’s a five-year life plan, and then you’re at Walmart.”

Glasgow pointed out, “Ideally, you’d like to be able to take risk down as you get closer and closer to retirement, but the only way you can do that is if you have accumulated enough to meet your retirement goal. There’s only so much you can do if you wait too late to get into the planning phase. Good investments can do good things, but they can’t work magic.

They can’t turn $100,000 into $100,000 a year.”

We can help guide your path.

Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR. Through special funding, tnREC is offering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds.

We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply online www.tnrec.org This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Office of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reflect ONC policy. 90RC0026/01 13.TREC.04.049

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A Sense of Independence Gjullin said of a unique aspect of Life Care Services. In comparison to a skilled nursing facility where a room could cost $300-$400 a day, those who transition within the CCRC continue to pay their monthly fee … for a couple in an apartment-style residence that typically runs under $200 a day and under $100 a day for an individual in a one-bedroom apartment. “If you wanted to preserve your assets, what other program would you select?” he questioned.

Again, Gjullin stressed, the goal is to keep seniors spiritually, physically, mentally and emotionally healthy for as long as pos-

By CINDY SANDERS

Nearing retirement in an era when 70 is the new 50, it can be difficult to picture a time when you won’t be able to hop in your car to run errands, swing a club or a racquet, attend an exercise class, or enjoy an evening out with good friends. Perhaps in the recesses of your mind the possibility exists that you might need a little assistance at some point in the very distant future … but that time is certainly not now.

However, in your most prudent moments, you know the big house and big yard are really too big now that the children are grown and gone. And you hate the thought of your spouse or the kids hurriedly having to make critical decisions should something happen to you.

Still, you just aren’t ready to give up your selfsufficiency. And why should you when a solution exists that allows you to keep your independence while having a contingency plan in place?

For a growing number of senior adults, continuing care retirement communities (CCRCs) provide the best answer – supporting active, independent lifestyles while offering increasing levels of care when required. That Timber Ridge Seattle continuum allows residents to age in place.

Headquartered in Des Moines, Iowa, Life Care Services has been developing and managing senior living communities for more than four decades. As the nation’s leading manager of full-service senior living communities, the company owns or operates more than 80 communities in 28 states and the District of Columbia and serves nearly 30,000 residents.

Erik Gjullin, vice president/director of marketing & sales for Life Care Services, explained that residents arrive while independent with the knowledge that assisted living, skilled nursing and memory care facilities are available onsite. Key draws for living in CCRCs are the social- Erik Gjullin ization aspect and knowing that once you are in, you have a home for life. Yet, Gjullin said, the focus of their communities is on maintaining wellness and independence.

“The driver for our prospects, who are looking for solutions to senior housing, is to live somewhere where it’s easy to participate in a lifestyle that enhances health,” he said.

Gjullin explained Life Care Services takes a ‘whole person’ approach to wellness.

“Our HealthyLife™ Services program is really the overall health and wellness program that we practice in all our communities. It’s not just fitness,” he continued, “It’s nutrition. It’s socialization. It’s education.

It’s ongoing lifestyle that really creates the wellness for the whole person.”

While a number of programs and ser16

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sible to enjoy the array of options that come with this type of community. On any given day, seniors can be found attending a yoga class, planning community outings, choosing from chef-inspired cuisine, working out in the fitness center, sipping cocktails with friends or enjoying a relaxing manicure.

“Our philosophy is choice, flexibility, and control,” Gjullin said. “That’s what we offer people who live here. That’s what seniors want. They didn’t get to the point where they could afford to live in a community like this and not have that as a basic philosophy.”

The Heritage at Brentwood Sagewood in Phoenix

vices are consistent across Life Care Services developments, the communities are far from ‘cookie cutter.’ Gjullin said, “The unique part of it is people live in different geographic regions for a reason. They like the lifestyle. They like the architecture. So if you go into our community in Phoenix, Ariz., it looks like it belongs in Phoenix. It’s got local architecture, spaces and cuisine.

It’s got the flavor of the southwest.”

Residents enjoy a range of living options from apartment-style residences to garden villas to detached cottages. Manicured lawns, gardening plots, walking and biking trails, guest accommodations, a clubhouse with restaurant-style menus, day spa, putting green, cocktail lounge, fitness center, library, convenience store, weekly cleaning service, 24-hour security and more are part of the well-appointed surroundings.

Luxury, of course, does come with a price. Gjullin said residents pay a one-time entrance fee and ongoing monthly fee, both of which vary depending on the size of the residence selected. The monthly fee, he continued, “covers everything you could possibly think about that you would be paying if you were living in your own residence.”

At death or upon moving, there are two return-of-capital plans that give back either 80 percent or 90 percent of the entrance fee to the resident or the estate. If residents needs to move to a higher level of care … either temporarily or permanently … they are guaranteed a bed, and the monthly fee remains the same as in the independent living phase.

“As you move through the continuum of services, your monthly fee does not increase,”

Where Living Well & Being Well Go Hand-in-Hand The Heritage at Brentwood is Middle Tennessee’s Life Care Services development, offering the wide array of amenities and services that are a hallmark of the LCS brand. Located on 48 acres just north of Concord Road and adjacent to the Williamson County Indoor Sports Complex, The Heritage at Brentwood features 217 residences with plans for future expansion.

With an emphasis on wellness, The Heritage offers nutrition services including healthy dining selections and ‘lunch and learn’ events focused on health-related topics. From a fitness perspective, the complex features heart-healthy walks featuring LifeTrail® equipment at exercise and stretching stations along the path, weekly exercise classes tailored to a range of abilities, fitness education by managers from the National Institute of Fitness and Sport, and strength and cardio equipment in the fitness center.

Also included in the monthly fee is a liaison with a home health agency should services be required, a number of support groups, wireless emergency response system in both public areas and private residences, a physician’s assistant clinic supervised by a physician certified in gerontology, eyeglasses repair and blood pressure, hearing and podiatry clinics. The Heritage also offers a healthcare navigator to provide assistance with scheduling medical appointments, pre-planned hospitalizations, discharge planning and coordination, assistance with medical equipment and follow-up after emergency calls.

All residents also have access to the Somerfield Health Center, which is currently undergoing a $9 million expansion. The health center houses assisted living, rehabilitative care, skilled nursing and memory care quarters for residents and private pay individuals referred by outside physicians. “Our LifeCare residents are always guaranteed a private room,” noted Administrator Dahlen Jordan, who added demand for services prompted the expansion.

