FOCUS TOPICS AUTOIMMUNE DISORDERS COMMUNICATIONS MODELS
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PHYSICIAN SPOTLIGHT PAGE 3
Hyatt Sutton, MD
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Assembling the Pieces: The Challenges of Autoimmune Diseases By MELANIE KILGORE-HILL
Highlights of MedTenn 2013 Physicians Tackle Tough Issues & Celebrate AwardWinners, New Leaders at Annual Meeting Last month, physicians from across the state gathered in Franklin, Tenn. for the Tennessee Medical Association’s 178th annual meeting ... 4
Crisis Mode People will talk. There are few givens in life, but one thing you can count on is that bad news travels fast. Clearly articulating your message can prove challenging under the best of circumstances. When operating in crisis mode, effective communication is crucial … yet nearly impossible if you haven’t given adequate forethought to your information-sharing plan. ... 10
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Endometriosis, type 1 diabetes and rheumatoid arthritis all fall under the oversized patio umbrella of autoimmune diseases – a dizzying list of 80-plus diagnoses that affect some 50 million Americans, or 20 percent of the population. While symptoms can haunt patients for years before a diagnosis is made, physicians are tasked with identifying and treating these potentially life-threatening conditions in their earliest stages. So just how does a doctor navigate the rocky waters of autoimmune disease?
Understanding Autoimmunity
Under normal conditions, an immune response cannot be triggered against a body’s own cells. However, in certain cases, immune cells mistakenly attack the very cells they’re meant to protect. And because symptoms are initially intermittent, diseases (CONTINUED ON PAGE 9)
None of the Above
Governor Selects “Third Choice” on Medicaid Expansion By CINDy SANDERS
100,000), or have no viable coverage solution in the absence of Medicaid expansion or acceptance of the Tennessee Plan. The Kaiser Commission has placed that last group at 370,000 Tennesseans with the state estimating approximately 181,000 would have been expected to enroll in an expanded TennCare program over the next 5.5 years had the governor opted to go in that direction.
When it came time to expand TennCare rolls to cover those up to 138 percent of the federal poverty level (FPL) or decline the offer that included a hefty federal match, Governor Bill Haslam opted for ‘none of the above.’ Instead, the state leader chose to put forth a third option he has dubbed the Tennessee Plan. Current estimates count a little more than How We Got to this Point 925,000 people in Tennessee among the uninsured. As written, the Affordable Care Act (ACA) sought Of that group, approximately 475,000 should qualto significantly reduce the number of uninsured ify for subsidies available to those between 100-400 Americans through the individual mandate requirGovernor Bill Haslam percent FPL in the new insurance marketplace. The ing coverage (with subsidies on a sliding scale to make balance of the uninsured either earn too much to resuch coverage more affordable) and by expanding ceive subsidies (an estimated 50,000 Tennesseans), or are currently Medicaid rolls. In 2012, the Supreme Court upheld the individual eligible but not enrolled in TennCare (estimates vary from 60,000(CONTINUED ON PAGE 6)
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PhysicianSpotlight
Frist Humanitarian Hyatt Sutton Shares Skill, Medicine At Home & Abroad Most physicians have that “aha!” moment when they just know that medicine is their career choice. For Hyatt Sutton, an internist with The Frist Clinic at TriStar Centennial Medical Center, that moment came during his senior year of high school when his mother was diagnosed with a spinal tumor. She made it through the surgery just fine, and Sutton bonded with her neurosurgeon, who encouraged the teen to consider Harding University in Searcy, Ark. because of its strong pre-med program. Sutton said he “fell in love” with the small, private, Christian-oriented university where he chose to earn his bachelor’s degree. Although his mother’s experience solidified his decision, choosing a career in medicine wasn’t unexpected. Sutton’s father, Frank, is a retired pulmonary and critical care physician “who prided himself on being an internist,” Sutton said. “I grew up on Sundays after church going with my father to the hospital and making rounds with him. That’s what first got me interested in medicine … the way that people responded to him and his impact on people’s lives.” Sutton was born in Memphis and grew up in Birmingham, Ala., with an older sister, Susan, and a younger brother, Spencer. “My main deal was playing sports growing up,” he recalled. When it was time for medical school, he returned to his hometown and attended the University of Alabama at Birmingham. A residency at Vanderbilt University, his father’s alma mater, is what brought him to Nashville – and he never left. After a short stint with the Veterans Administration Medical Center, Sutton joined an internal medicine practice associated with Saint Thomas. Three years later, he and one of his colleagues, David Allen, MD, moved to The Frist Clinic. Sutton sees patients in clinic every working day, he said, yet he begins his mornings making hospital rounds. “I still see my own patients in the hospital,” he said. “It’s a dying group of us, I know, but that’s when you want your doctor there.” Sutton puts that compassion to work as the chair of Centennial’s medical ethics committee. “It’s very challenging. A lot of it deals with termination-of-care issues and when family members may disagree about what’s best for their loved one at the end of life,” he explained. The committee of about 30 members includes physicians, nurses, social workers, lawyers and pastors, who together tackle these thorny issues and others, such as when a patient’s religion precludes the use of blood products. Sometimes physicians nashvillemedicalnews
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PHOTO COURTESY OF HCA CENTENNIAL MEDICAL CENTER
By SHARON H. FITZGERALD
will turn to the committee for help when they believe the treatment of a patient is futile. “What you find most is that the key to almost all these issues is just really good communication with family members,” Sutton said. “If they trust the physician who tells them, ‘We’ve done everything we can. We can continue, but the outcome is going to be the same. We need to focus now on more comfort care,’ then people are receptive. It’s all about trust.” Sutton acknowledged that his strong Christian faith guides him in discussions with patients and family. That same faith is behind his support of a nonprofit organization, Neverthirst, co-founded by his brother in 2008. The mission of Neverthirst is a simple one: to provide clean drinking water in some of the globe’s most impoverished regions. What makes Neverthirst unique
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is that the water is supplied to villages by partnering with local churches. “So the local churches get credence and, thus, they are more credible when they give their message,” Sutton said. Neverthirst is Christian-based, spreading the Gospel’s Living Water along with clean drinking water and medical care when possible. The organization has worked in India, the Central African Republic, South Sudan, Cambodia and Nepal. Sutton, who most recently was in the Central African Republic in September 2012, has been to India twice and to South Sudan. His sister, mother and father have crossed the globe on behalf of Neverthirst, too. “My father was in retirement, but we put him back to work practicing medicine,” Sutton said. What they found in all the locales were children dying of diarrhea, cholera and other water-borne stomach illnesses. “The thing that you really see is the poverty and just the brokenness of our world. Children are dying from completely preventable illnesses. It’s just heartbreaking,” he said, noting that the families in these remote locations are so receptive to the
help. “That’s the great thing about my job – you can take your skills and do it anywhere in the world,” he said. That attitude is why Sutton was the physician recipient of the 2012 Frist Humanitarian Award, presented in March. Two years ago, Sutton took his oldest son, Mason, to India. Mason is now 20 and a student at the University of Tennessee – Knoxville, majoring in kinesiology. The middle child, Grady, 17, is next on the list for a Neverthirst trip to either Sudan or India. “While we’re out there, I’ll practice medicine, but we’ll go to villages that are targeted for needing water. If they have a well that needs repair, we’ll repair it. We’ll talk to the people about their circumstances and hardships, too,” said Sutton, who even occasionally preaches. Sutton and his wife of 23 years, Jodi, are also the parents of 13-year-old Macaully. The couple met at Harding University. Jodi has a background in teaching at the pre-school level but spends most of her time as busy mom. The Suttons are members of Harpeth Hills Church of Christ, which supports the Neverthirst mission.
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Highlights of MedTenn 2013 Physicians Tackle Tough Issues & Celebrate Award-Winners, New Leaders at Annual Meeting By CINDY SANDERS
ognize symptoms of underlying mental illness, useful resources for physicians and patients, and ways the medical community can help reduce the stigma associated with mental health issues. Other sessions focused on the Controlled Substance Abuse Monitoring Database (CSMD) and new requirements that went into place April 1, ways the Direct Project Exchange could help with clinical care coordination, updated information on federal e-prescribing and the Physician Quality Reporting System, the “Choosing Wisely” campaign to avoid unnecessary medial tests and procedures, and updates on telehealth. Additionally, HCA’s Julie Appleton, CCS-P, CPC, CPC-H, led a session on the impending conversion to ICD-10, which is less than 18 months away. For those who were unable to attend the April meeting, the TMA is also launching the next phase of its ICD-10 Roadshow — with experts crossing the state this month to help providers, practice administrators, coding and billing specialists, IT consultants and others prepare for the Oct. 1, 2014 implementation deadline. The program, which is sponsored by BlueCross BlueShield of Tennessee and Emdeon, features expert help with coding and documentation compliance issues, testing timelines, dual processing procedures, minimizing payment delays, choosing implementation tools and creating a workable approach to the transition. For specific dates, registration and more information, go online to www. tnmed.org/icd-10/roadshow.
