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PHYSICIAN SPOTLIGHT PAGE 3
William Petrie, MD
TRY-ing to Get a Handle on Teen, Young Adult Addiction Federal Grant Allows Tennessee to Roll Out Pilot Program
ON ROUNDS
Depression Following Head Trauma The Lingering Results of a Physical Assault At the end of August, the National Football League settled a lawsuit brought by 4,500 former players over concussion-related brain injuries for $765 million ... 4
Studying, Assessing Problem Physician Behaviors The Vanderbilt Comprehensive Assessment Program (VCAP) offers an integrated approach to assessing and monitoring professionals … mainly physicians … referred for addiction, sexual boundary issues, anger management, burnout, mental health concerns, suspected cognitive decline, and disruptive behavior. ... 14
By CINDy SANDERS
The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) has received a federal grant to develop a pilot program in Maury and Madison counties aimed at teens and transitional youth for the treatment and sustained recovery of substance abuse. The four-year, $3.8 million grant from the federal Substance Abuse & Mental Health Services Administration (SAMHSA) will be used to establish TRY — Treatment and Recovery for Youth. To roll out the program, TDMHSAS has partnered with two community-based providers. Pathways of Tennessee will offer comprehensive treatment and recovery services in Madison County, and Centerstone of Tennessee will do the same in Maury County. Additionally, the team will collaborate with other state agencies including the Department of Children’s Services, Department of Educa(CONTINUED ON PAGE 6)
As ACA Starts to Fall into Place Bernard Health, Fifth Third Bank Host Annual Health Reform Seminar By KELLy PRICE
(L-R) James Blumstein, Cody Tell, Sen. Jim Tracy and Chris Ramsey at the recent update on healthcare reform.
As more planks in the Affordable Care Act transition from legislation to reality, employers, providers and lawmakers are scrambling to gain a foothold in the uncharted new economics of healthcare. Recently, Bernard Health and Fifth Third Bank invited more than 100 guests to attend a panel discussion during their Third Annual Health Care Reform Seminar. Attendees had an opportunity to hear an informed group of leaders in various segments of the healthcare arena give their most up-to-date assessment, information and practical advice on changes accompanying the sweeping reform legislation. Brian Tolbert, leader of Bernard Health’s sales account man(CONTINUED ON PAGE 10) Your
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PhysicianSpotlight
William Petrie, MD: Changing the Future of Mental Health By MELANIE KILGORE-HILL
As understanding of mental health grows, so does the need for experienced leaders in the field of psychiatry. That’s where William Petrie, MD, comes in. The geriatric psychiatrist has been one of Nashville’s leading behavioral health experts for more than 30 years and serves of the boards of Acadia Healthcare and the National Mental Health Association. In 2011, he returned to his Vanderbilt roots to teach tomorrow’s generation of mental health practitioners.
A New Role in Nashville
“Returning to Vanderbilt gave me the opportunity to develop services for seniors and to work with other depart-
ments to try to develop novel treatments,” Petrie said. “I also wanted to help young doctors take care of older patients. There’s not nearly enough interest in geriatrics, which is exactly what our country needs.” The Louisville native received undergrad and medical degrees from Vanderbilt before heading to Duke for residency training. There the up-and-coming physician received thorough training in geriatrics before honing his clinical skills at the National Institute of Mental Health, where he spent years researching drug therapies. Petrie later spent 25 years in practice, treating patients at Saint Thomas Hospital and serving as medical director at TriStar Centennial Parthenon Pavilion and Rolling Hills Hospital in suburban Franklin. Today he’s come full circle, focusing on
psychopharmacology at Vanderbilt and serving as clinical professor of Psychiatry. Petrie also works with residents, medical and nursing students to provide an outpatient service clinic for seniors suffering from memory disorders and other mental health symptoms. He says the Senior Assessment Clinic at Vanderbilt is now the busiest clinic in the Department of Psychiatry, allowing Petrie to provide support to patients and their caregivers.
Questions & Answers
While today’s science is better at diagnosing neurodegenerative disorders, Petrie says adequate treatment still isn’t on the horizon. “We’re better at identifying and understanding underlying pathological processes, but there’s a terrible need for effective treatments,” said Petrie, who spends much time in drug development. “Lots of new approaches have tried to aim specifically at causes of memory loss and deterioration, and we now think it begins as many as 15 to 20 years before the first symptom. We have better imaging and a better understanding of the biochemistry
and physiology of dementia, but we still don’t know what to do but offer fairly nonspecific treatments.” While today’s treatments can help to a modest degree, Petrie said many are anti-aging attempts to reduce dementia risk factors such as hypertension, inflammation, cholesterol, diabetes, sedentary lifestyles, lack of exercise and general vascular disease.
Seniors & Depression
Another problem seniors face is depression since frequency often increases with medical illness and chronic pain. Petrie said depression can look quite different in the elderly than in a younger person. “Depression is not a normal part of aging,” Petrie stated. “In fact, quality of life should improve the older you get if you don’t have a major medical or memory disorder.” For many seniors, a better quality of life springs from feeling more in control of their lives – a byproduct of the wisdom and peace of mind that often accompany aging. However, quality of life can easily (CONTINUED ON PAGE 12)
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Depression Following Head Trauma The Lingering Results of a Physical Assault By CINDY SANDERS
risk to something much more significant. At some point, the injuries build up and begin to have an effect on mood. There is evidence that even heading the soccer ball can cause injury over time.” West noted the attention that football players suffering from depression, cognitive deficits, chronic traumatic encephalopathy (CTE) and other neurological disorders have brought to the subject is important. “Recognition is key,” he stated, adding the first step is for physicians, coaches and parents to be aware of how serious concussion and other seemingly minor insults to the brain can truly be.