Ground was broken last September on the expansion of the health center, which has a five-star quality rating from the Centers for Medicare and Medicaid Services. Upon completion this coming October, Somerfield will more than double the current number of beds from 30 to 66.

“We’re going to a neighborhood concept so each neighborhood will have its own designated dining room, activity area, living room and country kitchen,” said Dahlen, adding the kitchen allows Somerfield residents to prepare some of their own meals if they so desire.

“Once the expansion is completed on the health center side, then we’ll have a designated memory care wing,” he added, noting memory care patients currently reside in the general skilled nursing section. “In the next phase, there will be an assisted living memory care.”

Also part of the next phase will be an expansion to the current fitness center to add an indoor pool, dedicated aerobics and strength training areas, auditorium, and 121 additional apartment-style homes. Currently The Heritage is about 90 percent sold with close to 300 residents. When the community hits 95 percent in sales, plans will go into high gear on the Phase II expansion.

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Retirement Roundup Brookdale Acquiring Chartwell Facilities Officials with Brentwood-based Brookdale Senior Living, Inc. recently announced the senior living solutions company has purchased seven retirement centers from Chartwell Retirement Residences for a little more than $80 million, pending completion of standard due diligence protocols.

The acquisition of the seven centers in Alabama, Arizona, Georgia, Louisiana and Oklahoma gives Brookdale 613 new living units made up of 80 independent living, 493 assisted living, and 40 Alzheimer’s residential units. Brookdale has been managing six of the communities since its acquisition of Horizon Bay in September 2011. The average occupancy for the seven properties was 91.8 percent in 2012.

Brookdale CEO Andy Smith said, “This acquisition is a natural step forward following the Horizon Bay acquisition to demonstrate Brookdale’s ability to execute its strategy of acquiring certain of the managed assets if and when they are sold.”

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.”

I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

SilverSneakers Keeps Seniors on the Go According to findings from a three-year study recently published in Population Health Management, Nashville-based Healthways’ SilverSneakers fitness program is an effective approach to improving seniors’ physical and mental health. One of the study’s most significant findings was from a multiyear analysis that suggests the program helps to slow or may even reverse the declining health of older Americans. Several study measures indicated that SilverSneakers participants’ health and abilities are declining at a significantly slower rate than similar Medicare Advantage plan beneficiaries who do not participate in SilverSneakers.

The research, conducted on 5,586 SilverSneakers participants and a matched group of 22,344 other Medicare Advantage beneficiaries for comparison, demonstrated SilverSneakers participants performed better relative to non-participants in simple but important activities of daily living, such as bathing, walking, climbing stairs, dressing, eating, getting in or out of chairs and using the restroom.

Nashville Shines as Retirement Destination A recent analysis by NerdWallet.com listed Nashville among the top 10 urban cities in which to retire based on affordability, social life, weather and walkability.

Miami topped the list, and Nashville came in at #10. Memphis also made the list at #5.

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Our Medical Specialty Group provides a dedicated team with tailored solutions to meet the unique financial needs of physicians and their practices.

Visit suntrust.com/medicine to find an advisor near you.

Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured • Are not Bank Guaranteed • May Lose Value. SunTrust Private Wealth Management Medical Specialty Group is a marketing name used by SunTrust Banks, Inc., and the following affiliates: Banking and trust products and services, including investment advisory products and services, are provided by SunTrust Bank. Securities, insurance (including annuities) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC registered investment adviser and broker-dealer, member FINRA, SIPC, and a licensed insurance agency. SunTrust Bank, Member FDIC. © 2013 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. How Can We Help You Shine Today? is a service mark of SunTrust Banks, Inc.

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Recognizing Retirement as a Major Life Transition Addressing the Emotional Aspects of a New Reality

By CINDY SANDERS

Generally, work as a means to income is only one part of the equation. For most professionals, a career also provides benefits ranging from a sense of identity, purpose, and structure to social connectivity and intellectual stimulation. When it comes to retirement, individuals must be as intentional in assessing how they will continue to meet these needs as they are in making long-term financial plans.

Kerry Loy, LCSW, MSSW, MTS, BCC, leader of the Life Coaching Program for Centerstone of Tennessee, said those preparing for retirement are often focused on one or two major activities planned for the future.

But, Loy said, “How do we navigate the daily?”

Kerry Loy She continued, “We really have to manage expectations. It’s not just about being a big vacation.”

Instead, she noted, retirees can easily find themselves feeling adrift with a lot of time on hand. Simply loading up on appointments, events and volunteer work, however, isn’t a viable solution to finding satisfaction in retirement, Loy said.

“Sometimes people fill their dance card with a lot of activities, thinking that will fulfill them.” However, she continued, it often has the opposite effect. “If they are not in alignment with your values … your sense of self … then activities can just be a distraction.”

Another mistake is thinking that retirement only impacts the one not going to the office, hospital or practice anymore. “Anytime you make major changes, it has repercussions for the whole family,” she noted.

Couples have to think about how having both spouses home all day shifts the space in the house, impacts the need for alone time, and redefines responsibilities.

Drawing from her own family, Loy noted that when her grandfather retired, he took over cooking. “However, when he did that, it displaced my grandmother and took her away from something that gave her purpose.”

Loy continued, “Transitions are always challenging. They’re always hard.

It’s going to require a lot of communication, understanding and planning to navigate that.”

Just as individuals and couples put in time thinking about a financial plan for retirement, Loy said they should also invest in planning for the emotional changes. “These issues are going to come up whether you think about them or not,” she noted. “Having put some time and attention and forethought into those transitions beforehand can really help alleviate emotional stress.”

In creating a transition plan, she continued, an individual should think about what the first six months after retirement will look like and how needs will be met.

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The first step is for the retiree to assess the various roles work has played in their life and to outline his or her top five needs and values. “Being armed with that knowledge is so powerful,” Loy said. “Being authentic in who you are is where we get the greatest satisfaction.”

With that list of values in hand, an individual has to begin to think about how those needs might be fulfilled outside of the work environment. An example, she added, might be to look at the role work has played in an individual’s or couple’s social life. “Maybe spend a little time before you retire really starting to create a

community for yourself and a network outside of work,” she counseled.

Once you’ve identified your top needs and values, she continued, “You can be intentional about saying ‘yes’ to things that are in alignment with who you are and saying ‘no’ to those not in alignment.” She added, “Don’t blame those around you if your needs aren’t being met … it’s still your responsibility.”