Last month, physicians from across the state gathered in Franklin, Tenn. for the Tennessee Medical Association’s 178th annual meeting. MedTenn 2013 included spirited discussion regarding a number of tough clinical and policy issues, continuing education on topics ranging from the state’s prescription drug epidemic to preparing for ICD-10, recognition of outstanding physicians, and a celebration of new leadership. The theme of the 2013 meeting was ‘Engage, Empower, Evolve.’ Members were encouraged to engage in networking opportunities with colleagues, to A distinguished club … former TMA presidents gather for a group photo each year at the annual meeting. empower themselves by learning from industry experts and to egates voted to support efforts to increase porting the required posting of patient evolve their practices and outlook in the state and federal money for mental health out-of-pocket costs for prescription drugs face of dramatic change within the healthscreenings and treatment in Tennessee. and for hospital charges. care industry. Maternal Mortality Review: The Medical Education & Physician HOD voted to support the establishment Involvement: The HOD voted to petiHouse of Delegates of a peer review-protected and HIPAAtion the national association to work with Access: The House of Delegates compliant maternal mortality review proCMS and other federal authorities to re(HOD), TMA’s governing body, voted to cess under the auspices of the Tennessee move onerous language from the guidesupport access to affordable healthcare for Department of Health to review maternal lines on care by physicians-in-training. all Tennesseans and has instructed TMA deaths in the state and make recommendaAdditionally, the Tennessee delegation members and leadership to make themtions for systemic changes to improve outpetitioned the AMA for requirements that selves fully available to the governor and comes and services to women in Tennessee. recognize more accurate documentation Tennessee Legislature to advocate for of care while allowing the profession to healthcare coverage. resume educating future colleagues in a Following a passionmore cost-effective and cost-efficient manate debate on mechanics ner. and long-term financial burden, the governing Educational Sessions body voted in favor of a A number of industry experts led eduthree-year trial to increase cational sessions and addressed the memaccess by using Medicaid bership during the two-day MedTenn expansion funds either to event. Keynote speaker and bestsubsidize uninsured resiselling author Robert Stevenson dents in the purchase of delivered his address on “Change in health coverage through Health Care. Tennessee Commisthe federal insurance exsioner of Health John Dreyzehner, changes or through diMD, and colleague Michael Warren, rect Medicaid expansion MD, discussed the state’s epidemic (although Gov. Haslam of prescription drug abuse and the has ruled that option out growing incidence rate of Neonatal at this point). Further, Abstinence Syndrome in Tennessee. the HOD stressed an The duo also discussed what physiinsistence that benefits Dr. John Dreyzehner, Commissioner of the Tennessee Department of Health, talks about the toll prescription drug abuse is taking on the health of cians could do to help prevent NAS purchased through the Tennesseeans. TMA successfully lobbied for passage of the Safe Harbor Act in newborns. In another session, exchange be comparable this year to help improve outcomes for infants born to drug-addicted mothers. Roland Gray, MD, hosted the oneto TennCare benefits. hour course “Epidemic: Prescribers’ “As physicians, our Cosmetic Surgery: Two resoluResponse to Tennessee’s Rx Drug patients must come first,” said Christotions were passed in reference to growing Crisis.” The CME program focused pher Young, MD, the Chattanooga physiaesthetic services offered in Tennessee. on proper prescribing of pain medician installed as the TMA’s 159th president The first is to pursue expansion of the cation and responsible management Passing of the gavel - TMA President Dr. Christopher Young during the recent meeting. “Increased acdefinition of the practice of medicine to of pain clinics and included informa- (L) receives congratulations from Dr. Wiley Robinson, the cess leads to better health outcomes. Our include any surgical procedure for costion on complying with new pain association’s outgoing president, at MedTenn 2013. policy is to support efforts to make affordmetic or aesthetic purposes. The second clinic laws. able healthcare more accessible, which is resolution supports efforts to prevent unIn other sessions, Rahn Kenpart of the TMA’s core mission.” licensed and unsupervised cosmetic surginedy Bailey, MD, chairman of the DeIndigent Care: Delegates also reNew Leadership cal procedures through legislative action partment of Psychiatry at Meharry affirmed the importance of physicians Christopher E. Young, MD, was and enforcement by the Board of Medical Medical College and president of the providing free and reduced-cost care to installed as the 159th president of the TMA Examiners. National Medical Association, discussed indigent patients and directed TMA to on April 6. The Chattanooga anesthesiHealth Cost Transparency: Delthe need to better integrate mental health support and promote such activities. ologist will serve on the TMA Board of egates passed separate resolutions supinto daily practice. He shared ways to rec(CONTINUED ON PAGE 5) Mental Health Screening: Del4
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Trustees, which is responsible for the direction and implementation of association activities between sessions of the HOD. Throughout the next year, Young will be the public spokesperson and representative of the association’s nearly 8,000 physician members. Young has served as a delegate to the TMA from the Chattanooga-Hamilton County Medical Society since 2006 and was elected to the TMA Board in 2007. In 2009, he served as treasurer of the state association’s Executive Committee. In addition to being active in his local physician chapter, Young is a past president of the Tennessee Society of Anesthesiologists and served as a delegate to the national association’s HOD. Board-certified in anesthesiology with specialized training in cardiovascular anesthesia and pain management, Young practices at Erlanger Medical Center with Anesthesiology Consultants Exchange. He graduated with honors from the University of Tennessee-Knoxville and received his medical degree from Georgetown University School of Medicine. Young is a founding board member for the Signal Mountain-based American Haitian Foundation and is responsible for establishing the first solar/wind-powered school in Haiti. Additionally, he has been involved in surgical mission work in Central and South America for two decades and led a surgical team to Haiti immediately following the devastating 2010 earthquake. Young is a former assistant professor of anesthesiology at the State University of New York (SUNY) Health Science Center in Syracuse and was the recipient of the Robert D. Dripps, MD, Memorial Award for Outstanding Graduate Resident in Anesthesiology in 1989. Other leaders installed for the 20132014 term were: Douglas J. Springer, MD, a gastroenterologist from Kingsport, was installed as president-elect and will sit on the TMA Board of Trustees. Keith G. Anderson, MD, a Germantown cardiologist, has been reappointed as chairman of the TMA Board. Bob Vegors, MD, an internal and geriatric medicine specialist from Jackson, has been installed as the new vice-chairman of the TMA Board. James “Pete” Powell, MD, an internal medicine and pediatric physician from Franklin, was reappointed as the TMA’s secretary/treasurer.
Middle Tennessee Honorees
Two Nashville physicians were recognized for their outstanding service to patients and the community during MedTenn 2013. John Lamb, MD, was honored with the Outstanding Physician award, which is presented annually by the TMA HOD to member physicians who have made their personal mark on the profession. Nominated by the Nashville Academy of Medicine (NAM) for his four decades of service to patients as an orthopaedic surgeon and for his dedication to the community, Lamb co-founded the Faith Family Medical Clinic in Nashville nashvillemedicalnews
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alongside colleague David Gaw, MD. He is an active volunteer specialist and board member for the clinic, which has served more than 20,000 low-income, uninsured Nashvillians since 2001. Lamb also serves on the board of the Nashville Rescue Mission, where he has volunteered monthly for two decades. A former chair of the Nashville Chapter of the Arthritis Foundation, Lamb received that organization’s Volunteer Distinguished Service Award in 1999. More recently, he was honored with a Health Care Heroes Lifetime Achievement Award from the Nashville Business Journal in 2012. A past TMA delegate, Lamb has held numerous leadership positions with NAM
and is active in a number of medical societies. Cathy Self, PhD, was recognized as the TMA Community Service Award honoree. Self serves as president and CEO of the Baptist Healing Trust, a private grant-making foundation that supports the work of Middle Tennessee nonprofits providing health services to underserved populations. In nominating her, NAM cited Self’s passion and advocacy on behalf of each organization funded by the Trust. In addition to the numerous organizations that benefit from the Trust, Self is credited for leading and expanding her organization’s “Caring for the Caregiver” program that addresses the emotional,
mental and spiritual needs of caregivers and medical professionals. “Thousands of lives have been changed as a result of Cathy’s leadership and her commitment to compassionate care,” noted NAM President Michael McDonald, MD. A physical therapist and home health professional by training, Self has served in a number of leadership roles for Saint Thomas Health Services. She began working with Baptist Health Trust as a consultant in 2005, was named senior vice president in 2007, and became CEO in 2010.
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None of the Above, continued from page 1 mandate but decided states could not be forced to accept a federal edict to expand Medicaid programs. Since the law was created with both parts of the equation in place, the Supreme Court’s decision to uphold one but strike down the other has left a gaping doughnut hole for citizens with the greatest need … non-pregnant, non-disabled adults under the age of 65 without minor children who are below 100 percent of FPL. “In the ACA provisions, anybody between 100 and 400 percent of poverty level could shop the exchange and get premium assistance,” explained Beth Uselton, program officer overseeing ACA outreach and planning for the Baptist Healing Trust. “The law assumed anyone who was under the 100 percent FPL income thresh- Beth Uselton old would get coverage through expanded state Medicaid.” The Supreme Court decision last summer left the lowest income group without any guaranteed assistance to secure coverage, explained Uselton. For states that opted to expand Medicaid, the federal government will cover 100 percent of costs for the newly enrolled population from 2014-2016, phasing down to 90 percent by 2020 where the match rate is slated to remain. This rate is still significantly higher than what states receive for current Medicaid enrollees, which is 65 percent for TennCare participants. In the FY 2014 budget presentation prepared by Darin Gordon, Wendy Long, MD, and Casey Dugan of the Tennessee Health Care Finance Administration (HCFA) and released prior to the governor’s decision on expansion, the group estimated “the net cost of health reform to the state could be approximately $1.2 billion over the first five-and-a-half years
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(Jan. 1, 2014-June 30, 2019) depending on programmatic/policy decisions.” However, the report added, “The majority of that cost is unavoidable and will be incurred by the state regardless of its decision on Medicaid expansion.” The vast majority of that increased cost over 5.5 years comes from the “Eligible but not Enrolled” (EBNE) population … those who currently qualify for TennCare but who haven’t been on the rolls. This group will pull down the current 65 percent match rate. The mandate requiring most individuals to carry coverage … coupled with screening tools in the online insurance marketplace that alert individuals to Medicaid eligibility … is anticipated to drive between 60,000100,000 EBNE individuals to TennCare. The other significant cost to the state is a new excise tax on health plans that includes Medicaid managed care plans. Had the state opted to expand TennCare to the 138 percent FPL threshold, the HCFA budget report estimated an additional $200 million in costs to the state over the next 5.5 years (state portion of coverage after 2016) and potentially an additional $100 million annually thereafter presuming the 90 percent match rate for the expanded population stayed in place … and perhaps significantly more if the federal government reduced their payment portion in the face of budget pressures down the line. On the flip side, saying ‘no’ to the expansion means Tennessee turns down billions of dollars in federal funds over the next few years. The Tennessee Plan In announcing his decision on March 27 to say ‘no’ to TennCare expansion, Gov. Haslam unveiled his ideas of how to insure those who would otherwise be left out of coverage assistance. He said expanding a broken Medicaid system doesn’t make sense for Tennessee. “That’s why I’ve been working toward a third option: to leverage the federal dollars available to our state to transform healthcare in Tennessee without expanding our TennCare rolls,” he stated. “I’d like to put in place a program to buy private health insurance for Tennesseans that have no other way to get it by using the federal money. I fundamentally believe that people having healthcare coverage is better for our citizens and state than people not having coverage.” The plan, which he said could cover up to 175,000 Tennesseans, calls for “copays for those that can afford to pay something so,” as the governor put it, “the user has some skin in the game when it comes to healthcare incentives.” He added the state would work with providers to lower the cost of care and move toward a payfor-performance model. He also said the plan would have a definitive sunset that could only be renewed with the blessings of the General Assembly when the federal funding decreased. During the period of 100 percent federal coverage, Gov. Haslam said there was a window of opportunity to implement true payment reform and reduce costs by working with the
healthcare industry. “We’d have a one-time opportunity to encourage their cooperation because healthcare providers will know that for the next three years, a portion of the population which had previously been receiving services with no reimbursement to the hospitals or doctors will now have insurance. But those same providers would clearly know that coverage for that population will go away unless they can prove to us that at the end of three years, when we start paying a percentage of the costs of the new population, our total costs would stay flat,” he said. The Reaction When the ‘no expansion’ decision was announced, Craig Becker, president of the Tennessee Hospital Association, released a statement noting his organization’s disappointment that the governor didn’t feel like he was able to get the information and assurance necessary from the Craig Becker Centers for Medicare & Medicaid to move forward but supportive of the Tennessee Plan. The need to get more people covered, however, is of critical importance to state hospitals. In negotiating ACA, hospitals gave up a significant chunk of funding with the expectation that most Americans would have insurance coverage. Without the expanded Medicaid rolls, however, a large portion of the population will remain uncovered and unable to pay for services. “We’re giving away about $1.4 billion a year in cost to care for indigent people who are uninsured,” said Becker, stressing that figure was in hard costs rather than billable fees. “That’s our Achilles’ heel … the uncompensated care is the key to this whole thing.” Although hopeful Gov. Haslam and CMS will come up with a consensus that the General Assembly will then approve, Becker said the alternative holds grim prospects for not only the hospital industry but also the state’s economy. “We’ve already seen one hospital close, and that’s Scott County,” noted Becker. “That’s a small rural hospital, and there are some who say it should close; but I don’t think the people of Scott County would agree.” He added that like most hospitals, the northeastern Tennessee facility was a major employer for the county. “Healthcare provides a lot of jobs and good paying jobs. If you had any other industry with job losses like this, there would be a huge hue and cry,” Becker noted. Without expanding coverage, he said the THA anticipates additional contraction within the state’s healthcare field. The economic factor, however, is only a part of the bigger picture, Becker said. Those with insurance, he noted, tend to be healthier because they receive primary care services and help managing chronic conditions. One of the biggest frustrations, however, would be losing access to federal funds if a deal isn’t struck soon.