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Vanderbilt Scientists Discover Potential New Way to Treat Anxiety
Steve Jaynes
avenuenashville.com
Those with traumatic brain injury have a much higher prevalence of major depressive disorder than the general population. Citing several studies released in the last decade, West said that within the first year of suffering TBI, the rate for developing depression is between 33-42 percent compared to just 5 percent among the general population. There is a 15 percent increase in the rate of suicide within five years as compared to the general population, as well. As West pointed out, it hasn’t been too long ago that a concussed player might sit out for only a few minutes and then go right back in the game. “Now with concussion, we’re holding people out,” West said. “Having concussion is an increased risk factor for another concussion,” he
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In August, Vanderbilt University scientists reported chemically modified inhibitors of the COX-2 enzyme has been shown to relieve anxiety behaviors in mice by activating natural “endocannabinoids” without gastrointestinal side effects. Endocannabinoids are natural signaling molecules that activate cannabinoid receptors in the brain, the same receptors turned on by the active ingredient in marijuana. These receptors are also found in the gastrointestinal system and elsewhere in the body, and there is evidence that they play a role in wide range of physiological and pathological processes, in addition to modulating stress Drs. Lawrence Marnett (L) and Sachin Patel and anxiety. If the “substrate-selective” COX-2 inhibitors developed at Vanderbilt PROOF APPROVAL also work in humans without side effects, they could represent a new REQUIRED approach to treating mood and anxiety disorders, the researchers conclude in a paper to be posted ____ online Aug. 4, 2013 in the journal Nature Neuroscience. Clinical trials of some Version of these potential drugs could begin in the next several years, said Lawrence Marnett, PhD, director MECH __RB ___ of the Vanderbilt Institute of Chemical Biology and the paper’s co-senior author with Sachin Patel, MD, PhD. AD ____________ The Vanderbilt scientists are pursuing other potential applications of activating CD ____________ endocannabinoids by substrate-selective COX-2 inhibition, including relieving pain, treating movement disorders, and possibly preventing colon cancer. It has been known PROOF _________ for several years that COX-2 inhibition also activates endocannabinoids. Because the AE_____________ “substrate selective” inhibitors developed at Vanderbilt increase endocannabinoid levels in the mouse without blocking prostaglandin production, “We think (they) will not have CLIENT ________ the gastrointestinal and possibly cardiovascular side effects that other NSAIDs do,” said Marnett, adding the approach used by the Vanderbilt team represents a powerful way to help design the next generation of drugs. nashvillemedicalnews
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PHOTO BY: STEPHEN DOSTER
At the end of August, the National Football League settled a lawsuit brought by 4,500 former players over concussionrelated brain injuries for $765 million. Without admitting liability, the NFL agreed to the sum to pay for medical exams, compensate players with cognitive deficits (or the families of deceased players) and to fund additional research. While the recent lawsuit focused attention on the dangers of concussion over time in pro athletes, W. Scott West, MD, a Nashville psychiatrist in private practice in Green Hills, said the danger isn’t limited to football players. In addition to military personnel and those in accidents who have suffered traumatic brain injury, a growing body of evidence points to issues resulting from even W. Scott seemingly minor assaults Dr. West to the brain over time. “We’ve known for a long time that head injury is a risk factor for the development of depression,” said West, who is certified by the American Board of Psychiatry and Neurology. “What we don’t know is where it goes from zero or minor
added of the escalating danger. And the real damage doesn’t always show up immediately. As demonstrated by former NFL players, the deficits might take years to become evident. Newer diagnostic tools, however, can highlight potential problems earlier. West said diffusion tensor imaging allows physicians to see the brain in a different way than structural MRI, which shows gray matter. “It’s a type of MRI, but it looks particularly at the white matter … the fiber tracks in the white matter,” he explained. “We’re able to see the shearing and atrophy of those fiber tracks in some of the areas that have to do with mood.” He continued, “Unfortunately even these techniques don’t show the chronic traumatic encephalopathy, which is currently only diagnosable at autopsy.” Recognition and diagnosis of depression are just the starting point, however. West said there are a number of treatment options that can be efficacious alone or in combination. Psychotherapy, ranging from education and problem-solving to learning new techniques to cope with deficits, is a key place to start. Mindfulness, a cognitive-based therapy that has been shown to be particularly effective in reducing anxiety and depression, helps a patient achieve a present-centered awareness as a coping mechanism. By staying in the moment or day, those suffering from
Using Technology to Drive Delivery Changes in Behavioral Health By CINDY SANDERS
Technology is changing just about every aspect of our lives … from how we share and organize information to how we shop, pay bills and book travel. The expectation, then, is that it is also revolutionizing the way we consume and deliver healthcare. To some extent, that is true; but in many ways, health information technology is still in its infancy. Wayne Easterwood, chief information officer for Centerstone Research Institute, said both consumers and providers see the promise technology offers to enhance healthcare. Consumers, he said, are asking, “How could this Wayne help improve the frustrat- Easterwood ing pain points of how we engage in healthcare?” On the other side, providers are wondering, “How can it make my work more efficient? How can I connect with my patients more regularly?” At this point, he continued, there are a growing number of apps and pilot programs that test different methodologies, but most are operating independently without a backend connection. “Really, where the value comes in is when we begin to coordinate care,” Easterwood stated. The payoff, he added, is when “patients begin to communicate with their providers in between visits … providers begin coordinating with each other … and we make sure what we’re doing is really complementing each other.” The sticking point, he said, is reimbursement. Moving from a fee-for-service to a value-based payment system will help drive the technology faster and further in an effort to coordinate care. However, Easterwood said with one foot in each canoe, we’re not there quite yet.
Instant Access to Information
While big picture issues take up Easterwood’s day as he focuses on improving clinical decision support and collaborative communication across disciplines, Matt Hardy, PsyD, regional director for clinical services for Centerstone of Tennessee, said the hard work Easterwood and his team already have put in on Dr. Matt the organization’s internal Hardy technology has made a big difference in the way care is delivered. “It really enhances our ability to provide timely and accurate services to people nashvillemedicalnews
.com
in need,” he said of Centerstone’s electronic health record, which has been in place for more than a decade, and telemedicine capabilities. “We’re spread out across 26 counties in Middle Tennessee,” he continued. “People can go out in the communities, enter information into the (patient) record on their laptop, and everyone can instantly see it. That really enhances our ability to provide service,” Hardy said. He added that with a number of programs in operation around the clock, it’s imperative for a clinician who comes on duty at 8 a.m. to immediately know her next appointment was in the Emergency Department at midnight or talking to a crisis counselor at 3 a.m. Hardy noted he and a colleague were recently discussing the ‘old days’ (pre-2001) before Centerstone’s EHR was in place. “Can you imagine going back to a paper record?” they asked each other. “It wouldn’t be just one or two steps backward but leaps backward,” Hardy stressed.