That said, Loy noted most people experience bumps in the road. It’s important to understand that transitions are just that … a period of adjustment between the old way of life and the new one. “Allow

yourself and everyone around you a little grace and patience,” Loy cautioned. “An equilibrium has been disrupted. And, for a time, chaos may ensue … but that’s normal, and it doesn’t mean you’ve made a mistake.”

She continued, “As you work through these processes, a new normal will develop … but know you’re not married to your new normal.” In fact, she noted, this post-work phase of life can be filled with surprises and allow people to reinvent themselves. With a little bit of due diligence, retirement can become the next big adventure.

Patient Safety Takes Flight in Tennessee, continued from page 1 management (CRM) training that is known as TeamSTEPPS At the helm of LifeWings is Steve Harden, a former Navy pilot and TOPGUN instructor and current international pilot for FedEx. Harden, a Naval Academy graduate with more than 300 aircraft carrier landings, has been involved in safety training during the majority of his career and has personally trained more than 20,000 physicians, nurses, staff and administrators in TeamSTEPPS over the last decade.

After joining FedEx, he began training pilots in CRM, which was a relatively new discipline for commercial airlines at that time. CRM was born from work done out of NASA that found that 70-80 percent of airline accidents were the result of a breakdown in communication and teamwork. The specific course Steve Harden created for FedEx was so highly regarded that Harden began getting calls from outside organizations asking for similar training.

With blessings from FedEx, Harden helped found Crew Training International (CTI) in 1992. A few years later, CTI brought its expertise to the healthcare industry.

“Quite honestly, it wasn’t our idea,” Harden noted with a laugh about what has become a major focus of their business.

That first foray into patient safety came at the request of a hospital emergency department director who knew a CTI employee.

Harden recalled, “He said, ‘I really think it could make a difference in my emergency department. Could you come in here and see if my instincts are correct?’”

After observing many similarities to the types of interactions and protocols used on flight decks during a site visit to the hospital, the CTI group came back with suggestions to improve safety and teamwork. “We said if we were kings for a day, here’s what we’d do. He said, ‘OK, do it,’” Harden said.

From there, word-of-mouth spread quickly, and the group began sharing their expertise with other hospitals and departments.

By 2005, the healthcare group had become so large that it was spun off into a separate entity … LifeWings.

Following the landmark Institute of Medicine Report, ‘To Err is Human,’ the Agency for Healthcare Research & Quality (AHRQ) created a CRM course specifically designed for healthcare and called it TeamSTEPPS. Harden noted TeamSTEPPS is really the generic term for crew resource management courses in the healthcare setting, and the term is often used interchangeably with CRM. Harden has been responsible for innovating a number of subsequent generations of CRM training program, and the LifeWings team uses a program they call TeamSTEPPS 2.0.

When LifeWings trains healthcare staff, the focus is on one department or area. “We don’t train the entire hospital at once. It’s just too big an elephant to eat at one setting,” Harden noted. Once a focus area has been determined, the hospital must decide who should attend. Harden said the standard answer is anyone responsible for good patient care, which very probably includes non-clinical staff in addition to physicians and nurses.

It is, however, crucial for physicians to attend training. “We won’t work with a hospital unless they agree to interdisciplinary training that includes physicians,” Harden stated. “It would be like a football team running plays without the quarterback.”

While the checklists and processes vary by specialty, Harden said the common element in all programs is the ability to have effective assertion … what is commonly known as a ‘stop-the-line’ conversation.

“All the research shows facilities that have a stop-the-line culture have the fewest number of patient-harming events,” he said.

Harden continued, “Can your most junior and inexperienced nurse have a stopthe-line discussion with your most senior and experienced physician if they perceive a problem with patient care? If the answer is ‘no,’ you’re going to have patient-harming events.”

Those conversations are easier said than done considering the hierarchical nature of most healthcare facilities. “There’s

such a great power distance,” Harden noted between a neurosurgeon who has spent years in medical school, residency and fellowships and a brand new scrub nurse who has been employed for six months. Still, that scrub nurse must feel confident in speaking up if a problem is perceived.

“One of our mantras for the hospitals we work with is ‘It’s the right thing to do for the patient, and the right thing for the hospital’s bottom line,’” Harden continued.

He noted that safe care is also cost efficient care. With fewer mistakes come fewer penalties and lawsuits and greater market share.

“As your quality goes up, your metrics and reputation improve,” he pointed out.

Empowering the entire team also improves staff satisfaction and reduces turnover rates. “The average cost to turn over a nurse is $25,000,” Harden noted. In departments where they have implemented TeamSTEPPS, Harden said they’ve seen turnover rates drop from 10-15 percent to 2-3 percent, which is a huge savings to the bottom line.

Between decreased malpractice costs and increased savings, Harden noted two hospitals systems that used LifeWings’s TeamSTEPPS program in Illinois increased profit margin to 16 percent … considerably higher than the national average of 3 percent.

“Hospitals are not going to survive unless they do a program like this and do it well,” he stated.

Harden noted best practices and evidence-based protocols aren’t kept secret so ostensibly everyone should know the right steps to take. Without a stop-the-line mentality, however, it’s almost impossible to achieve the desired outcomes. “If you have high infection rates, it’s typically not a process problem. It’s typically a culture problem,” he said.

TeamSTEPPS training helps turn that culture around. “It’s the mutual support and crosscheck and holding one another accountable and communicating as you use the process … that is the secret sauce,” Harden concluded.

For more information on the TeamSTEPPS training, go to the TCPS website at www.tnpatientsafety.com. A brochure and training schedule is available to download under the “What’s New” section of the TCPS homepage.

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Vanderbilt Set, continued from page 1 Miller said, “We know that students can make very valuable and meaningful contributions to patient care, and we need to get them in the workplace so that they can do that, well supervised, very early in the educational process.” She continued, “The other part of that is that even the most seasoned physician still needs to learn.”

AMA Initiative Hand-in-hand with Vanderbilt’s curriculum transformation is the opportunity for the university to nab a grant from the American Medical Association, a grant that Miller said would “jumpstart” the program with needed personnel and provide resources to evaluate the new curriculum more rigorously.