“We’re already paying for this,” Becker said of the dollars the state would pass up if CMS doesn’t approve the Tennessee Plan. “It’s a redistribution of taxes. We’re getting cut $5.6 billion over 10 years,” he continued of money being diverted from the state’s hospitals under ACA. “So those dollars are going to D.C. Then, they distribute them to those who participate (in Medicaid expansion). Why should we send our dollars to California and New York when they should stay here in Tennessee?” he questioned. Becker added the THA is very open to the governor’s option but nervous that the state could lose an entire year of funding that would provide a necessary cushion while healthcare professionals make the changes in payment models and costcutting requested by Gov. Haslam. “If we’ve got the coverage and we show uncompensated care going down, then reform becomes a whole lot more palatable and easier to implement for hospitals,” he said. Michele Johnson, managing attorney for the Tennessee Justice Center, worries about whether or not the Tenness Plan will gain approval. She said CMS has now posted ground rules, and Tennessee is asking for concessions that have already been deemed a non-starter by Michele the federal government. Johnson “If they are interested in succeeding in getting federal approval for the plan, they have to propose something that’s real, and they have to negotiate in good faith with the federal government,” Johnson said of Tennessee’s leadership. She said Gov. Haslam sought clarifications from the federal government. “CMS responded by issuing guidance — Frequently Asked Questions, Medicaid and the Affordable Care Act: Premium Assistance.” That information, Johnson continued, makes it clear that the governor can do much of what he proposes … but not everything. Her concern is the state plan includes items like co-pays and an appeals process that differs from Medicaid, which CMS has clearly stated it wouldn’t allow in negotiating Medicaid expansion funds to be used for purchasing insurance in the marketplace. “You can’t expect people to pay a co-pay they can’t afford,” she said of those under 100 percent FPL. On the flip side, the governor has also indicated he didn’t want to give on these items. “With our administration, either they are really bad at negotiating, or they’re not serious about making this a reality for our state,” Johnson stated. She continued, “We pray the governor will do all in his power to make health coverage a reality for working Tennessee families. His ability to take advantage of this opportunity is vitally important for all Tennesseans — not just uninsured working citizens but also the rest of us who will benefit from $6.6 billion dollars pumped into our economy and our healthcare infrastructure.”
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Helping Tennesseans Get Covered Collaborative Effort, Navigator Grant Assist Public in Understanding New ACA Options By CINDY SANDERS
Go forth and get covered. Easier said than done … particularly if you are unsure of the terminology commonly used in healthcare policies, unclear about the way various options might impact your family, unaware of how your income aligns with federal subsidies, and uncertain about when and where to start. Prior to Gov. Haslam’s decision not to pursue a state-run insurance exchange, Beth Uselton had come on board with the Baptist Healing Trust as the program officer overseeing outreach and planning for the Affordable Care Act. The state and Baptist Healing Trust had already begun working together to develop a publicprivate partnership to offer consumer assistance in navigating the local exchange. After the governor opted to have Tennesseans access coverage through the federallyadministered exchange, Usleton said the decision was made to “take the same model we were developing with the state and turn it into a private, stand-alone initiative.” A group of 17 leaders representing various stakeholders across the state have come together to serve as an advisory council for that initiative … Get Covered Tennessee … in advance of the insurance exchange marketplace opening enrollment
on Oct. 1, 2013. Uselton and Baptist Healing Trust are providing the administrative support for the leadership council and subsequent statewide consumer assistance network. Uselton explained Get Covered Tennessee, “is really a big umbrella that is going to fold in community partners, nonprofit organizations and direct service agencies. Our goal is to be able to raise public awareness about the new health insurance options that will be available to families and businesses in Tennessee to help them to understand how to enroll and to provide them with assistance if they need it.” Chances are that many Americans could use some additional education on coverage rules and opportunities. Uselton said research by the group Enroll America found that 78 percent of people who will be eligible for low-cost insurance didn’t even realize it. Of that group, she continued, 75 percent indicated that they would want personal assistance to help them navigate the online exchanges and figure out options. “The idea is the marketplace will simplify the customer experience so that individuals and small businesses can see all of their options together to make a choice on their plan,” she said. “I think of it as Travelocity for health insurance,” Uselton added of navigating the online site.
“All options have to include certain minimum benefits,” she continued, adding that there are bronze, silver, gold and platinum tiers based on actuarial values. By entering in some basic information regarding income and family size, Uselton said the marketplace tools are designed to calculate eligibility for premium tax credits, which can then be applied directly to the chosen plan. The sliding scale of subsidies covers consumers from 100-400 percent of the federal poverty level (FPL). On the upper end, that means a family of four with an annual income of $94,000 would still qualify for some premium tax credits to assist in purchasing insurance in the marketplace if an option doesn’t exist through their employer. “Even though the marketplace is going to make it much simpler to shop for insurance, there are a lot of folks who are going to need help knowing what those different options mean to their families,” Uselton said. Already, she continued, “The council is helping to develop a strategic plan to do outreach, public education and enrollment assistance. We’re right now recruiting nonprofit organizations and direct service agencies across the state who already have a trusted relationship with uninsured Ten-
nesseans.” Uselton noted the idea isn’t to set up new physical locations to assist consumers and small business but to work through established organizations “that do not have a conflict of interest and can provide unbiased consumer assistance to facilitate enrollment.” The criteria for these navigators were set through the Funding Opportunity Announcement (FOA) released by the federal exchange last month. Tennessee has been allocated approximately $1.48 million to fund navigator programs in the state. There will be at least two navigator grants awarded with at least one of those going to a community/consumer-focused nonprofit. Entities that have any tie to health insurers or their subsidiaries are not eligible to be navigators. The council is helping identify existing agencies with differing strengths that could form a collaborative network to meet the requirements set out in the FOA. Uselton said people are hungry for details about what the marketplace will mean to their family. “For years, people have heard about this through political rhetoric,” she noted. Now, the time has come to lay out the facts about coverage options and to launch a coordinated outreach effort to maximize enrollment of currently uninsured Tennesseans.
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“As physicians, we have so many unknowns coming our way...
Unconventional Wisdom
Rethinking the approach to some autoimmune disorders By CINDY SANDERS
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What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research findings. Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treating a range of inflammatory and autoimmune disorders. The rheu- Dr. Stephen A. Paget matologist, who is also a professor of Medicine and Rheumatic Disease at the Weill Medical College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease. Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is due to the body’s subsequent response. “What you were left with was an inflammatory problem that was no longer tied to the previous organism,” Paget explained. A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder. In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological Association, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order
to rein in the overactive immune system we believe to be causing the disease, we employ immunosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.” A small but intriguing study out of the Division of Rheumatology at the University of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combination antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospective, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in any variable. At month six, the authors found significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The primary end point was achieved in 63 percent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into complete remission. No patient in the placebo group achieved remission. Pointing to this study, Paget noted that one of the failures of antibiotic regimens in the past in treating autoimmune disorders might be the duration of the therapy. “If you give long courses of antibodies, you may very well calm the problem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosuppressive drugs to ameliorate the ongoing inflammatory issue after treating the triggering microorganism with antibiotics or antivirals for a relatively short course, “It may very well be we have to improve the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system. While much more research must be done, Paget said mounting evidence of the important connection between microorganisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ultimately portend a paradigm shift in the delivery of care. “In some of these, the organism is slow, smoldering … but still there in a low-grade way that is triggering the inflammatory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded. nashvillemedicalnews
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The War Against Lupus By MELANIE KILGORE-HILL
In the world of autoimmune diseases, lupus remains one of the least understood, yet most complicated, diagnoses. The problem, rheumatologists say, is the mixed onset of symptoms from one patient to the next. “By itself, lupus is not a single entity that presents itself the same way,” said Bobo Tanner, MD, rheumatologist and cofounder of Vanderbilt’s Asthma, Sinus and Allergy Program. “Some patients suffer damage to their heart or kidneys, and some just have joint Dr. Bobo pain. There are a myriad Tanner of symptoms and patterns,” added the assistant professor of Medicine in the Divisions of Rheumatology and Allergy and Immunology. The Lupus Foundation of America estimates the disease affects more than 1.5 million Americans … mostly women of childbearing age, although it can impact men, children and teens, as well. And, like
most autoimmune diseases, genetics and environment are believed to play a part. Forms of Lupus Lupus is broken down into four forms: Systemic Lupus Erythematosus is the most common form and causes inflammation of the kidneys, nervous system and brain. Cutaneous Lupus Erythematosus affects the skin and is evidenced by a disk-shaped rash or a rash over the cheeks and across the bridge of the nose. Drug-induced Lupus Erythematosus is a lupus-like disease caused by certain prescription drugs and rarely affects major organs. Neonatal Lupus is a rare condition that affects infants of women who have lupus. Hope for Patients Awareness and treatment of lupus have increased drastically over the past few years. In 2011, Human Genome Sciences released the first lupus drug in more than 50 years. An intravenous medication used in patients with systemic lupus, Benlysta® (belimumab) received FDA approval March 2011. While the therapy is proving successful in certain categories
of patients, several more drugs are now under investigation including a self-injectable treatment being studied by Tanner and his colleagues at Vanderbilt University. “To have a clear pathway for measuring outcomes, to know whether a drug is working or not, and to have a standard that’s scientifically rigorous are all huge breakthroughs for lupus,” Tanner said. “There are also new understandings of the mechanisms of immunology and dysfunction of systems that occur in lupus so we can target these properties and develop small molecules to help treat it.” Thanks to researchers like Tanner, today’s physicians have an unprecedented awareness of the disease and are often quick to order blood tests when patients present with chronic aches, pains and peculiar rashes. While the ANA test for antinuclear antibodies can help piece the puzzle together, experts agree it’s not the end all in lupus diagnosis. “People are used to very black and white diagnoses,” Tanner said. “Catching a cold or breaking a leg are easy events to recognize. Autoimmune diseases smol-
der for a while, and the waxing and waning course makes it difficult to diagnose. People don’t present one day with all 11 symptoms of classic lupus. It takes a lot of sleuth work and observation and entails frustration on everyone’s part. People are used to a quick fix, but that’s just not this disease at all.”