Data & Analytics
Despite the gains made, both Easterwood and Hardy recognize there is untapped potential that will ultimately make Centerstone’s system even more efficient and effective. Easterwood said the HIT team is currently building protocols for both depression and suicide with best practices, decision support, and clinical prompts. “We’re working to build our system to support those protocols, as well as collect data and statistics … making the right thing to do the easy thing to do,” Easterwood said. “This is where we’re working to push the envelope.” He added that Centerstone believes it is as important to input physical health measures into their system as their own notes and measures so that providers have a better picture of complex behavioral health issues in connection to physical issues. “You can’t treat those things separately,” Easterwood stated. While a frequent complaint in the healthcare industry is that we tend to be ‘data rich and information poor,’ Hardy said their easy-to-use analytics software allows clinicians to quickly sort mountains of data into useful bites … from creating reports to help guide practice to making appropriate decisions about staffing levels. “Data is only good if it’s valid and accurate and if you can make decisions with it,” Hardy said, adding it also has to be simple enough for someone without a technology background to navigate. Easterwood was quick to applaud the
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TRY-ing to Get a Handle on Teen, Young Adult Addiction, continued from page 1 tion, Department of Human Services and Department of Health to create a feedback loop to identify barriers and test solutions in real time. TDMHSAS data shows about 4 percent of adolescents and 13 percent of transitional youth (ages 18-24) in the focus areas are dependent on or abuse alcohol. Respectively, another 4 and 6 percent are dependent on or abuse illicit drugs. Additionally, Tennessee ranks in the top 10 nationwide for the highest prescription drug use among high school teens, and about 13 percent of transitional youth report using prescription pain relievers for nonmedical use. Rodney Bragg, assistant commissioner for the Division of Substance Abuse Services for TDMHSAS, said TRY will be an intensive outpatient treatment program using a combination of two evidencebased cognitive behavioral interventions — Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC). A-CRA seeks to involve families, society and community partners to support and sustain recovery. ACC is a model of active follow-up to check on an individual’s progress and help link that person to support systems within the community. He said the TRY program will be aggressive in identifying those in trouble or at high risk by working with partner agencies and reaching out to schools, colleges, vocational training programs, hospitals and the court system. Over the next four years, he
expects to serve about 400 youth between the two counties in the pilot. A key component of TRY will be a research arm with learning labs to inform infrastructure development and assess what strategies work best. Bragg noted that limited services exist for transitional youth … a segment that doesn’t typically respond well to being included in groups of much older adults. “Capturing folks at such a young age enhances the ability for them to have a productive life,” Bragg said. Gino DeSalvatore, director of Therapeutic Foster Care & Academy Services for Centerstone, said they regularly see youth that have substance abuse issues as a co-occurring disorder alongside other behavioral health issues. This grant, he noted, will not only provide more services to that known group but will also idenGino tify and extend services DeSalvatore to more teens and young adults. A supporter of the evidence-based approaches being employed, he said, “The A-CRA piece really focuses in on both the individual and family.” He added, this allows therapists to see issues from both the youth’s point-of-view and that of the family and to explore those dynamics. By taking the multifaceted approach, DeSalvatore said therapists have the opportunity to
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provide education on parenting styles and interactions, communication skills, anger management and coping techniques, and peer relationship skills. It also allows providers to identify negative influences and scheduling gaps that could increase risks for substance abuse. “For all the kids I’ve met in my life, I’ve never met a bad kid … I’ve met kids who have made bad decisions,” DeSalvatore said. Identifying community supports that will allow teens and young adults to make better decisions is a foundational component of TRY. DeSalvatore said it’s critical to sustain the gains made during active intervention so that long-term recovery is achievable. “You’re really trying to tackle this problem from multiple, multiple angles,” he said. “Can what we do have staying power for a long time?” he asked, adding the goal of any treatment program is to equip individuals with the skill sets and community supports to keep them on the right track. Measuring results also will be an important part of TRY. “The idea is to reduce substance abuse by 70 percent at discharge and follow up at six months to see if that still holds,” DeSalvatore said. He added another goal is to reduce mental health symptomology by 50 percent for those who have a dual diagnosis. He is particularly excited about including young adults in the programming. “Kids are given more opportunities and chances to change their life,” he said of minors. “Once you cross that 18-year-old threshold … that line … the world really changes.” DeSalvatore noted young adults have probably aged out of a number of services, face stiffer consequences in the court system, and have more time on their hands if they aren’t in school. They are ‘grown ups’ by age, yet many haven’t developed the skill sets to successfully navigate adulthood. “If you don’t have the support system in place to help teach, guide, move you along, what happens is these kids seek social supports that are similar to them in nature
Latest Edition of TDMHSAS Newsletter Now Available The latest issue of “Update,” the newsletter of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) was released last month. Go online to www.tn.gov/ mental and click on the current newsletter link to read the quarterly publication. This latest issue includes information on: • The nation’s first statewide residential Recovery Court (Morgan County), • Introduction of kidcentraltn. com by the Governor’s Children’s Cabinet as a one-stop shop to help families raise healthy, happy children, and • Highlights from the first Statewide System of Care Conference.
or seek validation for what they are doing,” he explained. “Everyone needs validation. We all have to be connected.” He added that cults, gangs and the wrong crowd provide that validation if better options aren’t identified and available. “It’s why the grant is important. We’re hoping to shore up the social support system,” DeSalvatore concluded. Bragg summed up, “Treatment is effective and people do recover.” Unfortunately, he added, “Those are important concepts to us that are not always understood in our society … that treatment does work.” Hopefully, TRY will serve as an illustration of how effective intervention can make a lasting, lifelong difference in a young person’s life.