In March, Vanderbilt learned that it had made the first cut in the AMA’s $10 million Accelerating Change in Medical Education Initiative. Earlier this year, AMA President Jeremy A. Lazarus, MD, told Medical News, “What we’re looking for are bold and innovative programs that will help create the next generation of physicians who are more attuned to the emerging healthcare system.”

Vanderbilt’s new curriculum plans dovetail with its proposal outline to the AMA. From a pool of 119 applicant outlines, the AMA chose 31, whose full proposals delineating their specifics for medical education improvement were due May 15. Eight to 10 grant awardees will be announced this month at the AMA’s semiannual policymaking meeting in Chicago.

“Grants of this magnitude are really hard to come by in the education world.

The AMA really had a robust response,” said Miller, adding, “This is not a slamdunk for us, by any stretch of the imagination, and we’re honored to be in that group of 31 submissions.”

Miller said the money, of course, would be exciting, but there’s more to the AMA initiative than the cash. “The thing about the grant to me that is particularly attractive is that we would be part of this national consortium of medical schools all working toward the same thing and around the table discussing how to make all of these things happen and learning from each other,” she said. “I think that would be such a phenomenal opportunity for Vanderbilt.”

Vanderbilt’s proposal to the AMA and its plans for the new curriculum focus on three goals: 1. workplace learning, 2. a competency-based assessment system that places students on a continuum from novice to expert, and 3. personalized learning plans for each student.

Workplace Learning “Moving forward, one of the goals of the healthcare system is to keep people so healthy that they don’t even need to come into a clinic. Yet our education is still focused on an inpatient setting,” Miller said.

In fact, that imbalance exists both in medical school education and in residency, despite the reality that most doctors won’t practice in a hospital. nashvillemedicalnews

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Thus, Vanderbilt’s new curriculum will assign students to a clinic from the second month of medical school, and they will return to the clinic weekly. “They become embedded in that clinic, and the purpose of that isn’t so much to learn clinical skills, because they will learn that,” Miller said. “The purpose of the continuity clinical experience is for them to learn M. systems-based practice. Dr. Bonnie Miller They become part of that clinical team … they understand how that clinical site works, and they get involved in improvement projects at the clinic.”

Key to that will be immersion in healthcare information technology, she added.

Competency Assessment The proposed competency-based assessment system gets rid of something at the core of traditional education – grades. “It’s a very, very different way of thinking about education,” Miller said. Instead, students move from to Level 1 to Level 5. Assessment is based on a culture of constant improvement, with students mastering one competency before they progress to the next milestone.

Students who grasp a concept quickly don’t have to wait for their peers to move on.

Residency programs are working toward the same model. “What we’re doing, we hope, will allow our medical students to ease right into residency because we’ll be doing the same thing,” she said. At the undergraduate level, Miller added, the eventual goal would be that an undergraduate Level 5 would be the “entry milestone” for graduate medical education, “so it just becomes a seamless progression.”

Personalized Learning The final piece of the puzzle, which builds on the competency assessments, is a personalized learning plan for each student, based on his or her needs, skills and interests. In fact, the AMA is calling for individualizing plotting of progress, Miller said.

“We plan to shorten the pre-clinical phase, with students predominantly in the classroom, from the traditional two years to one year. They will have their required core ‘clerkships’ in the second year, and then the third and fourth years are what we’re calling ‘immersion’ years, which will be highly customized to the students’ learning needs,” she said.

Acknowledging that such customization is complicated, she said Vanderbilt would turn to its informatics specialists to develop portfolios to track students’ competencies and individual learning strategies.

Miller said an overhaul of medical education is being driven nationally on several fronts. For example, both the Institute of Medicine and the Institute for Healthcare Improvement are calling for drastic changes to improve the safety and efficiency of America’s healthcare delivery. “All the organizations that have looked at how to staff a healthcare system say that this transformation won’t be successful and it won’t be sustainable if physician learning isn’t transformed at the same time,” she said.

The Trust Factor

Nashville Firm Reveals Results of 7th Annual Payor Survey; Trust Greater Factor than Rates

By LYNNE JETER

NASHVILLE – In the wake of national health reform, the trust factor between hospitals and health insurance companies is perilously low.

That’s the consensus of 373 hospital and health system administrators responsible for negotiating contracts with major health plans in the seventh annual National Payor Study. Conducted by Nashville-based ReviveHealth, the 2013 survey paints an interesting picture of administrators’ opinions about various private payor trends, including rates, payment of claims, denials and other actions.

“The trust factor is huge when it comes to hospitals and health plans being able to play nice in the new world order of risk— sharing and improved health outcomes,” said ReviveHealth CEO Brandon Edwards.

For the second consecutive year, hospital and health system leaders who negotiate managed care contracts with national health insurance companies pointed to WellPoint/ Anthem as the nation’s worst plan, with only a 16 percent favorability rating. WellPoint manages health plans in 14 states, including Anthem Blue Cross in California.

“Even though WellPoint now has a CEO with a strong provider background, he’s got to turn around an aircraft carrier, and that takes time,” said Edwards, noting that business practices and corporate behavior have contributed to the company’s poor reputation. “Their major imperative has to be improving their reputation and rebuilding trust with providers.”

For the third consecutive year, UnitedHealthcare exacerbates its perennial poor showing, ranked worst in all areas of contract negotiations except payment plans.

The payor held firm as the health plan with the most consistently poor reputation among hospitals – and the slowest to pay.

“Honesty and candor represent United’s biggest challenges,” noted Edwards.

“Hospitals year in and year out cite UnitedHealthcare’s low rates, slow payments, bureaucracy, and honesty as reasons for their poor rankings.”

Aetna was given high marks for the best rates, followed closely by Cigna.

“Honesty and easy business dealings seem to matter more than rates,” said Edwards. “Otherwise, Aetna would be the best rated plan in every category.”

This year, independent Blue Cross and Blue Shield (BCBS) plans and Cigna tied for the top favorability spot, with 49 percent.

Last year, Cigna held the spot alone. In this year’s survey, Aetna’s approval rating was 46 percent, followed by Coventry and UnitedHealthcare at 30 percent each, and Humana at 25 percent.

Despite having the lowest rates for three consecutive years, BCBS plans earned top ranking for best overall business practices.

“Independent BCBS plans, however, ranked well ahead of Cigna (30 percent compared to 19 percent) in terms of overall best to deal with, despite having the lowest ranking in payment rates to hospitals,” said Edwards. “For several years in a row, the

survey revealed a complete lack of correlation between payment rates from any payor, and a hospital’s perception of that payor.”