Clinical Trial Opportunity for Lupus Patients Vanderbilt University is seeking lupus patients with active disease but who do not have severe nephritis or CNS lupus. Participants will have been diagnosed with lupus and receiving treatment for the disease. Subjects will continue to take their current lupus medication in combination with the study drug. Those interested should call Nan Frey at (615) 9365841.
Assembling the Pieces: The Challenges of Autoimmune Diseases, continued from page 1 can go undiagnosed for years. Inflammation of organ systems is the primary characteristic of autoimmune disease, causing morning stiffness, rashes, swollen joints and a host of less obvious symptoms. To make matters worse, symptoms cross multiple specialties and can affect all organs.
The Challenge of Diagnosis
Heritage Medical Associates rheumatologist Christian Rhea, MD, said it’s not uncommon for autoimmune patients to misdiagnose themselves in the agonizing search for answers. “In their minds, patients often connect dots that aren’t necessarily connected,” Rhea said. Dr. Christian Rhea “People usually diagnose themselves, and 89 percent of the time it’s wrong.” Throw in today’s Web MD world of self-diagnosis, and patients suffering from a plethora of seemingly unrelated symptoms often chase the wrong answers for months or even years. That’s because they typically look for and treat the “big” symptoms – swollen joints and severe rashes – but disregard smaller signs, like a pesky patch of psoriasis lingering since childhood. Rhea said rashes are of particular importance, as pattern recognition (size and location) can be clearly indicative of a specific diagnosis. Lesser-known signs might include pits in fingernails and the pattern of distribution of joints involved. “Your definition of joint pain but may be different than this person’s with nashvillemedicalnews
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the same problem,” Rhea said. “Making a diagnosis is like putting a puzzle together. It’s a coalescing of pieces.”
Looking for Answers
Typically, a patient’s search for answers begins in a primary care office. TriStar Summit Medical Center internist Seth Banks, MD, said it’s tricky to figure out which complaints have an underlying cause and how far to go to pursue a diagnosis. “The difficulty in diagnosing is a lot of overDr. Seth lap,” Banks said. “Some Banks patients have combined symptoms and become very difficult to classify based on presentation.” While evolving symptoms could trigger fear of hypochondria in patients, Banks said there are clear ways physicians distinguish between an excessive worrier and a patient at risk. “Hypochondriacs report changing symptoms, various pains and rashes here and there,” Banks said. “What I look at are the patient’s history and a constellation of patterns that fit into a specific diagnosis. Your primary care doctor is aware of changing symptoms and also knows your usual level of concern, which is one reason having a relationship with a primary care doctor is so important.”
Testing, Testing
Labs can help round out the big picture but aren’t always beneficial in and of themselves. Many autoimmune disorders don’t have a specific test, and the more generalized test for antinuclear antibodies
(ANA) doesn’t necessarily mean an autoimmune disease like lupus exists … only that the autoantibodies are present. Rhea cautioned that physicians sometimes place too great an emphasis on blood tests – especially ANA, which he considers notoriously inaccurate. And while some tests maintain a higher level of accuracy, Rhea said they must be considered only with history and objective findings from an exam. “Tests can be definitive in a certain setting, but you don’t want to hang the entire diagnosis on blood tests, which can result in misdiagnosis,” Rhea said. “If a physician’s clinical suspicion is high, they need to get a patient in front of a rheumatologist regardless of test results.”
Finding Answers
Researchers at Vanderbilt University are working to understand the nature of autoimmune disease and what makes the body turn on itself. A Vanderbilt mouse model study published in March’s Journal of Immunology unveiled promising research, indicating that, “Autoreactive B lymphocytes – immune cells that recognize ‘self’ antigens – can join the repertoire of circulating B cells in a state of functional silence, called anergy. Anergy is a form of immune tolerance that keeps these cells in check: they fail to proliferate or produce antibodies.” The findings indicate that, “anergic, autoreactive B cells may promote autoimmune diseases, such as type 1 diabetes, by driving the activation and expansion of autoaggressive T cells via antigen presentation.” Bobo Tanner, MD, Vanderbilt rheumatologist, researcher and assistant pro-
fessor, said the university is always looking for ways to disrupt the autoimmune process. Once targets have been identified and medications proposed, Tanner’s lab studies the effectiveness of those proposed medicines and compares the drugs to existing therapies. He currently is conducting more than a dozen clinical trials for autoimmune patients. “Most trials contain background medications that are already on the market,” Tanner said. “A standard of care is out there, but we offer patients the opportunity to try something different.” Another Vanderbilt rheumatology lab investigates immune tolerance lesions in type 1 diabetes patients in an effort to correct them and provide therapeutic benefit to patients. Nationally, research of autoimmune disease is still in its infancy, although the need is imminent. The American Association of Autoimmune Related Diseases cites autoimmunity as the No. 2 cause of chronic illness in the U.S. Researchers also have linked the disorders to other serious conditions including cardiovascular disease.
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Crisis Mode By CINDY SANDERS
People will talk. There are few givens in life, but one thing you can count on is that bad news travels fast. Clearly articulating your message can prove challenging under the best of circumstances. When operating in crisis mode, effective communication is crucial … yet nearly impossible if you haven’t given adequate forethought to your information-sharing plan. “You don’t think logically in a crisis … no one does. Emotions get in the way,” noted Molly Cate, partner at Brentwood-based Jarrard Philips Cate & Hancock, one of the nation’s largest healthcare public relations firms. “It’s really hard to be falling and trying to build Molly Cate a parachute on the way down.” That logic is behind the federal mandate that hospitals conduct emergency preparedness drills to hone processes before disaster strikes. It’s also the reason healthcare practices and companies create crisis plans with clearly outlined operational procedures in the wake of circumstances ranging from natural disasters, terrorist attacks and large-scale accidents to clinical mistakes, security breaches and corporate malfeasance. The part of the plan that is sometimes over-
looked is the process of telling internal and external audiences what is happening. Unfortunately, a nervous or defiant CEO sends unintended cues to staff members, patients and the public. Having multiple voices talk to various stakeholders leads to mixed or partial messages that create confusion rather than clarity. And, hurriedly disseminated data is sure to leave out critical information or miss an important target audience. Cate, who is nationally recognized for her expertise in crisis communications, said a thoughtful plan offers the opportunity to avoid all those mistakes. The first steps, she added, are to categorize the different types of crisis events, begin to think through the response strategy for each, and form a designated crisis management team. She noted the response team should be a small, nimble group of key executives. Although the makeup of the group might vary slightly by crisis, typically the CEO, communications director and legal counsel would be the foundation for all such teams. Depending on the scenario, human resources, operations and medical representation might be added to the group. “They understand when a crisis is declared, usually by the CEO, they go into action,” Cate said. “The fewer the better,” she continued of the team structure, “because nothing goes out without this group signing off on it.” The next step is to define the audiences … both internal and external. “We
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always suggest starting internally if you can because employees are the best messengers, and it’s also really important from a morale standpoint,” she said. It’s never a good idea for employees to find out their company is under investigation by reading it in the morning paper along with everyone else. Cate also added that employees as ‘messengers’ means that they have an understanding of the situation when asked by friends, family and neighbors … not that they are granting media interviews. Which leads to the next task … the organization must designate a spokesperson. “Nine times out of 10, it’s the communications person,” Cate said, but added it could be the CMO if the issue is clinical in nature or another executive if a small practice or company doesn’t have a communications staff member. “From an external perspective, there needs to be one voice,” she said. “It keeps things consistent. It sends a sign of solidarity. It sends the message —‘We’re in control … we’re on top of the situation.’” The crisis communications plan must also define how each of the audiences will be reached. If a company is facing penalties over a regulatory infraction or personnel issue, the messaging and vehicles used will look different than responding in the wake of a deadly tornado. In the case of a natural disaster, for example, the plan should include ideas on ways to share information if traditional mechanisms are damaged or disabled. The ‘post-game wrap’ is another critical component that sometimes gets shortchanged. Cate noted it’s vitally important to gather the crisis communications team together to assess events and outcomes. “That usually happens at the end of the first day, but it also needs to be after the first week … the first month,” she said. “It’s really important to know what people are thinking about your organization after the fact. What are they saying? You have to keep your finger on the pulse of a situation.” Cate continued, “What I see a lot is that people just want to let it lie and not talk about it anymore.” In the wake of an incident, however, she said organizations have to be vigilant about monitoring traditional and social media, paying attention to what is being said internally and externally, and using surveys and other tools to assess ongoing rumors, inconsistencies, and misinformation. “After a crisis, you want to know where people’s hearts and minds are so you can tailor your messages and your activities to how they are feeling. All your constituents are vulnerable and thirsty for information. When you have that first reengagement with them, you really want
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to be pertinent. If you’re not, it winds up backfiring. It looks like the organization is out of touch or doesn’t care,” she stated. In the face of crisis, Cate concluded, the leadership team can take charge, shape the message and be part of the conversation … or they can surrender that power to others. What they cannot do, however, is stop the conversation.