Not Alone Receives Wounded Warrior Grant to Bolster Nationwide Counseling Efforts Not Alone, a national nonprofit organization headquartered in Nashville that provides confidential, nocost programs and services to warriors and their families facing post-traumatic stress disorder (PTSD) and other invisible wounds of war, recently received a $424,000 grant from Wounded Warrior Project® (WWP) to strengthen its counseling and support services across the country. As part of the grant, Not Alone and WWP will collaborate to expand Not Alone’s free services for veterans, military personnel and family members in all 50 states including in-person and online counseling, support groups, peer mentoring and retreats. Not Alone will also strengthen online services that offer an anonymous, accessible outlet for veterans and spouses to learn coping skills and share life experiences. The new funding will also help support a 24-hour crisis hotline for any veteran or family member, as well as peer mentoring through Not Alone’s help line, blog and video blog. Each peer mentor is trained in empathetic listening, suicide prevention, domestic violence, and communication skills. “This grant provides crucial funding to extend Not Alone’s services to our nation’s servicemen and women,” said Debbie Cagle, interim CEO for Not Alone. “With this new funding, we will be able to reach thousands more people in need. We are thrilled to work with Wounded Warrior Project to see that service members and their families affected by the invisible wounds of war receive the support they need to cope with life after war.” nashvillemedicalnews
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TAMHO
The Voice for Behavioral Healthcare in Tennessee By CINDy SANDERS
For 55 years, the Tennessee Association of Mental Health Organizations has served as the voice for community mental health centers and nonprofit organizations that provide behavioral health services to some of the state’s most vulnerable residents. Founded in 1958 as the Tennessee Association of Mental Health Centers, the statewide trade association changed its name in 1995 to better represent the changing organizational structure of its members. “The purpose of the organization is to advocate for people who need services,” said Ellyn Wilbur, executive director for TAMHO. To achieve that goal, the association promotes the advancement of effective behavioral health services, advocates for access to care, and works to serve Ellyn Wilbur its 21 member organizations, which include community mental health centers, specialty providers, and substance abuse experts. To carry the behavioral health agenda forward, working committees, task forces, and professional membership sections bring together more than 400 staff from TAMHO member organizations on a regular basis to identify problems and issues from a provider perspective and to develop recommendations to effectively address them. As the primary provider network for the state’s Medicaid waiver program, Wilbur noted, “The majority of the people our centers serve are TennCare-eligible, although that number has decreased slightly, and there are more uninsured
people now than in years past.” She added some centers also serve those with private insurance and Medicare. “We see, on average, about 90,000 people a month,” Wilbur said of the provider network, noting many people access the system multiple times a year. “The community mental health centers see, by and large, those with severe mental illness or substance abuse disorders, which means repeat visits. We typically see more adults than children … roughly two-thirds adults to one-third children.” Every county has at least one provider and some have multiple providers, she said of the network’s reach. In addition, there are 13 crisis providers across the state available around the clock, seven days a week, 365 days a year; and eight crisis stabilization units (CSUs) spread across Tennessee. Wilbur explained a CSU is a short-term unit staffed by a range of professionals and paraprofessionals where an individual typically stays two to four days to get past the point of crisis. “When you have this type of system in place, you can often stave off the need for hospitalization,” Wilbur said. “The sooner you can return someone to their community with the supports they need, the better the outcome often is.” Wilbur, who has worked in community behavioral health and social services for more than 30 years, said she has seen the science behind behavioral health markedly evolve. “From my perspective, we’ve seen a tremendous increase in the knowledge base of what actually works for people with severe illness,” she said. “There’s been a pretty dramatic increase in the number of effective medicines that are now available,” she added. “At the same time, we’ve seen a pretty dramatic increase in demand over the last four or
five years.” Wilbur said there are multifactorial reasons for the increased demand including stress brought on by economic concerns, mental health parity laws making services more accessible, and a lessening of the social stigma of seeking help. “We have worked hard as an industry to decrease the stigma and impress upon people that mental illness is an illness. It’s a brain disease just like diabetes or another chronic disease.” With the health insurance exchanges launching this month, Wilbur said her member organizations anticipate the marketplace plans will enable even more people to come through the doors to seek services. “I think we’re concerned that if the state of Tennessee does not agree to expand Medicaid, there will be a significant group of people with no payer source for services at all,” she said, referring to the group of people caught in the gap between TennCare eligibility and qualifying for health exchange subsidies. Wilbur added the hope would be for an increase in state funding from the Department of Mental Health. “Right now about 33,000 people are served through that fund every year.” TAMHO members are also dealing with more medically complex cases as patients present with co-occurring disorders … either a physical/behavioral health combination or a mental health diagnosis plus substance abuse. “Many of our providers are doing more integrated care,” Wilbur said, adding the new reality means providers have begun to meet a range of physical and behavioral health needs and to collaborate and connect with each other to better coordinate care and improve outcomes.
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Annual Conference Dec. 3-4 Embassy Suites Hotel & Conference Center • Murfreesboro Ellyn Wilbur, executive director of TAMHO, said integrated care is a main theme for the 2013 meeting, which includes a full slate of keynote, public policy and educational sessions, plus an awards and recognition celebration, annual business meeting and installation of the new board. On Dec. 4, Charles Good, CEO of Frontier Health, will pass the presidential gavel to Bob Vero, EdD, CEO of Centerstone Tennessee, as the 2014 board of directors is seated. Wilbur is particularly excited about the broad appeal of this year’s keynote speakers. TAMHO has partnered with the Tennessee Department of Health to bring Nadine Burke Harris, MD, MPH, to attendees. Harris is CEO of the Center for Youth Wellness in California. “Her expertise is in adverse child experiences as a risk factor for adult disease,” said Wilbur. “I think we’ve not always made the connection between those two things.” Wilbur added, “She understands when children have been exposed to trauma or violence, that exposure changes the way their brains develop and leads to more physical issues later.” Kathleen Reynolds, a consultant with the National Council for Behavioral Health, is an expert on bidirectional integration between behavioral health and primary care. Kenneth Minkoff, MD, a clinical assistant professor at Harvard, is another nationally renowned speaker and consultant. “He is considered one of the nation’s leading experts on integrated treatments for individuals with cooccurring psychiatric and substance abuse disorders,” Wilbur noted. A fourth expert on integration speaking at this year’s conference was found a little closer to home, she continued. Jeff Howard with Cherokee Health Systems, which is headquartered in Knoxville, will discuss his organization’s more than 30 years experience blending primary care and behavioral health services. Cherokee staff members have provided technical assistance on integrated care to more than 100 organizations nationwide. Although always open to those outside the TAMHO membership, Wilbur said this year’s meeting with its focus on integrated care should be especially appealing to a range of providers and encouraged anyone interested to attend. For more detailed program information and to register, go online to www. tamho.org.
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Gresham, Smith and Partners Paving the Way in Healthcare Architecture GS&P is providing architectural, engineering and workplace strategy services for the 106,000-squarefoot Lentz Public Health Center replacement facility. Scheduled for completion this year, the facility includes a unique combination of administrative office and health clinic space.