The survey, conducted in partnership with Catalyst Healthcare Research (CHR) and The Godbey Group, is the only one of its kind in the United States to target hospital leaders who negotiate managed care contracts with national health insurance companies. Respondents included CEOs, CFOs, and managed care/payor relations executives who negotiate on behalf of about one-third of the nation’s hospitals.

“The goal of the study is to provide a national perspective of hospital leaders’ opinions of large health plans,” said Edwards, who initiated the survey after noticing a void in payor ratings. “Even though health plans rate hospitals and their physicians routinely, no one was rating the health plans.”

On an optimistic note, nearly half of all participants believe their negotiated rates will improve this year.

Providers have varying strategies for success, with wellness programs a top priority for their employees, and clinical integration a second focal point.

“Hospitals are taking the lead on wellness and population health programs with their own employees,” said Edwards. “Now they need to take that experience and go out to local employers with solutions to keep those employees healthy and costs down.”

Nearly 40 percent of respondents reported their hospital had been in at least one public contract dispute in the past five years that resulted in non-participation. Also, the gap between rates for the largest payor and rates for the second and third largest payors have widened considerably.

“This ‘payor cost shift’ drives up profitability for the biggest plans at the expense of the smaller market share plans,” said Edwards. “That’s proven by the fact that more than one-third of hospitals would fail to meet profit margin goals if all private payor rates were the same as their largest payor.”

Contracting priorities for the upcoming year – the top three are the same as 2012 – involve: 1. Increasing rates with the largest payor.

2. Producing better language protection against denials.

3. Increasing rates with the second and third largest payors.

4. Balancing the threat and opportunity of narrow networks within the hospital’s market.

5. Having better contracting language with the largest payor.

6. Procuring better reimbursement for high-cost drugs, implants and other carveouts.

7. Expediting claims processing and payments.

8. Improving rates for Medicare Advantage plans.

9. Shifting reliance away from the largest payor.

10. Bundling payments for medical home, ACO, or other population health strategies.

SOURCE: ReviveHealth.

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GrandRounds Let’s Give Them Something to Talk About!

Awards, Honors, Recognitions

David B. Dunn, MD, FACS, vice president of Brentwood-based ZHealth, a national firm specializing in interventional coding and compliance, was installed as president of the National Advisory Board (NAB) for the AAPC at its recent national conferDr. David B. ence in Orlando. With Dunn more than 115,000 members, the AAPC is one of the nation’s leading medical coder/ICD-10 advocacy organizations.

Strategic communication firm ReviveHealth took home three 2013 SABRE awards, including Best Boutique Agency to Work For and Issues Management Campaign of the Year, at The Holmes Report’s annual SABRE (Superior Achievement in Branding and Reputation) Awards dinner in New York City last month.

Cynthia Y. Reisz, a member at Bass, Berry & Sims PLC, has been elected to the board of the American Health Lawyers Association (AHLA) for a term to begin in July 2013, Cynthia Y. Reisz following AHLA’s annual

Physician Spotlight, continued from page 3 see Men’s Health Report Card (see box), Penson utilizes his expertise in quality and outcomes research on the national stage.

“I have a number of different roles in D.C.,” he explained. “Within my specialty society, the American Urological Association, I’m chair for health policy.” He was in Washington last month for the National Quality Forum and has a role with the National Institutes of Health on a study section. Penson is also on the national advisory council for AHRQ. When he steps outside of his multiple healthcare duties, he happily joins Jennifer as tandem taxi drivers for their three children — Maya, 13, Ryan, 10, and Keira, 8, who all attend USN. Jennifer, a pastry

chef with a burgeoning events and catering business, occasionally pushes him out the door to the golf course. “My wife likes when I go out and play … she says it mellows me out,” Penson said with a laugh.

His real passion, however, is the Red Sox. “I’m a ridiculous baseball fan. Baseball is a numbers sport, and I’m a numbers guy,” he said, adding that he’s sharing that love of the sport with his own son.

Although he and his family still miss Los Angeles, they have quickly plugged into Nashville. “It’s a great community.

People made us feel welcome here, and it’s a great place to raise kids.” That’s important because of all his multiple titles … the very best ones are still husband and dad.

Making the Grade with the Men’s Health Report Card Working in concert with Meharry, the University of Tennessee, the Department of Health and other stakeholders, David Penson, MD, MPH, also counts chair of the Tennessee Men’s Health Report Card Advisory Panel among his duties at Vanderbilt.

Produced biennially (the next issue will be released in 2014), Penson said the value of the analytical report is to bring awareness to key issues impacting the state of men’s health in Tennessee. Common public health concerns including smoking, obesity, limited seatbelt use and sexually transmitted diseases can’t be addressed effectively unless proper attention is given to the negative outcomes of these problems.

“Our goal was to provide data for the patient, for the advocacy groups, and for the public health groups to go out there and motivate people to change,” he said. “The report card also makes legislators aware of issues that perhaps they hadn’t thought about because in the end we do rely … we being the entire community … on state and federal government to redirect tax dollars to help the community.”

The resulting data has, at times, even caught the experts by surprise.

Penson said he didn’t realize the scope of mental health issues at the outset. “In young men in this state, one of the biggest issues is suicide and depression,” he noted. “One of the things that grew out of the men’s health report card was this desire to let men know there are helplines out there, which I think a lot of men aren’t aware of … just making people aware is a laudable goal.”

When awareness translates into action, everybody wins.

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meeting in San Diego. Reisz is the past chair of AHLA’s Physician Organizations Practice Group and was the chair of the Planning Committee for the 2013 AHLA Physicians and Physician Organizations Institute. She also co-chaired an AHLA task force that wrote a handbook on representing physicians in 2006 and continues to serve as an editor of subsequent editions.

President and CFO of HCA Milton Johnson will serve as co-chairman of the Nashville Area Chamber of Commerce’s Partnership 2020 committee beginning July 1, 2013. He Milton Johnson will co-lead the economic development initiative with Mayor Karl Dean.

Baptist Hospital, Middle Tennessee Medical Center and Saint Thomas Hospital are the only hospitals in Tennessee and among only 18 care facilities in seven states that won recognition from the American Society for Healthcare Engineering (ASHE) of the American Hospital Association for cutting energy consumption more than 10 percent, which not only helps the environment but also allows hospitals to direct more resources to patient care. The Saint Thomas Health facilities reduced emergency consumption by 25 percent at Baptist, 10 percent at MTMC and 15 percent at Saint Thomas Hospital.