Fessing Up Let’s face it … there’s no such thing as a good crisis, but it’s certainly preferable to talk about how your team responded heroically in the face of disaster rather than to discuss why federal agents have set up camp at your headquarters or to explain a lapse in safety protocols that led to a tragic clinical mistake. When something has gone terribly awry, Molly Cate, partner with Jarrard Phillips Cate & Hancock, said the right choice is also the best choice … be truthful. “Our rule of thumb is you tell it first; you tell it all; and you tell it again and again,” she said. “An organization needs to take responsibility for what happened under their watch.” At that defining moment, you can come off as humble and apologetic or arrogant and defiant. “People will remember how you responded more than they will remember the actual event,” Cate said. Being defensive gets you nowhere fast in the public’s eyes. “It makes it linger longer. It makes it worse,” she stressed. “Whether you like it or not, you have been put on stage with a spotlight and microphone. You can shape the conversation, or someone else will step onstage and grab the microphone from you … but no one is going to tell your story like you do.” Cate said after admitting the error, the message needs to rapidly shift to the response … what the organization is doing to ensure this problem doesn’t happen again. “That’s the storyline you want to move to as quickly as possible,” she noted. Although there does need to be a clean break from the crisis event at some point, it won’t happen immediately, and it can’t occur without fully tackling the incident. “Organizations will get past it if they address lingering issues and then move on. When you continue to let issues simmer, then they are going to continue to bring the organization down,” Cate stated.
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Dear Addy:
Expert Advice from Area Advertising, PR Executives By CINDY SANDERS
Dear Addy: I am part of the large healthcare industry in the Nashville area. What is your best advice to help set our organization apart and to keep us on the straight and narrow when it comes to effectively telling our story? — Part of the Healthcare Pack Dear Part of the Pack: Lucky for you, Nashville is filled with firms that specialize in healthcare marketing, branding and communications. We asked some of the city’s best and brightest for their advice in answer to your question. They were happy to share some of their favorite nuggets of wisdom … Healthcare providers are often apprehensive adopters when it comes to public relations but should not underestimate its value. The smartest providers understand that positive exposure in the right channels builds brand awareness and name recognition. — Dave Chaney, Senior Vice President, Lam-Andrews Don’t forget about your employees. Whatever your objective may be — selling a product or service, competing against another healthcare provider, re-engineering your image or recovering from a crisis — your staff are your most important allies in your success. Unfortunately, engaging this group is often an afterthought for many organizations. — Nicole Cottrill, Partner, Seigenthaler Public Relations So many public relations issues fall in the category of “tell the truth so you don’t have to remember all your lies.” In fact, I think PR has somehow developed the reputation for “spin” when our mantra pivots off the old New York ad agency mantra of “truth well told.” Every problem or potential problem can be handled, yet sometimes people want to mislead because they’re embarrassed … or concerned about litigation … or just plain sneaky. It’s always best to deliver “truth well told” with good judgment, integrity, and an eye toward the long-term rather than just the next few days and weeks of a difficult situation. — Kristi Gooden, Vice President, ReviveHealth A mentor in the public relations business taught me there is no such thing as “off the record.” If you don’t want to see it or hear it, don’t say it or write it … period. In today’s world of social media, emails, texts, voicemail, etc., it is true now more than ever. — Aileen Katcher, APR, Partner, KVBPR – Katcher Vaughn & Bailey Public Relations nashvillemedicalnews
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Once diagnosed, patients quickly become very educated to their illness … market accordingly. — John Lam, Co-founder & Chief Creative Strategist, Lam-Andrews Never underestimate the power, truth, and impact of patient stories and testimonials … they are the bread and butter of healthcare PR. — Paul Lindsley, MA, ABC, Public Relations Director, Sullivan Branding The best advice I ever gave (and continue to give) is related to media training and trying to get clients to stay “on point.” The late Margaret Thatcher said it best: “Of course, it is the same old story. Truth usually is the same old story.” — Paula Lovell, Founder & CEO, Lovell Communications Inc. The best advice … but very hard to execute … is to create a timeless framework for your message that is proactive, not just reactive, and then resist the urge to change your message regularly. When you and your management team think your message is tired, the public is just beginning to hear it, understand it, and remember it. — Phil Martin, President, Phil Martin Affiliates, Inc. “There is an old rule in politics: Never dance to someone else’s music. What it means for healthcare leaders is to tell your own story constantly and proactively, and don’t fall victim to reacting to competitive or detracting voices. If you are dancing to their music, you are letting someone outside of your organization to speak for you and ultimately to dictate your business strategy.” — Anne Hancock Toomey, Partner, Jarrard Phillips Cate & Hancock, Inc. In today’s fast-paced world, readers and viewers are taking in news ‘on the run’ or with mobile apps. People are so busy they usually only read the headlines and the first part of a long story. Using photographs and strong photo captions lets the audience quickly absorb the story/ issue/need within 10 seconds. This also allows you to achieve additional awareness by complementing traditional news venues with New Media sources such as Twitter, Instagram, Facebook, Yelp and others. — Deborah Varallo, President, Varallo Public Relations
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The Move from Social Media Marketing to Social Business Strategies By CINDY SANDERS
Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “Social business is modern communications brought into the Andrew Dixon business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular tool being used today to do that is email, but email was never intended to be a collaborative tool.” In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. 12
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The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.
Creating Engaged Communities
Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate messages about wellness and disease man-
agement to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.
Security
“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology
is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”
Avoiding Information Overload
Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said. However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.
The Bottom Line
With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”
Three Trends Driving Change Three trends are driving change in the workplace – social, mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space. “It’s incredible how powerful each of these trends is alone, and they are all converging,” said Andrew Dixon of Igloo Software. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statistics. “All of their IT requirements will be outsourced and provided to them by the cloud.” Citing recent research from business and technology research firms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.” Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Taking the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone professionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent. Furthermore, half of the tablet-owning doctors have used their device at the point of care.
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Best Practices Evidence Based Standards of Care Endovascular Treatment for Acute Ischemic Stroke By Michael T. Froehler, M.D., Ph.D. and J. Mocco, M.D., M.S.
Treatment of ischemic stroke has advanced rapidly over the last two decades, beginning with the introduction of systemic thrombolytic therapy, or IV tPA, which was approved by the FDA in 1996. Since that time, whole systems of care have been developed to optimize the delivery of thrombolytics for acute stroke. But while IV tPA has been a major advance in stroke care, patients with large artery strokes – those with the most profound neurologic deficits and the worst prognoses – derive the least benefit from IV tPA. In fact, tPA is successful in just 6% of patients with occlusion of the internal carotid artery, 30% for middle cerebral artery occlusions, and 33% for basilar artery occlusions.1 Furthermore, many patients are ineligible for IV tPA for a variety of reasons. Thus an alternative and more efficacious method of revascularization for large artery stroke is needed. Fortunately, more directed therapies have recently been developed that allow the retrieval and removal of these large clots. Specifically, the first endovascular thrombectomy device became available in 2004, and these devices have advanced tremendously over the last 9 years. In 2012 a new class of such devices – the “stentriever” - was introduced after clinical trials showed overwhelming superiority compared to the first-generation device. The use of these new stentrievers is recommended in the most recent AHA / American Stroke Association guidelines for acute stroke management.2 For example, we recently encountered an 18 year old woman who awoke with hemiplegia involving the left face, arm, and leg, spatial neglect, and a visual field defect. A CT scan revealed an occlusive thrombus in the right middle cerebral artery, but unfortunately she was ineligible for IV tPA because she awoke with the symptoms and thus the time of onset could not be established. We immediately performed emergency thrombectomy with a stentriever device, resulting in re-establishment of normal blood flow (see figure). By the next day her weakness was gone and her spatial neglect resolved. While clinical experiences like this are compelling, evidence-based medicine dictates that randomized trials be done to rigorously prove the utility of specific treatments. It was with such lofty intentions that three separate trials of endovascular stroke treatment were undertaken, all of which were published in February 2013.3, 4, 5 Unfortunately, by the time these trials were started, most practitioners had seen enough endovascular stroke treatment and
A.
A. An angiogram showing occlusion of the right middle cerebral artery (arrow). B.
B. An angiogram after clot retrieval, showing reperfusion of the artery that was blocked. C.
single-arm trials to convince them that randomizing patients to a control treatment was unethical, thus creating a widespread absence of clinical equipoise. So while over 10,000 patients were treated annually, these trials struggled to enroll a handful of patients per year. To the further detriment of their results, those trials were initiated prior to the introduction of the new generation devices, such as the stentrievers, and were mostly based on the old belief that intraarterial tPA (rather than systemic IV tPA) would result in better outcomes. For these reasons and others, the recent trials of endovascular therapy proved negative, and have now created more confusion in the realm of endovascular stroke treatment. Clinical trials often offer more questions than answers, and the results of the three recently reported trials leave clinicians in a quandary. In this case, most physicians who frequently deal with acute ischemic stroke still have substantial experiences of success with the use of endovascular interventions. The technical advances in the last decade in endovascular treatment imply that the results of the trials may not be applicable to current practice. Thus many physicians in practice remain convinced that endovascular interventions remain an important option for treatment of some patients with acute ischemic stroke. But we must now also recognize the need for quality randomized trials. At the Vanderbilt Cerebrovascular Center, we are committed to utilizing these treatments when needed but also to advancing our understanding of stroke treatment by participating in and designing definitive clinical trials. Our comprehensive clinical service includes experts in vascular neurology, neuro intervention, neuro critical care, neuro imaging, and vascular neurosurgery, and is dedicated to serving the needs of stroke patients throughout our region. REFERENCES:
1 Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 2007 Mar;38(3):948-54. 2 Jauch EC, Saver JL, Adams HP, Jr., et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947.
C. The clot that had caused the occlusion, still adhering to the stentriever device used to remove it.
3 Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013 Mar 7;368(10):893-903. 4 Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013 Mar 7;368(10):914-23. 5 Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013 Mar 7;368(10):904-13.