By MELANIE KILGORE-HILL
For more than 40 years, Nashvillebased Gresham, Smith and Partners has been envisioning, designing and building premiere medical facilities. From rural outpatient clinics to a 3,000-bed Shanghai medical city, the architects at GS&P are known for their innovative hospital and healthcare facility design. Meeting a Need “Our practices are built around local needs,” said Chairman and CEO James Bearden. “Whether local or international, our clients’ needs drive where we’re at as an organization and determine what their role is in healthcare delivery. The common element is that it has to James be fitted appropriately Bearden for their community and the set of people they’re responsible for.” While the company is a leader in a wide range of industries, healthcare and hospital design has been the group’s primary business since opening in 1967. Here in Nashville, GS&P projects include the Lentz Public Health Center and Vanderbilt Health at One Hundred Oaks. “Nashville has a very sophisticated set of healthcare providers working at a large scale,” Bearden said. “Based on that large scale, we’re looking at how you scale up processes and delivery methodologies to where they’re an asset to you.” The New Look of Healthcare Today’s successful firms venture far outside of traditional architecture roles, working hand-in-hand with other professionals to create and apply a plan on a local, regional or national basis. Scaling appropriately to keep patients at the center of the design and quality first, as well as approaching healthcare with a preventative rather than reactive mindset, are priorities for Bearden’s team. “The design and construction community has to understand and know that it’s not about a single project but about learning from it and how it can contribute,” Bearden said. As the variety of physical healthcare environments grows, providers are redefining the role of acute care facilities by moving outpatient and less acute services closer to where patients live. “Hospitals are still a key component but are more of a hub and spoke model,” Bearden said. “There’s still a hub, but what’s at the end of the spoke may be different.” In urban communities like Nashville, spokes often end in physical and mental health facilities, wellness centers and proactive medical providers, all of which curb the need for reactive healthcare services. nashvillemedicalnews
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“Being able to break down the types of interaction points in healthcare allows us as an organization to say to a client, ‘There are a variety of ways to provide that end, and let’s explore those together,’” Bearden said. “We’re no longer just taking orders.
As a team member, we’re contributing toward strategy and sitting down with clients to look at the pluses and minuses of different models.” Other trends in hospital design include standardization of rooms and en-
The redevelopment of One Hundred Oaks into a mixed-use outpatient center and retail destination has been selected for presentation at the 2013 AIA National Convention. “This was a landmark project for Nashville, not just because it transformed a dying mall and revitalized surrounding retail areas, but because it created a more convenient and accessible setting for patients to benefit from Vanderbilt’s high-quality medical care,” said GS&P Senior Vice President Steve Johnson, AIA, NCARB.
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vironments to serve multiple purposes. Emergency rooms, for example, are now being built to adjust to peak volume times — evenings and weekends — while transitioning to other uses during slower times. Patient rooms also are being designed to serve varying levels of acuity in one environment. Walking that line between understanding patient needs and providing an environment that’s not overly specialized is a common concern for facility administrators. Playing by the Rules Another challenge facing architects is the need to understand and comply with ever-changing healthcare regulations like the Affordable Care Act. “If you took all the changes over the last 30 years and bundled them together, it still wouldn’t be as significant as this one set of changes the industry has brought,” said Bearden, a 30-year industry veteran. “When someone changes the rules, it’s not ‘How do we comply?’ but ‘How do we excel within the rules?’” As revenue sources are impacted, clients also are asking how to maintain quality care for the uninsured while simultaneously helping providers survive. Architects are expected to bring expertise that not only helps processes but ensures every dollar is spent wisely to minimize (CONTINUED ON PAGE 10)
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As ACA Starts to Fall into Place, continued from page 1 agement and service teams, served quiring businesses with 50 or more as moderator. The distinguished full time employees to offer coverpanel included Professor James age that is affordable (defined as Blumstein, director of Vandernot over 9.5 per cent of household bilt’s Health Policy Center; Tenincome) means those businesses nessee State Senator Jim Tracy; are looking at a 30 to 40 percent Chris Ramsey, director of the increase in costs. Office of Health Care Reform for Blumstein said the ACA foBlueCross BlueShield of Tennescuses on funds to build a better see; Cody Tellis, wealth advisor brake. “Wouldn’t it be better not for Fifth Third; and Alex Tolbert, to push so hard on the accelerafounder of Bernard Health. tor?” he queried. A healthcare and constituBlumstein added, people are tional law professor at Vanderbilt, numbed by a “fiscal Novocain” Blumstein has served as principal where they don’t feel the pain investigator on numerous grants of paying. ‘We have to educate and studies concerning managed people to expect to pay out of care, hospital management and their pocket for what things cost. medical malpractice. His amicus We’ve got to change perception brief is widely cited as what the and make the patient feel that he U.S. Supreme Court followed in is in change of his own care and striking down the “Medicaid coget back where people think about ercion” portion of the ACA law. Alex Tolbert (L) and Joe Rowling take a coffee break during the recent what triggers reactions.” Tracy, who represents Tennes- healthcare reform panel sponsored by Bernard Health and Fifth Third Bank. Using the postal system as an see’s 14th district, was part of the example, Blumstein said, “Mail is discussions around Tennessee’s decision to not efficient, but the postal system does a benefit from the coming changes. opt for the federally run exchange. Ramsey pretty good job for 46 cents … not everyFrom the government perspective, leads BCBST’s efforts to comply with rething needs to be FedExed.” Tracy noted that … by law … Tennessee form requirements and is knowledgeable He also advocated essential benefit has to balance the state’s budget but said about the forthcoming challenges and oppackages including mental health and subchanges in the rules are making the goal portunities. Tellis provided insight into the stance abuse, deductible maximums, no harder to reach. He noted, “The goverbusiness challenges that come with reform. more lifetime limits and deductible ceilnor can’t do anything if we don’t know the Tolbert, who founded the nation’s first ining. That said, Blumstein observed ACA rules — it’s like changing the height of the dependent healthcare retail store to offer requires 85 percent of the premiums colbasketball goals in the middle of the second non-commissioned advice on health insurlected have to be paid out, which he noted, quarter.” ance to employers and individuals, outlined could be a “disincentive” for some payers He also said the employer mandate reways that employers and individuals can to participate. Alex Tolbert observed that for many small employers, the decision to drop the group health plan is just a smart tax move. In 1954, the tax incentive was for group health insurance, he said. In 2014, the tax incentive is now for individual health in-
surance. The savviest healthcare consumer will take advantage first. “We have experts saying we need the new business model of (an) ongoing, monthly fee for the kind of primary care doctor relationship most people say is what they want,” Tolbert said. “When it comes to primary care, patients want an involved, comprehensive relationship with their doctor.” He continued, “Many patient are already on the hook to pay cash out-ofpocket for their healthcare needs up to the deductible. As things currently stand, when they go to the doctor, they pay the insurernegotiated rate. It has surprised many to find to that this insurer-negotiated rate is higher than the provider’s cash-paying patient price.” Tolbert pointed out that there are three types of “prices” in healthcare: • Retail price: what the provider publishes as its retail rate; • Insurer-negotiated rate: The rate the provider has negotiated with the insurer that all members have to pay; and • Cash-paying patient price: what the provider is actually willing to take if the patient is paying in cash. Tolbert said, “We need to become better educated about healthcare. On 1-1-14, healthcare costs will dramatically change from defined benefit to defined cost.” He added in the ‘old way,’ employees were offered XYZ and picked from those plan options. In the ‘new way,’ an employer will contribute $250 a month and consumers will buy what they want. “This way, employees and employers are on the same side of the table. By removing negative energy, we are all marching together,” he concluded.