On May 20, the 6th Annual HHH Charity Golf Tournament, hosted by architectural firm Earl Swensson Associates, Inc. (ESa), raised $44,480 to support programs for patients and families of Hospital Hospitality House of Nashville.

Last month, the latest Fortune 500 list was released and included nine Tennessee companies … three from the healthcare industry: HCA (#82), Community Health System (#184) and Vanguard Health System (#391).

Ten Middle Tennessee health leaders made the ballot for Modern Healthcare’s 12th Annual “100 Most Influential People in Healthcare.” Voting takes place through June 14 with the honorees, a combination of reader’s votes and editor’s picks, published in the Aug. 26 edition. The 10 from Middle Tennessee are: Richard Bracken (HCA), Bill Carpenter (LifePoint), Jason Dinger (MissionPoint/ STH), John Donahue (Cogent HMG), Charles Martin (Vanguard), Dr. Barbara Paul (CHS), Dr. Jonathan Perlin (HCA), Dan Slipkovich (Capella), Wayne Smith (CHS) and Carl Whitmer (Iasis).

David Hoke, president of The Hoke Company, has been named as chair of the Rutherford Heart Walk, to take place at Middle Tennessee Medical Center on SaturDavid Hoke day, Sept. 14.

OnFocus Healthcare, Inc., a leading provider of healthcare enterprise

performance management solutions, has been named to the “Cool Vendors in Healthcare Providers” by analyst firm Gartner, Inc. OnFocus is one of five vendors evaluated in the report, which recognizes companies that offer innovative and potentially transformative ways for healthcare delivery organizations (HDOs) to respond to the stress that arises from wholesale changes in healthcare systems.

Yasmine Subhi Ali, MD, MSCI, FACC, FACP, of Nashville Preventive Cardiology, PLLC, has been named chair of the American College of PhyDr. Yasmine Subhi Ali sicians’ Tennessee Council of Young Physicians (TCYP). The TCYP was organized in September 2008, and the council is composed of the chair and two representatives from each Tennessee region.

LBMC Security & Risk Services, a division of Lattimore Black Morgan & Cain, PC, earned first place in the recent Symantec Nashville Cyber Readiness Challenge. The Symantec Cyber Readiness Challenge is a competition designed to put participants in a hacker’s shoes to understand their targets, technology and thought processes so they can ultimately better protect their company or clients. The competition took the form of a ‘capture the flag’ style cyber-attack simulation, with players competing against each other in a race to discover hidden vulnerabilities within the testing environment. Not only did LBMC Security win first place overall, members of the team took three of the top five spots.

Guy Appointed CMO of TriStar Centennial Officials with TriStar Centennial Medical Center announced the appointment of Jeffrey Guy, MD, MSc, MMHC, FACS, as chief medical officer last month. Guy joined TriStar Centennial CMO of TriS- Dr. Jeffrey Guy tar Centennial Women’s & Children’s hospital in September 2012 and has been serving as interim CMO of TriStar Centennial since November 2012.

In his current role, Guy will be responsible for overseeing the medical affairs of the comprehensive services at TriStar Centennial Medical Center. He will play a significant role in quality and utilization analysis, as well as policy development and implementation.

His areas of expertise include program development, process improvement activities, burn surgery, trauma surgery, and surgical critical care services.

He is board certified in general surgery and surgical critical care. Prior to joining TriStar Centennial, Guy was director of the regional burn center and acute operative services at Vanderbilt University Medical Center.

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GrandRounds Recent Certifications, Accreditations & Commendations Saint Thomas Hospital has earned disease specific certification from The Joint Commission for its hip fracture program, becoming the first hospital in Tennessee with a certified program.

The program is among only three in the Southeast and 16 nationwide to receive certification.

Riley Taking Sabbatical With few details, a statement issued

by Meharry Board of Trustees Chairman Dr. Frank Royal announced Wayne Riley, MD, president of the medical school would be going on sabbatical for an unspecified time. Cherrie Epps, PhD, was selected by the board Dr. Wayne Riley to serve as interim president in Riley’s absence. A professor of Internal Medicine, Epps previously served as interim president prior to Riley’s hiring 2007. She has held numerous leadership positions with the medical school.

Haslam Tapped to CoChair NGA Health Care Sustainability Task Force As lawmakers at both state and federal levels of government look for ways to improve the quality of healthcare and reduce the costs of public programs, governors are developing innovative Medicaid programs as they seek to retain flexibility in impleGov. Bill Haslam menting these measures.

In late May, the National Governors Association (NGA) announced the members of a new Health Care Sustainability Task Force (Task Force). Co-chaired by Tennessee Gov. Bill Haslam and Oregon Gov. John Kitzhaber. The governors of Alabama, Arkansas, California, New Mexico, New York, South Dakota, Utah and Vermont will serve on the committee. NGA Health and Homeland Security Chair Maryland Gov. Martin O’Malley and Vice Chair Nevada Gov. Brian Sandoval will serve as ex-officio members.

“Governors are working in their states to find ways to cut costs when it comes to healthcare,” said Haslam. “It is our responsibility to examine every possible option in an effort to make sure promising new initiatives can be fully utilized.”

Buntin to Chair New Vanderbilt Department of Health Policy Melinda Buntin, PhD, deputy assistant director for health at the federal Congressional Budget Office, has been named chair of the newly created Department of Health Policy at Vanderbilt University Medical Center. She will begin her work with VUMC in August.

The new department represents a reorganized and growing version of the nashvillemedicalnews

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Department of Preventive Medicine, chaired for 31 years by William Schaffner, MD, who will continue his VU teaching and his work with the emerging infections program, a population-based network including the federal Centers for Disease Control and Prevention and state health departments.

At the CBO, Buntin has been responsible for managing and directing studies of healthcare and healthcare financing issues in the office’s Health, Retirement and Long-Term Analysis Division. Previously, she was deputy director of RAND Health’s economics, financing and organization program, director of public sector initiatives for RAND Health, and co-director of the Bing Center for Health Economics.

Buntin has an AB from the Woodrow Wilson School at Princeton and a doctorate in health policy with a concentration in economics from Harvard.

Steven Holman Joins Centerstone as CFO

This spring, healthcare industry veteran Steven Holman joined behavioral health provider Centerstone as chief financial officer.