All source data for this article has been provided by
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HealthcareEnterprise
Richards & Richards Offers Data Security Keeping the Past Secure for Future Needs
management systems.” Richards explained, “We take April 15 has come and gone. the responsibility of the patients’ After tax time, many busimedical histories when we take nesses and individuals across the custody of the records. We invencountry are left with at least one tory them by last name and date thing … a resolution to do a betof birth. We can provide the docter job of recordkeeping in the tor with forms that are compliant future. with privacy requirements so that Recordkeeping can certainly any legitimate request for patient be a challenge — one that deinformation can be fulfilled, while mands accuracy and thoroughcontinuing to comply with privacy ness, as well as the accumulation regulations.” of all types of documentation. Richards pointed out their The need for such thoroughfacility currently stores more than ness goes on throughout the life 1 million banker’s storage boxes of the business … and often befor over 2,000 physician clients yond. This is particularly true for within a 45 minute driving radius medical practices. Even when — “from Cookeville to Columbia they retire or close their pracand west to Jackson and north to tices, physicians are required by Hopkinsville,” he said. law to provide access to patients’ “Depending on what is medical histories for at least 10 Bowman Richards in the storage facility at Richards & Richards Office needed, it takes no more than 45 Records Management years after the date of retirement minutes for us to locate the reor closing. quested records, make electronic and regulatory requirements related to W. Bowman Richards, vice president copies and send them in encrypted form,” information retention,” Richards noted. for New Business Development at RichRichards said. “It is not just about storing “We observed that a lot of our mediards & Richards Office Records Manageyour files to get them out of your way, it cal clients were starting to retire and ment, said, “The last thing a retired doctor is also about being able to find what you uncertain what to do with their patient wants to do is to have to come back to the need, when you need it — securely and records, and we realized that we could office to search for a patient’s record. We efficiently with minimal retrieval time.” relieve the physician from the stress of take care of that.” With more than 115 years of colmaintaining the security of the records,” Richards & Richards has been helplective experience among their team, he continued. “With record management ing businesses and individuals keep up with Richards & Richards has created and led services that include state-of-the-art bartheir paperwork for more than a quarter numerous records management programs code tracking and inventory technology, century. The founders realized people were in Tennessee, as well as providing consecure shredding, off-site data protection, running out of room to store their vital resulting services. The company also prodocument scanning and consulting to help cords, but the company’s success is not just vides logistics or “cross-dock” services for practices and businesses create record rea matter of providing more space. companies that need to distribute items tention policies and procedures, we can “Successful management of recorded throughout the Middle Tennessee area, reduce costs, provide litigation support information requires analysis, systematic receiving large shipments of documents and identify problems in information controls and an understanding of legal to be scanned, catalogued, and broken By KELLY PRICE
• Turnkey Billing and Collections • Reduce Management Headaches • Improved Bottom Line • Peace of Mind Clean Claims Rate Average Increase in Revenue Average Reduction in AR days
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“The very positive experience with the MedEvolve PM software prompted our decision to expand their services to include Revenue Cycle Management, which has absolutely improved our billing services. Overall a very positive experience, with a few key contacts in the company that are always available and promptly responsive and accountable to our practice. MedEvolve really does stand out not only in software performance, but particularly in customer service.” Barry Seibel, M.D., Los Angeles, CA, is a worldrenowned ophthalmic surgeon, author, inventor and frequent consultant to the ophthalmology industry.
up into smaller units for pick-up by local contacts. They also can scan specific documents on demand. For a business that needs access to only a small percentage of its archived files, their Scan on Demand service costs $36 to store a one-cubicfoot box on the company’s shelves for 10 years, converting only the fields that are needed when they are needed. Scanning all a company’s or practice’s documents would cost 80-90 percent more just for the scanning alone. Richards pointed out it is easier to store records in their original form rather than undergo the expense of digitizing them. Conversion to electronic format can increase productivity, free up valuable office space and improve security, “but it can be costly,” he added. “We can help you decide what makes good business sense to scan, store, or destroy.” When Richards & Richards outgrew their original Third Avenue location, the business moved to a 12-acre property on Elm Hill Pike and built a six-acre enclosed facility to house the medical, legal and financial records for which the company has assumed responsibility. Richards & Richards takes that responsibility — to keep the contents secure —very seriously. Employees must pass a strict background check, be fingerprinted by the FBI and TBI, undergo a background check of their employment records for the previous seven years, and submit to random drug tests. Richards said, “Auditors show up on announced inspections twice a year and are here on unannounced visits three times a year. We even pay people to try to breach our security, just to test ourselves. If one breach occurs — we’re out of business,” he said. “Security and compliance are our key words.” When medical records come into the facility, they are sorted by their legal “destruct date.” When that date arrives, they are pulled from the shelves, verified, and shredded under video surveillance. Richards & Richards has the largest paper shredder “south of Pittsburg and east of Denver,” Richards noted. The shredded product is then de-inked, boiled, and mulched. Much of it ends up recycled into industrial brown paper towels. Richards said he sees two trends that have led to a dramatic increase in the need for secure management of medical records — the rise in the use of electronic medical records and the need for vigilance in protecting against identify theft. He pointed out that there is an increase in the number of physicians who have their electronic system downloaded onto an external drive and need to store backup copies of the discs. “Records are always going to be necessary; the medium may change,” he concluded. nashvillemedicalnews
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Conway-Welch Stepping Down as Dean of Vanderbilt School of Nursing By CINDy SANDERS
When the Vanderbilt University School of Nursing (VUSN) graduating class walks the stage on May 10, it will mark the end of an era. As this latest class of nurses prepares to embark on the next chapter in their careers, their leader is planning a new adventure of her own. After serving more Dr. Colleen than 28 years as VUSN Conwaydean, Colleen ConwayWelch Welch, PhD, FAAN, CNM, has announced her plans to step down from that post effective June 30. The second longest sitting dean of any U.S. nursing school, Conway-Welch has spent much of this academic year winding down her storied career as dean. As the Nancy and Hilliard Travis Professor of Nursing prepares for the next chapter of her career, she looks to continue teaching, lecturing and working on health policy … after taking a year-long sabbatical to rest and recharge. In 1984, Conway-Welch was recruited to become VUSN’s dean by then vice chancellor for Health Affairs, Roscoe R. “Ike” Robinson, MD. At the time she was recruited, the School of Nursing was educating only about 100 baccalaureate students, a very small number of master’s students and had no doctoral program. Today, VUSN’s enrollment totals nearly 1,000 students, and the educational institution produces nationally sought-after graduates at all levels from baccalaureate through doctorate. VUSN is ranked 15th in the nation by U.S. News and World Report’s Best Graduate Schools edition. Following a well-deserved break, Conway-Welch will serve as a member of the faculty, working with her successor and Jeff Balser, MD, PhD, vice chancellor for Health Affairs and dean of the School of Medicine, in support of VUSN. “Colleen’s contributions to Vanderbilt have been enormous,” Balser said. “We stand in admiration of her sustained impact on nursing education not only here on our campus but across the nation. Her vision for innovation in advanced practice training for nurses has set a national standard and has made Vanderbilt a leading destination for nursing education and research.” Widely recognized for her dedication to the field, Conway-Welch has been a nurse and certified nurse-midwife for almost 50 years. She holds degrees from Georgetown University School of Nursing, Catholic University School of Nursing and New York University. On the national stage, her numerous and varied contributions are evident throughout the profession of nursing — both in the educational and clinical setting — with innovations that have helped transform healthcare and impact the way nashvillemedicalnews
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nursing care is delivered. In 1997, she was elected into the Institute of Medicine of the National Academies. President Ronald Reagan named her to “The Presidential Commission on the Human Immunodeficiency Virus Epidemic, 1988,” a bipartisan commission on the HIV epidemic. In 2006, President George W. Bush appointed her to a five-year term as a member of the Board of Regents for the Uniformed Services University of the
Health Sciences. She is also a Fellow of the American Academy of Nursing. Conway-Welch is the recipient of the Project HOPE Global Health Leaderships Award, CABLE’s Women on Boards “Board Walk of Fame,” the Policy Champion Award from the National Nursing Centers Consortium, Modern Healthcare’s “Top 25 Women in Healthcare,” and the National League for Nursing Award for Outstanding Leadership in Nursing Edu-
cation. In 2003, she was named “Nashvillian of the Year” by the Nashville Scene. Locally, she and her husband, Ted Welch, are known for their community involvement and support of a wide range of organizations including the Tennessee Performing Arts Center, the Comprehensive Care Center, the Nashville Symphony, Renewal House, Alive Hospice, the Hospital Hospitality House, Habitat for Humanity and the YWCA.
Woman’s
It’s a ^Man’s World
Noted Sexologist Returns to Meharry for Panel Discussion on Women’s Health By CINDy SANDERS
Despite her curiosity about the intersection of medicine and sexuality … particularly for women … Rachael Ross, MD, PhD, found there just wasn’t much offered in the medical school curriculum when she was a student at Meharry Medical College. Now a nationally renowned clinical sexologist, Ross was thrilled to be invited back to her alma mater last month to participate in the panel discussion “Not the End of the Road: Menopause in Women over 50” as part of the Center for Women’s Health Research Community Forum. During residency, Ross began doctoral coursework with the American Academy of Clinical Sexologists and is board certified in the subspecialty, as well as in family medicine. A contributor to the popular television program, “The Doctors,” Ross has also been an oft-quoted expert in consumer magazines and is the author of numerous articles and a book on the topic of sexuality and sexual health. “For so long, the menopause discussion just glossed over sexuality,” Ross said, adding the focus was always on hot flashes, mood swings, weight gain and wrinkles. “It’s nice to see sexuality becoming part of the discussion. Women deserve answers and solutions just like the guys do.” Of the media messages bombarding women, she said, “Every magazine you read … every news story … is telling you when you hit 50 it’s all over.” On
Dr. Rachael Ross practices medicine with Primary Care Consultants in her native Gary, Ind. After earning her undergraduate degree from Vanderbilt University, she followed a family tradition of attending Meharry Medical College. Four of the five physicians in her immediate family, including her father and two sisters, received medical degrees from Meharry.
the other side of the equation, Ross noted, it’s very interesting to see how drugs targeting erectile dysfunction have impacted and changed long-term relationships. Now one partner is ready, willing and able, but the other is struggling with physical and emotional issues that also must be addressed. Certainly, she said, vaginal dryness and hormonal changes impact desire, but a woman’s sex drive is much more complicated. “It’s ‘did you take out the trash, am I mad, am I feeling OK, am I stressed out?” she noted. “It’s very hard to come up with a magic solution to all of that.” In addition to vaginal dryness, Ross said menopausal women often find they are losing muscle mass, have a lower sex drive, feel fatigued, lose skin elasticity, have weight gain that is difficult to combat, are subject to irritability and mood swings, and experience atrophy of the clitoris and vagina. “Orgasm takes longer and takes a little more energy to get there. Coupled with a partner who might not have as much stamina, you end up with more sexual frustration than you used to,” she said.