For More on ACA Implementation, Please Go Online to NashvilleMedicalNews.com
HealthcareEnterprise, continued from page 9 long-term viability costs. Bearden said the front-end cost of design and construction is a small percentage of overall duration of costs spread over a facility’s life. Not unlike a physician, architects also must constantly research how environments affect quality of care and outcomes of patients, and then understand how to affordably put those environments in place so it fits into a long-term cost model for the client and community. “Up front costs need to be the best dollar spent in the best way and in a timely way so it’s providing as quickly as possible,” Bearden said, “Instead of revenue going out for capital, it’s how quickly can you get revenue coming in.” East to West With 17 offices worldwide, the vast majority of GS&P’s healthcare projects are built outside of Tennessee. Among their most daunting projects is a 3,000-bed medical community being planned from the firm’s Shanghai office. This summer, 10
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GS&P announced ground has been broken on the Shanghai New Hongqiao International Medical Center Shared Facility, the central logistical, clinical and public support facility for the planned medical campus’s five hospitals and additional specialty clinics. Having individual hospitals plug into a centralized facility is a new concept in healthcare delivery, and Shanghai’s Shared Facility is the first of its kind in the world. Additionally, the team in China also is working with government officials to bring rural healthcare to a people accustomed to traveling to bustling city hospitals. “I made a statement 10 years ago that if we’re the same in 10 years, we will have failed,” Bearden said. “It’s a continual challenge to dig deep into not just what we’ve done in the past but our contribution to the future. That doesn’t happen by doing the same thing over and over again. Our closeness and desire to be close to our clients early on in the envisioning of what they do is what we see as part of our successes and helping our clients succeed.” nashvillemedicalnews
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Advances in breast cancer O c t o b e r i s b r e a s t c a n c e r awa r e n e s s m o n t h By Nancy Peacock, M.D., Medical Oncologist, Tennessee Oncology October is breast cancer awareness month and brings the opportunity to share new and interesting developments in the arena of breast cancer treatment. As you would expect, prevention remains preferable to treatment. Clearly the risk of developing breast cancer is not in one’s control, but, there are strategies that help women reduce their risk. For women with an increased risk of breast cancer (those with premalignant lesions like DCIS or LCIS), taking the drugs Tamoxifen or aromatase inhibitors can decrease the risk of developing an invasive breast cancer. This strategy is also effective for women with a family risk of breast cancer or even an inherited genetic risk such as a mutation in BRCA 1 or 2. The current recommendations for bilateral prophylactic mastectomy and oophorectomy and hysterectomy are still preferred for women with BRCA 1 and 2 mutations. These women have extraordinarily high risks of developing breast and ovarian and fallopian tube cancers, and preventive surgeries have lowered that risk. It is worth emphasizing that following a healthy diet by including five to seven servings of fresh fruit and vegetables daily, maintaining a healthy weight, adding 120 minutes of aerobic exercise weekly, and eliminating cigarette smoking decreases the risk of developing breast, colon, and lung cancers. Early diagnosis remains important. Mammographic screening every other year is the current and updated recommendation for women ages 50 to 75 stated by the Institute of Medicine and the U.S. Preventative Services Task Force. The American Cancer Society, however, continues to recommend annual mammography. For women under 50 or above 75, there can be valid reasons to perform mammography, but there is not enough data to show that these are helpful screening tools in women outside the recommended age range. There are no recommendations that include breast MRI or ultrasound in a screening program, even in women with increased breast density. Recently we have been able to take advantage of molecular profiling to help understand the risk of relapse and benefit of chemotherapy for specific breast cancers. Molecular profiling tests, including the Oncotype Dx, the Mammaprint, and the Pam50, give clinicians and their patients more accurate predictions of who will really benefit from chemotherapy and who will not. The results of newly published studies have shown that continuing adjuvant hormonal therapy beyond five years reduces the risk of later relapse in premenopausal women treated with Tamoxifen, and in postmenopausal women treated with Tamoxifen followed by an aromatase inhibitor or an aromatase inhibitor alone. None of these advances would have been possible without the collaboration of scientists, clinical investigators, and most importantly the patients who participated in these trials. The class of biologic anticancer drugs that target the Her 2 protein like Trastuzumab and Pertuzumab work with chemotherapy in the pre-operative, the post-operative, and the metastatic settings to improve the survival rates in tumors with more aggressive natures. Oncologists continue to struggle with difficult breast cancers, particularly triple negative cancers which do not express the Er, PgR and Her2 proteins. These tumors have proven resistant to many known chemotherapeutics. This is a group of patients for whom clinical trials remain extraordinarily important. The many benefits seen in the systemic treatment of breast cancer have occurred at a time when we have also seen an improvement in surgical techniques and radiation therapy options. In fact, for select patients, it is possible to receive novel radiation treatments at the time of surgery or even over a one-week course as opposed to the usual six-week course of external beam radiation therapy. Surgeons are able to effectively remove smaller cancers with limited damage to the breast or to the axillary lymph node areas by removing only the lymph nodes most likely to be involved at the time the cancer is diagnosed. This is a time of great optimism in the treatment of breast cancers. We still have much work to do though, to provide a chance for a cure in all patients affected by this disease.