One of the nation’s largest not-for-profit providers of communitybased mental health and Steven Holman addiction services, the position is new to the company. As CFO, Holman will direct fiscal operations for Centerstone of America and each of its companies, including assessing the organization’s performance, overseeing financial reporting and developing long-term strategies and annual budgets across operations in Indiana and Tennessee.

With three decades of finance and management experience, Holman most recently served as CFO at Nashville-based Precedent Health, Inc. Previous experience include work with Heritage Health Systems/Universal American Corp. where he was CFO for the Medicare Advantage HMO division with operations in several states and executive management positions in finance at Lakeside Community Health, FHP International Corporation and Deloitte & Touche. Holman received his bachelor’s degree from the University of Southern California Marshall School of Business.

Arteaga to Lead Major New Cancer Research Initiatives at Vanderbilt Carlos L. Arteaga, MD, professor of Medicine and Cancer Biology, has been appointed to a leadership role of two newly created cancer research initiatives at Vanderbilt-Ingram Cancer Center. He has been named the founding director of the Center for Cancer Targeted Therapies (CCTT) and director of the Vanderbilt-Ingram Cancer Center Research Network (VICCRN).

The CCTT is an extension of the Cancer Center’s expertise in personalized medicine. Through the VICC Per-

sonalized Cancer Medicine Initiative, translational and clinical investigators focus on genomic signatures in a patient’s tumor and use that information to match the patient to a targeted therapy. The overall goal of the new initiative is to integrate the “first-in-man” drug development efforts at VICC with state-of-the-art molecular profiling of tumors and novel imaging approaches that predict drug action and efficacy. The net outcome of this integration will be an expansion of VICC clinical trials that should contribute to faster approval of new, targeted drugs and combination therapies for cancer patients. The CCTT will place renewed emphasis on the Phase I clinical trials program and will create more research and training opportunities for basic, translational and clinical investigators.

The new VICCRN will create a regional cancer research consortium by providing clinical research opportunities between VICC investigators and affiliate partners in Tennessee and surrounding states. As director, Arteaga will work closely with leaders of the healthcare systems that provide care to thousands of cancer patients in the region.

Arteaga currently serves as associate director for Clinical Research, director of the Breast Cancer Program and leader of the Breast Cancer Specialized Program of Research Excellence (SPORE) in the cancer center. He was recently named president-elect of the American Association for Cancer Research (AACR) for 2013-2014.

Murfreesboro Medical Clinic, TOA Offer Innovative New Options for Back Pain Murfreesboro Medical Clinic and SurgiCenter, an independently owned physician clinic with more than 20 different specialties, became the first practice in Tennessee to implant a next generation spinal cord stimulator called Precision Spectra™, which is designed to provide relief to a wide range of chronic pain patients.

Spinal cord stimulation (SCS) may be prescribed for chronic intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated with failed back surgery syndrome, intractable low back pain and leg pain. Precision Spectra is the world’s first and only SCS device with 32 contacts and 32 dedicated power sources, which expands the level of coverage across the spinal cord and provides greater flexibility for physicians to treat chronic pain. William Newton, DO, a board-certified physical medicine and pain management physician, performed the procedure.

TOA recently announced spine surgeon Juris Shibayama, MD, is utilizing a new technique during minimally invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) spine surgery, providing relief to patients suffering from life-alternating lower back and leg pain. Back pain is the second most common reason for seeing a physician in the United States.

Spring Hill’s First Comprehensive Cancer Care Center Opens In late April, Tennessee Oncology, the state’s largest community oncology practice, became the first comprehensive cancer care provider in Spring Hill with the opening of a new clinic specifically designed to serve the growing community.

“Tennessee Oncology’s focus has always centered on providing local, academic quality medicine in the communities where our patients live, and we are pleased to bring superior oncology services to Spring Hill,” said Jeff Patton, MD, Tennessee Oncology CEO. The new clinic was designed with the needs of oncology patients and their families in mind, improving pathways to care and providing all services in one convenient location. The clinic boasts comprehensive onsite services including chemotherapy and injection treatment, lab services and the availability of clinical trial participation through a partnership with Sarah Cannon Research Institute. Spring Hill patients also have access to Park Pharmacy – Tennessee Oncology’s in-practice pharmacy specializing in oncology and hematology medicines not commonly carried in other local pharmacies.

Ruth Lamar, MD, a medical oncologist with Tennessee Oncology, will oversee coordination of patient care at the Spring Hill clinic. Lamar, who joined Tennessee Oncology in 2005, specializes in all adult malignancies and is board certified in Medical Oncology and Internal Medicine. She completed medical school at the University of Tennessee and her internship, residency and fellowship at Vanderbilt University.

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GrandRounds Middle Tennessee’s Primary Source for Professional Healthcare News

News from Simplex Healthcare & Diabetes Care Club In late May, Franklin-based Simplex Healthcare announced COO Michael Iskra had been named the company’s new chief executive officer effective July 1. Iskra, who has served in his operations role since 2010, was unanimously chosen by the company’s board of directors to succeed Douglas Hudson, Simplex’s founder. Hudson will remain with the company as board chairman. Simplex, which operates under the brand Diabetes Care Club, has grown to become the third largest diabetic testing supply provider in the nation.

Last month, Hudson announced Diabetes Care Club had acquired Priority Diabetes Supply, Inc. As a result of the acquisition, Diabetes Care Club is now one of 18 providers in the nation with a contract from the Centers for Medicare and

Medicaid Services national mail-order competitive bidding program to distribute diabetic testing supplies to Medicare beneficiaries. The contracts go into effect July 1.

“The acquisition of Priority Diabetes Supply allows us to continue serving our current patients, while also offering a new home to patients who must move from their existing provider to one that has been approved and contracted through the competitive bidding program,” Hudson said.

In conjunction with the acquisition, the company also announced it has entered into an agreement with Roche Diagnostics Corporation to distribute its line of ACCU-CHEK products to Medicare recipients, ensuring that patients affected by the competitive bidding program are still able to find these supplies and receive uninterrupted service.

Webber Named Director of Family Staffing Solutions’ Nashville Office Trey Webber has been named director of the Trey Webber Nashville office for Family Staffing Solutions. In her new role, she will oversee client services in Davidson County for the personal care assistance company. Additionally, she will be responsible for overall operations including company expansion and management of office staff and caregivers.