M WO AY I HE MENS MOALTH ’S NT H
Although there might not be one ‘magic pill’ to address all those issues, Ross said physicians could certainly help their female patients find strategies and solutions to improve their sex lives. One of the first items to check is a woman’s testosterone level to see if it has decreased too much. “The number one hormone responsible for the desire component of the sexual response cycle in both men and women is testosterone.” She also suggested physicians go over medications with patients — particularly antidepressants, blood pressure prescriptions and allergy medications. Antidepressants can suppress the ability to experience passion, and some allergy drugs contribute to vaginal dryness. “Oftentimes, it requires a late-in-life switch around your mindset about sex and sexuality,” Ross said, noting that might include the use of sexual aids or thinking about ‘sex’ in new or different ways. “It then becomes helping a patient break down their cultural attitudes and barriers and beliefs around this issue,” she said of the challenge. “Open communication with your primary care doctor is very important,” Ross stressed, adding it is quite likely the physician would have to address the subject. “Studies show patients are very embarrassed to bring this up to their physicians.” Yet, she continued, “One in three women will complain of some sex drive issue during their life.” The time to start those discussions, Ross added, is well before menopause so that sexual desire and health become a part of the ongoing dialogue in a patient’s larger, global health picture. “Healthy sex lives help keep couples engaged with each other,” Ross said. Besides, she added, “Sex is one of the few pleasures in life that’s not going to get you fat, raise your cholesterol or increase your risk of heart disease.” MAY 2013
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GrandRounds Save the Date May 14: Chipping in for Children™ Golf Tournament • Gaylord Springs Golf Links • 10am -8pm The first annual Nashville Chipping in for Children™ charity tournament raises money for local Children’s Miracle Network Hospitals, Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville and East Tennessee Children’s Hospital in Knoxville. www.chippinginforchildrengolf.com June 1: Marshall Molar 5K Presented by Delta Dental • Music City Center • 6:30 am The Marshall Molar 5k, presented by Delta Dental of Tennessee, is the first organized run for Nashville’s new Music City Center. Early registration is $25, race day registration is $30. Registration includes admission to the Music City Sports Festival on May 31, which features events for all ages including a showcase of college athletic programs, children’s events and a hockey clinic. www.MusicCitySportsFestival.com. June 6-7: Introduction to DSM-5 • Trevecca University The DSM-5 is scheduled for release next month. Licensed mental health professionals must receive training on changes in the new manual. This twoday workshop will provide a comprehensive overview of the DSM-5. The keynote speaker will be Dr. K. Dayle Jones, former ACA DSM-5 Task Force chair. www. tamho.org/professional.php
Baptist Hospital Opens Craig Center for Advanced Wound Healing Last month, the Baptist Hospital Foundation announced the opening of the Craig Center for Advanced Wound Healing at Baptist Hospital. Located on Murphy Avenue, the Craig Center features 20,000 square feet of space and addresses the need for more clinical space and improved accessibility. Additionally, it provides a larger focus on prevention and treatment of diseases – such as peripheral vascular disease – that lead to non-healing wounds. Using a multidisciplinary and patientcentered approach, screening, diagnostic, education and cutting-edge therapeutic and treatment services are within a single facility. The Diabetes Center at Baptist Hospital is also now located in this building. An interdisciplinary wound care team works with vascular, plastic and reconstructive surgeons, podiatrists and infectious disease specialists to provide healing based on the specific needs of each patient. A combination of advanced techniques including hyperbaric oxygen treatments, total contact casting, vacuum assisted closure, topical dressings, debridement and application of bio-engineered skin grafts are used to speed the healing process. A critical extra step is also taken to identify and treat the underlying cause of a patient’s chronic non-healing wound – with the hope of breaking the cycle and encouraging the body to heal future wounds on its own.
Monroe Carell Patients Collaborate With Nashville Superstars to Bring Their Songs to Life Everybody Has A Story to Benefit Music Therapy Program
Heartfelt songs penned by a group of patients of Monroe Carell Jr. Children’s Hospital at Vanderbilt while working with their music therapist Jenny Plume are being released May 14 on a compilation CD featuring some of Nashville’s top recording stars. Artists Kix Brooks, Melinda Doolittle, the Fisk Jubilee Singers, Vince Gill, Amy Grant, Faith Hill, Alison Krauss, Maura O’Connell, Johnny Reid, SHEL and Phil Vassar breathe life into songs written by patients Austin Bagby, Ethan Carpenter, Courtney Gaoette, Erica Kilburn, Amy Overton, Gigi Pasley and Christopher Weber, along with Plume. “Everybody Has A Story” is a selection of songs resulting from clinical music therapy sessions involving the patients and Plume. Those participating were treated for a variety of chronic and acute illnesses. Plume helped patients shape their thoughts and feelings into lyrics and a melody. Some lyrics were crafted out of a story idea, and some were created by long discussions about the patients’ feelings and situations. The song topics range from serious to fun and silly. “I hope they will go on to know that they can do anything; they can create things; and hopefully music will always be in their lives,” Plume said of the young lyricists. “For those patients who have passed on, this will be a legacy to celebrate their lives,” she continued. The CD, which will be available at music retailers throughout North America, will benefit the Julian T. Fouce Music Therapy Fund, which was founded at Vanderbilt in 2007 by Tom and Maria Fouce in memory of their son who died in 2005 after battling leukemia. Tom Fouce, a Music Row recording engineer approached his industry contacts to help make the project a reality.
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Using these comprehensive techniques, the wound care team at Baptist Hospital has achieved a 97 percent healing rate, far above the national average, and the center is recognized as a Center of Distinction by Healogics, Inc., which manages more than 500 wound care centers across the country. Construction of the center was made possible through a donation from The Deborah and C.A. Craig, II Family Foundation. The late C.A. Craig, former president and CEO of National Life and Accident Insurance Company, was committed to helping others and was active in fundraising and support for healthcare philanthropy.
TriStar StoneCrest Performs Area’s First Robotic Single Incision Gallbladder Removal In March, TriStar StoneCrest Medical Center announced surgeons had performed Middle Tennessee’s first robotic single incision gallbladder removal. Rather than making several incisions to remove the gallbladder, this new robotic process makes just one incision through the belly button where no visible scar can be seen. The new surgical method with the da Vinci robotic surgery system offers an alternative to open and laparoscopic surgery. Each year, approximately 1 million people in the U.S. undergo gallbladder removal.
MissionPoint Health Partners Joins Nashville Commits in Effort to Increase College Readiness MissionPoint Health Partners recently announced an innovative partnership with Nashville Commits, a community initiative aimed at tripling the number of low-income, college and workforce ready graduates in Davidson County by 2020. Through the agreement, MissionPoint will provide services such as care transitioning, wellness programs and education, free of charge to students, families and staff of LEAD Public Schools. The partnership is rooted in MissionPoint’s commitment to serve the healthcare needs of the entire community, including the vulnerable. LEAD Public Schools educate low-income students with the singular goal of graduating 100 percent of them and helping them gain admission to a four-year college.
Insight Genetics, NCI Collaborate to Develop New Technologies for Clinical Trials Nashville-based Insight Genetics, which has developed a diagnostic test that can more accurately determine if certain lung cancer patients will respond to targeted therapies, has been selected by the National Cancer Institute (NCI) to participate in the Clinical Assay Development Program (CADP). The CADP is an initiative of NCI’s Division of Cancer Treatment and Diagnosis that
aims to move promising assays from the research lab into clinical trials. Insight Genetics’ Insight ALK Screen™ offers comprehensive data that informs a physician if a patient’s cancer is associated with anaplastic lymphoma kinase (ALK) and may respond to ALK-inhibitor therapies, an emerging class of cancer treatments. ALK fusions and mutations have been shown to be a contributing cause in approximately 5-10 percent of lung cancers. NCI —through the CADP — will support Insight Genetics by providing services of two CLIAcertified labs that will further validate the assay, access to clinical samples, subject matter expertise, and statistical consultation.
Recent Certifications, Accreditations & Commendations
The Certification Board for Professionals in Patient Safety (CBPPS) has recognized Vanderbilt’s Ken Young, MBA, CPHQ, as a Certified Professional in Patient Safety (CPPS). Young, who works as a surgical technologist at VUMC, is one of only five Ken Young to receive this designation in Tennessee and one of 205 CPPS’s worldwide. Healthcare Management Systems, Inc. v12 has been tested and certified under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Certification Body (ONC-ACB) program. This EHR software from HMC is compliant in accordance with the criteria adopted by the Secretary of the U.S. Department of Health and Human Services. Drummond Group’s ONC-ACB certification program certifies that EHRs meet the Meaningful Use criteria for either eligible provider or hospital technology. At the end of March, United Neighborhood Health Services (UNHS) became the only community health center in the state of Tennessee to be designated by The Joint Commission as a Primary Care Medical Home (PCMH). Nashville’s Lifeguard Ambulance Service has received the prestigious accreditation for the Commission on Accreditation of Ambulance Services (CAAS) for its compliance with national standards of excellence. According to officials with CAAS, out of approximately 230 ambulance services in Tennessee, Lifeguard is only the second to receive this accreditation in the state and is the first in Middle Tennessee. In addition, of the approximately 15,250 ambulance companies in the U.S., only 155 are accredited.
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GrandRounds Centerstone & Unity Physician Partners Form Joint Venture to Enhance Patient Care Unity Physician Partners and Centerstone Health Partners, a subsidiary of Centerstone, have joined forces to improve patient care and enhance the quality of healthcare across the U.S. The organizations have formed a joint venture that will care for medically underserved patients with physical and behavioral healthcare needs by establishing integrated care clinics. The financial terms of the partnership were not disclosed. “We know the vital connection between physical and mental health, but for decades primary care and mental health providers have not effectively collaborated,” said David C. Guth, Jr., Centerstone CEO. “Our goal with this joint venture is to eliminate this disconnect, creating a bridge that allows primary care and mental health providers to work together to improve the overall health of our patients.” Through their joint venture, Centerstone and Unity will explore a clinical model that addresses whole health to achieve better patient outcomes by opening integrated care offices that feature both primary care and behavioral health providers. Having these providers co-located in a common clinic will create opportunities for needed collaboration and improved care coordination. The joint venture will begin by establishing Unity primary care physician offices in six existing Centerstone locations – four in Tennessee and two in Indiana. These clinics will open in the third quarter of 2013.