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Happy, Safe Workforce Prerequisite for Patient Safety Report Emphasizes Impact of Workplace Culture on Patient Outcomes By CINDY SANDERS
If the workforce ain’t happy … ain’t nobody happy. This spring the Lucian Leape Institute at the National Patient Safety Foundation (NPSF) released a report, Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care, that underscored the fundamental importance the workplace environment plays on patient safety. The result of two roundtables on the topic, the report contends patient safety is inextricably linked to healthcare workers’ own sense of safety and well being since providers who feel disrespected or threatened are more likely to make errors and less likely to follow institutional protocols. Julianne Morath, RN, MS, president and CEO of the Hospital Quality Institute based in Sacramento, Calif., co-led the roundtables with former U.S. Treasury SecJulianne retary Paul O’Neill, now Morath CEO of Alcoa. A founding member of the Lucian Leape Institute, Morath was the inaugural recipient of the John M. Eisenberg Award for Lifetime Achievement in Patient Safety from NPSF and is a noted author and speaker on the topic of safety and workforce improvement. Going into the roundtables, Morath said the working hypothesis was, “A workforce, no matter how committed and skilled, cannot create a culture of safety unless they themselves are free from harm and disrespect.” This hypothesis was borne out during the discussions that included the experiences and opinions of frontline practitioners, leaders of healthcare organizations, scholars, and representatives of government agencies and healthcare professional societies. Morath said, “It became very evident through the course of the roundtables that we have a long way to go in healthcare workforce safety.” When workers live in a constant state of risk, they become blind to that risk and resigned to their situation, Morath said. “It’s a dangerous place to be if you think this is as good as it’s going to get no matter what you do,” she noted. When a workforce reaches this state, Morath continued, the workers won’t speak up or speak out. Yet, the evidence clearly shows having a culture that allows for effective assertion … or a ‘stop-the-line conversation’ … is a prerequisite for patient safety. Morath, who served as chief quality and patient safety officer at Vanderbilt University Medical Center at the time of the roundtables, said her co-leader O’Neill has often made the statement that every person in a workforce should be able to answer affirmatively to three essential questions: 12
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1. Am I treated with respect and dignity by everyone? 2. Do I have the support and training tools to do my job? 3. Am I recognized and thanked for my contributions? Unfortunately, ‘no’ is too often the answer to those questions. “It was jarring to find not only was there a lack of respect … but even worse, there was a culture of disrespect in many of our healthcare organizations that was tolerated,” she said of the group’s findings. “We have a somewhat historic and toxic culture where the hierarchy has to do with positional titles and the number of degrees,” Morath added. Vulnerabilities in the system include accepting emotional abuse, bullying and learning by humiliation as ‘normal,’ performing demanding tasks under severe time constraints due to the production and cost pressures that dominate today’s healthcare landscape, and having a higher rate of physical harm than such high-risk industries as mining, manufacturing and construction. This culture of fear and intimidation takes away the joy and meaning from work that most healthcare employees chose for the very purpose of helping others and making a difference. “While this report is concerning, it’s also hopeful,” said Morath, noting there were also examples of healthcare workplaces that are getting it right … at least most of the time. New healthcare models that rely heavily on teamwork are also helping make cooperation part of the landscape. “It really requires an appreciation and respect for everyone’s contribution in a team to deliver high quality, safe care in this complex environment in which we work today,” she noted. The report asserts joy and meaning are created when the workforce feels valued, safe from harm and part of the solutions for change. The Mayo Clinic and Virginia Mason Medical Center are two examples that Morath said stood out for their culture of respect. She also said Hospital Corporation of America (HCA) has an exemplary employee safety and security initiative. To create safe, supportive work environments, healthcare facilities must become high-reliability organizations with a fundamental precondition that employees are their most valuable assets and that the health and well being of those employees is a non-negotiable priority. The report outlined seven strategies to move the needle toward becoming this type of an effective organization. 1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines. 2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance. 4. Create a learning and improvement system. 5. Establish data capture, database and performance metrics for accountability and improvement. 6. Recognize and celebrate the work and accomplishments of the workforce regularly and with high visibility. 7. Support industry-wide research to design and conduct studies that will explore issues and conditions in healthcare that are harming the workforce and patients. “It sounds deceptively simple, but it’s about and individual and collective commitment to continual learning, continual improvement, and continual engagement,” said Morath. “When you start, you’re never finished. This is a commitment … a long term commitment.”
Through the Eyes of the Workforce To download the full report and related materials, go online to www. npsf.org. Click on “About Us” and select the Lucian Leape Institute at NPSF. From there, choose the LLI Reports and Statements link under “Related Pages.”
Physician Spotlight, continued from page 3
diminish as seniors begin to slow down activity and involvement. Petrie urges patients, regardless of age, to walk at least a mile every day, rain or shine, and to push harder with each passing year. “It’s essential to keep patients active as they age,” Petrie said. “Older people need to increase physical activity, which has a major bearing on overall health and will improve quality of life. Physical exercise improves memory in older people and adolescents, improves sleep, increases the ability to deal with illness when it occurs, and also reduces falls and fractures, which can be catastrophic.”
Building a Legacy
In all of this, Petrie’s goal is to continue mentoring young professionals and to make progress with new and effective treatments for symptoms of neurodegenerative diseases. He also hopes to continue to provide support to families who are often the primary caregivers. “I would love to see us devise a system to rate facilities, sort of a Trip Advisor for nursing homes and assisted living facilities,” Petrie said. “I want to provide a way of empowering families to know what they’re getting and how they can improve care for their loved ones. I want to give power back to the consumer by providing excellent programs.” Another focus, he said, is to overcome the challenge of viewing mental health as a second-class illness. “We’re still way behind in mental health and have to develop more focus on quality and psychiatric patients who need the same access to care that people with other illnesses do,” Petrie said. “We’ve gotten better, but there’s still a long way to go.