Previously the scheduling coordinator for Nashville, Webber brings several years of retail sales and management experience to her new position. She spent several years working at her family’s luggage and gift store, Nashville Trunk and Bag Co. A Nashville native, Webber is a 1988 graduate from the University of Tennessee – Knoxville.

HCA Appoints Lamont to Board of Directors

TriStar StoneCrest Offers Higher Level of Care for Preemies with New NICU On May 20, TriStar StoneCrest Medical Center announced the opening of its new Neonatal Intensive Care Unit (NICU). The family-centered unit is designated a Level IIB nursery by the State of Tennessee, providing a higher level of care for premature and critically ill infants. Located on the first floor, the hospital invested $3.5 million to construct and equip the new 8-bed, 1,629 square-foot unit.

TriStar StoneCrest can now provide additional services to care for expanded types of complications in premature infants, including ventilator support services for brief periods. Other features include a family bonding room, breast-feeding support by a certified lactation consultant and new patient monitoring equipment. The specially trained obstetricians, nurses, respiratory therapists and other healthcare professionals will provide care for babies born as early as 32 weeks gestation and as smalls as 3.3 pounds.

HCA Holdings, Inc. announced last month that Ann Huntress Lamont, managing partner of Oak Investment Partners, has been named an independent director of HCA’s board, effective immediately. With her addition, HCA’s board of directors Ann Huntress Lamont increases from 13 to 14.

Lamont will also serve as a member of the company’s Compensation Committee and Nominating and Corporate Governance Committee.

Lamont leads the healthcare and financial services information technology teams at Oak Investment Partners. Her industry expertise includes enterprise software and services, healthcare, information technology and financial services.

Not So Transparent A recent report by Health Care Incentives Improvement Institute and Catalyst for Payment Reform gave Tennessee a failing grade when it comes to healthcare pricing transparency. The group recently evaluated state laws to determine how much price information is reported by providers and how easy that information is for consumers to access. .

Aspen Dental Opens New Practice in Clarksville Clean Secure Climate-Controlled

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Last month, Aspen Dental opened a new office in Clarksville at 2702 Wilma Rudolph Blvd. The practice, led by Hung Tran, DDS, will provide dental services ranging from dentures and preventive care to general dentistry and restoration.

Tran received his DDS from New York University College of Dentistry, which included a yearlong fellowship in oral and maxillofacial surgery. He also completed internships in oral and maxillofacial surgery at Emory University in Georgia and at Jacobi Medical Center in New York.

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SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains Nashville Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

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GrandRounds UNHS Reopens Waverly Family Clinic United Neighborhood Health Services (UNHS) celebrated the reopening of the Waverly Family Clinic with a community party on Friday, May 10. The clinic, located on 12th Avenue South, was closed after sustaining damage following severe weather that swept through the area in late January. Straight-line winds ripped part of the clinic’s roof away, allowing several inches of rainfall to inundate the building. The storm damage required approximately $65,000 in repairs.

While repairs were underway, patients were successfully moved to other UNHS clinics and, thanks to electronic recordkeeping, the transition was an easy one.

The Waverly Family Clinic typically sees approximately 5,500 patients annually.

“We are so happy to have the Waverly Clinic up and running again,” said Mary Bufwack, CEO of UNHS. “This experience has taught us so much about

the value of teamwork, and we appreciate the support of the community as we’ve worked to make this resource available again.”

digiChart Changes Name to Artemis Last month, Nashville-based digiChart, Inc., which specializes in mobile patient engagement and specialty-specific technology solutions for OB/GYN physician practices, announed a name change to Artemis. For more information, go online to artemisobgyn.com.

cal, occupational, and speech therapy services. Additionally, other services will include outpatient therapy, nursing case management for patients transitioning from Signature’s ExceleratedCARE Unit back home, and home and communitybased services. The 70,000 square-foot building includes nearly 28,000 square

feet of renovated space and a new 42,000 square-foot acute rehabilitation addition.

The center includes 50 private rooms with in-room showers. The new facility also has a spacious therapy gym, Internet cafe, theater rooms and a chapel. Addition of an amphitheater is planned for a later date.

Vanguard Health Systems to Implement Omnicell G4 Unity Platform Omnicell, Inc., headquartered in California but with offices in Nashville, recently announced the company has been named the exclusive provider of medication management solutions for Nashville-based Vanguard Health Systems, which operates 28 acute care and specialty hospitals in five major metropolitan areas. Omnicell G4 Unity platform solutions were chosen to help Vanguard standardize systemwide medication management processes, better manage inventory control and improve clinical outcomes.

Signature HealthCARE Opens $17M Rehab & Wellness Center Recently, Signature HealthCARE completed construction on the 119-bed, $17 million Signature of Nashville Rehabilitation and Wellness Center. Located on Wedgewood Avenue, the center offers skilled nursing in conjunction with physi-

Tennessee First Lady Joins Grover, UnitedHealthcare to Encourage Reading, Fitness & Healthy Food Choices Sesame Street’s Grover, UnitedHealthcare Community Plan of Tennessee CEO Scott Bowers and Tennessee First Lady Crissy Haslam play a game with kindergarten and pre-K students at Buena Vista Enhanced Option School that teaches the difference between a “sometimes food” and an “anytime food.” The May 14 event featured a series of interactive lessons, integrating the complementary missions of the First Lady’s Read20 Book Club, Sesame Street’s Food for Thought: Eating Well on a Budget program and UnitedHealthcare’s commitment to helping Tennesseans live healthier lives through education on nutrition, fun and fitness activities. Photo credit: Photo courtesy of state of Tennessee.

HealthTech Opens New Headquarters in Franklin HealthTech, a healthcare information technology management company, officially celebrated the grand opening of its new corporate headquarters on Carothers Parkway on May 15. The new location provides HealthTech the additional space needed as the company continues its rapid growth and hiring. Healthcare Management Systems (HMS), MEDHOST and Patient Logic, which HealthTech manages, were part of the relocation and in total employ more than 550 people.

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615.320.0225 www.clcpas.com Participating the ribbon cutting were (L-R) Allen Borden, Assistant Commissioner, Tennessee Department of Economic and Community Development; Rogers Anderson, Williamson County Mayor; Dr. Ken Moore, City of Franklin Mayor; Matt Largen, President & CEO of the Williamson County Chamber of Commerce; Bill Anderson, President & CEO of HealthTech; Steve Starkey, President of HMS; and Craig Herrod, President of MEDHOST.

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