TriStar Centennial Women’s & Children’s Hospital Continues to Grow Team Recently, TriStar Centennial Women’s & Children’s hospital announced the addition of pediatric anesthesiology services and pediatric general and thoracic surgery to its children’s services program. The hospital welcomed two board-certified anesthesiologists specializing in pediatric care and two board-certified pediatric surgeons. All four most recently practiced at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. Ian S. Landsman, MD, received his medical degree from the State University of New York in Buffalo. After completing a residency in pediatrics at Children’s Hospital of Buffalo, he went on to serve as chief resident of pediatrics. After next completing felDr. Ian Landsman lowships in pediatric critical care and then emergency care with Texas Children’s Hospital in Houston and The Children’s Mercy Hospital in Kansas City, respectively, Landsman completed his residency in anesthesiology at St. Luke’s Hospital of Kansas City in Kansas City, Mo. He then went on to complete a pediatric anesthesiology fellowship at
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Children’s Hospital of Pittsburgh. Silvio Sitarich, MD, graduated from University of Zagreb Medical School in Zagreb, Croatia. After completing a residency in urology and serving as a urology research associate at Clinical Medical Center Osijek in Croatia, he served as a postdocDr. Silvio Sitarich toral research associate in the Department of Biochemistry at Meharry Medical College. He then went on to serve as a research instructor in pediatrics at Vanderbilt University Medical Center, where he later completed a residency in anesthesiology. He served as an anesthesiologist with Sacred Heart Hospital in Pensacola, Fla., before returning to Vanderbilt to complete a fellowship in pediatric anesthesiology. Stephen E. Morrow, MD, FACS, received his medical degree from Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, in Bethesda, Md. After completing a residency in general surgery at the Naval Regional Dr. Stephen Morrow Medical Center in San Diego, he completed a research fellowship with the Division of Pediatric Surgery at the University of Chapel Hill School of Medicine in North Carolina and then a pediatric surgery fellowship at Children’s Mercy Hospital at University of MissouriKansas City School of Medicine. He has served in numerous roles with the U.S. Navy, including chief of pediatric surgery of National Naval Medical Center and Walter Reed Army Medical Center. Thomas P. Rauth, MD, MPH, received his medical degree from Vanderbilt University School of Medicine, where he then completed residencies in research, general surgery, and pediatric surgery. Since 2002, Rauth has served as a resident Dr. Thomas Rauth physician in general surgery and, most recently, pediatric surgery at Vanderbilt University Medical Center.
Son Le, MD, received his medical degree from The Chicago Medical School, followed by residency at the University of Chicago Schwab Rehabilitation Hospital.
Nashville Medical Group Welcomes Internal Medicine Practitioner Recently, Nashville Medical Group, a member of Saint Thomas Health, welcomed board certified internal medicine practitioner, Jennifer T. Rayburn, MD, to its medical staff. She received her medical degree from the University of Tennessee Dr. Jennifer Rayburn College of Medicine in Memphis and completed her internal medicine residency with the University of Tennessee at Baptist Hospital in Nashville. Rayburn is board certified in internal medicine and has a special interest in dermatology.
Alive Hospice Names Johnson Director of Quality Operations Eileen Johnson, CPHQ, MSN has joined Alive Hospice as director of quality operations. In her new role, Johnson oversees the training of Alive Hospice’s clinical staff as well as continuing education, performance improvement and
Cardiac Surgeon Jeffrey Gibson Joins Saint Thomas Heart Saint Thomas Heart at Baptist Hospital recently announced the addition of Jeffrey Gibson, MD, board-certified cardiothoracic surgeon, to its medical staff. Gibson has an extensive background in cardiothoracic surgery and Dr. Jeffrey Gibson vascular procedures. He relocated from Memphis where he most recently practiced at Methodist Healthcare, and prior to that he maintained a private practice at St. Francis Hospital. Gibson attended medical school at the University of Tennessee in Memphis and completed both his residency in general surgery and his fellowship in cardiothoracic surgery there, as well. He is certified by the American Board of Surgery and the American Board of Thoracic Surgery.
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TriStar Southern Hills Welcomes Three to Rehabilitation Team Recently, three physicians board certified in physical medicine and rehabilitation joined the medical team at TriStar Southern Hills. Bart Huddleston, MD, will serve as medical director of Inpatient Rehabilitation. He received his medical degree from the University of Tennessee in Memphis and completed residency at Eastern Virginia School of Medicine in Norfolk. He is also board certified in pain medicine. Damita Bryant, MD, graduated from Albany Medical College in Albany, N.Y. and completed her residency at JFK-Johnson Rehabilitation Institute in Edison, N.J.
quality measurement. Previously she served as senior analyst for quality and process improvement at Cogent HMG, the nation’s largest private hospitalist company. Johnson, a certified professional in healthcare quality (CPHQ), began her career as an emergency nurse with HCA. She holds an MSN from The University of Texas at Austin.
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GrandRounds Let’s Give Them Something to Talk About!
PHOTO COURTESY VANDERBILT UNIVERSITY
Awards, Honors, Recognitions
Harold L. (Hal) Moses, MD, professor of Medicine and Pathology, professor and acting chair of Cancer Biology, and director emeritus of Vanderbilt-Ingram Cancer Center (VICC), has received the 10th Annual American Association for Cancer Research (AACR) Award for Lifetime Achievement in Cancer Research. He received the award last month during the AACR Annual Meeting 2013 in Washington, D.C. “This is a wonderful honor and I am very grateful to receive this recognition for my career as a cancer researcher,” said Moses, who holds the Hortense B. Ingram Chair in Cancer Research. “It is especially meaningful to receive this Dr. Hal Moses award from an organization which I was honored to lead as president.” In other AACR news, Carlos L. Arteaga, MD, professor of Medicine and Cancer Biology at Vanderbilt University School of Medicine, has been named the 2013-2014 president-elect. Chosen for his new role by the organization’s members, Arteaga will work collaboratively with the AACR board and the 34,000-plus membership to further the organization’s mission to prevent and cure cancer through research, education, communication and collaboration. He will assume the presidency in April 2014. Dr. Carlos L. Arteaga A recent $1 million gift from Delta Dental has given the students, faculty and administrators at the University of Tennessee Health Science Center a lot to smile about. The money will be used to revamp the Delta Dental Simulation Laboratory where students receive needed hands-on experience. Since 1998, Delta Dental has donated more than $7.5 million to the UT College of Dentistry, including challenge gifts that match alumni donations. Becker’s Hospital Review recently included Saint Thomas Hospital and Vanderbilt University Medical Center among the 100 Great Hospitals in America, a list recognizing hospitals that continually improve and are innovators for medical treatments, research, technology and care delivery. Jeff Whitehorn, CEO of TriStar Summit Medical Center, has been named Lipscomb University’s 2013 Alumnus of the Year. A 1984 graduate of Lipscomb University, Whitehorn is a veteran healthcare industry leader. Jill Grandas, RN, CPTC, corporate executive director at DCI Donor Services, Inc. (DCIDS), won a gold Stevie Award in the 9th Annual Stevie Awards for Women in Business. Grandas was recognized in the “Female Executive of the Year – Government or Non-Profit – Up to 2,500 Employees” category. The Stevie Awards for Women in Business are the world’s top honors for female entrepreneurs, executives, and Jill Grandas the organizations they run. In other news, DCIDS earned the Commitment Award in the annual Excellence in Tennessee recognition program administered by the Tennessee Center for Performance Excellence, which is Tennessee’s only statewide quality program patterned on the nationally-recognized Baldrige Performance Excellence Program. The Tennessee Hospital Association (THA) recently presented Mark Medley with its 2013 Small or Rural Hospital Leadership Award. Medley is president of Hospital Operations for Capella Healthcare and serves on the THA board. He began serving on the Tennessee Rural Partnership board as it became a subsidiary of THA during 2012. Medley is a Fellow in the American College of Healthcare Executives (ACHE) and serves on the Advisory Council to Tennessee’s Regent of the ACHE. He also (l-r) Mark Medley and Craig Becker. serves on the Board of the non-profit Tennessee Rural Partnership Group. Lattimore Black Morgan & Cain, PC (LBMC), Tennessee’s largest regional accounting and business consulting firm, has ranked 47th among the top 100 accounting, tax and consulting firms in the United States by Accounting Today. Additionally, LBMC ranked 15th in the nation in the Pacesetters of Growth division. Healthcare public affairs firm Jarrard Phillips Cate & Hancock, Inc. is ranked among the top 25 fastest-growing independent public relations firms nationwide, according to the annual O’Dwyer’s PR Firm Rankings released in March. With $4.86 million in 2012 net fees, Jarrard posted 27 percent year-over-year growth. The firm is ranked as 11th in size among all specialized healthcare PR firms (a jump from 14th last year) and 65th among all PR firms (up from 74th last year). ReviveHealth, with headquarters in Nashville and an office in Santa Barbara, was recently named Boutique PR Agency of the Year by industry trade publication PRWeek,
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Ingenious Med Opening Nashville Office Ingenious Med, the Atlanta-based provider of the nation’s largest multispecialty charge capture and physician rounding platform, recently announced expansion into the Nashville market with the opening of a location at Cummins Station. A member of the Nashville Health Care Council, Ingenious Med’s time-ofcare software allows doctors to quickly and efficiently record charges and capture PQRS quality metrics after seeing a patient, making revenue and quality processes faster and more efficient. Ingenious Med’s signature program, impower, has a 95 percent adoption rate among its customer base, which includes Saint Thomas Physician Services among other Nashville clients. A nationwide company with more than 22,000 users throughout the U.S., the leadership of Ingenious Med said they recognized Nashville as one of the most important cities for healthcare services in the country, prompting the need for establishing its second location in Music City.
LBMC Family of Companies Adds Services, Staff
LBMC Strategic Staffing, LLC, recently announced the addition of information technology staffing to the services portfolio. As part of the expansion, IT recruitment specialist Vanessa Taylor has been brought onboard to bring her 15 years of experience to the IT placement function. LBMC Technologies, LLC, has added Andrea Mixon as a senior project manager to the Brentwood office to serve clients in all three locations across the state. She has more than 15 years experience in the areas of project management, business analysis and product management. Also joining LBMC Technologies in the Brentwood office is Scott Cornelisen to its Brentwood office as a senior software developer with more than 10 years of experience in the development of custom software and database administration. LBMC also recently added Brandon Raff to the Nashville office as a staff analyst in the litigation, valuation and business transition services group. He comes to LBMC from Pershing Yoakley & Associates and brings with him valuation experience working with hospitals, health systems, physician practices imaging centers and ambulatory care centers. Morgan Miller has also joined the Nashville office in the role of tax administrative assistant with the LBMC Tax Services Division where she will focus on tax preparations, administrative tasks and special project needs. She is working on her master’s at Lipscomb University.
Middle Tennessee’s Primary Source for Professional Healthcare News
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