Depression, continued from page 4 depression don’t feel as overwhelmed. Medicines to reduce symptoms of depression are also an important part of the arsenal, West said. “If someone’s mood is better, they will deal more effectively with whatever other issues they have,” he noted. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are two other options. ECT has been around a long time, and much of the stigma attached to ‘shock therapy’ is based on early treatments. West noted, “We’ve made a lot of improvements in the technology over time so the side effects have improved … although it’s certainly not without side effects. We’re also more clinically careful about the usage of it.” He added there is significant research showing ECT can be effective in managing depression when other treatments have been unsuccessful. However, he added, there isn’t much research focused on using the modality in depression stemming from traumatic brain injury. TMS is a much newer option. “Transcranial magnetic stimulation was approved in 2008 for the treatment of
depression that doesn’t respond to medication,” West explained. “It uses MRI technology to cause repetitive pulses of the magnet that stimulates the brain, specifically the left prefrontal cortex, thus appearing to increase the efficacy of the neurotransmitters in the areas of the brain that control mood.” West, who brought NeuroStar TMS to Tennessee in April 2010, said the outpatient procedure is well tolerated without significant side effects. When he began using TMS there were about 130 sites across the county with the technology. Today, there are more than 500 sites using TMS. “Often it takes a combination of medication plus TMS and psychotherapy,” West said. “Once you get mood symptoms under control, you still need to improve the ability to cope.” While depression is a chronic, difficult disorder that impacts patients and all those around them, the good news is that the science has progressed to a point where most respond to treatment. “In the majority of cases, people can show significant improvement,” West concluded. nashvillemedicalnews
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Studying, Assessing Problem Physician Behaviors By CINDY SANDERS
The Vanderbilt Comprehensive Assessment Program (VCAP) offers an integrated approach to assessing and monitoring professionals … mainly physicians … referred for addiction, sexual boundary issues, anger management, burnout, mental health concerns, suspected cognitive decline, and disruptive behavior. The multidisciplinary team provides fitness-for-duty assessments on behalf of referring agencies for professionals outside of the Vanderbilt Health network. What the team doesn’t provide is treatment. This, however, is by design to eliminate any appearance of conflict of interest by the VCAP evaluators. “Our independence is attractive to many physicians,” explained Reid Finlayson, MD, associate professor of Clinical Psychiatry for Vanderbilt University School of Medicine and medical director for VCAP. “We’re not Dr. Reid providing treatment for Finlayson these doctors, but we try to understand their behavior and recommend ways to help them practice safely
and more effectively. We’re trying to give them a forensic definition of whether or not they’re fit to practice.” Finlayson launched the program in late 2001. The board certified psychiatrist and addiction specialist had been doing similar work in Canada prior to moving to Nashville. What started at Vanderbilt with Finlayson and Judy Rose, RN, a licensed addiction counselor, has now grown to include a staff of seven plus consultants including specialists in psychiatry, addiction, internal medicine, psychology, neuropsychology, sex therapy, social work and nursing. The VCAP team assesses professionals in crisis and looks for the underlying issues causing the problematic behavior and helps providers determine the best options to get their careers back on track. Typically, the outpatient assessment takes between two and four days. With permission, the team often speaks with relevant third parties — including a spouse, family members, and colleagues — to get a clearer idea of the physician’s interactions. “Our goal is to get the complete picture of the doctor as a person,” said Finlayson. At the end of July, the VCAP team had a paper accepted for publication in General Hospital Psychiatry outlining their Your
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findings from 381 physician assessments. “Very early on we thought it would be interesting to collect data on these physicians and analyze it because this is a special population,” Finlayson noted. From that data, he noted the most common reason for a referral is some type of disruptive behavior in the workplace (nearly 40 percent). Aggressive behavior such as a surgeon throwing an instrument in the OR, condescending comments aimed at staff or passive/aggressive behaviors such as undermining colleagues might get a physician referred to VCAP. Ron Neufeld, BSW, LADAC, program manager for VCAP, added evaluations for cognitive impairment is a growing sector. “As Ron Neufeld our physician population ages, we are doing some cognitive testing to see whether or not there is a cognitive decline … a decline in executive function,” he explained. The VCAP study showed those referred for disruptive behavior are more likely to receive a fit-for-duty recommendation than those referred for substance abuse and other behavioral health disorders. Those being referred for evaluation are more likely to be middle-aged (almost 66 percent are between 35-54 years of age), white (83.5 percent) males (89.5 percent) who received their medical training in the United States (83.4 percent). Surgeons and family medicine practitioners tended to be overrepresented in the VCAP study as compared to the percentage of these practitioners in the general physician population. Conversely, internal medicine was underrepresented. Although the American Medical Association’s statistics show a little more than 41 percent of physicians are internists, the group only represented 27.6 percent of VCAP referrals. “We tend to see the worst offenders,” said Finlayson. He added that many providers don’t require a formal evaluation. Instead, they modify their behavior simply by having an administrator or supervisor speak to them and point out actions that are deemed inappropriate. “I think systems … 20, 30, 40 years ago … were much more tolerant (of bad behavior),” said Neufeld. “Nurses were trained to be submissive to physicians so physician behavior was tolerated.” However, that willingness to turn a blind eye is evaporating. Neufeld said in the wake of The Joint Commission’s 2008
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guidelines to create a culture of safety in healthcare environments, VCAP has seen a definite upsurge in referrals for disruptive or aggressive behavior. Prior to 2008, responsibility for physician conduct was largely in the form of self-governance by the profession. Now that responsibility has shifted to the organizations that employ physicians. In addition to disruptive behavior, sexual boundary issues (22.6 percent) and substance abuse (20.2 percent) round out the top three reasons for a referral. Neufeld said about 70 percent of the referred physicians are found to be fit to practice. For the 30 percent who aren’t ready to practice, the hope is that many of them ultimately will find their way back to the hospital or clinic with appropriate intervention. Finlayson noted the healthcare industry’s vigilance about alcohol and drug abuse and advances in addiction medicine have led to effective treatment options with the critical component of sustained follow up and monitoring. “In the general population the outcome of addiction treatment is marginal,” Finlayson said. “In one study, over 75 percent of physicians with addiction were still practicing five years later with proper intervention and follow up … that’s something the general public doesn’t usually get,” he added of the ongoing monitoring. He continued, “I think physicians are often on the leading edge when it comes to society in changing behaviors.” He added physicians were held accountable for sexual boundaries far in advance of sexual harassment being recognized in the general workplace. Similarly, he hopes to see a decrease in referrals for disruptive behavior as medical schools begin training physicians to be team players and hone collaborative leadership skills. Finlayson noted the most important finding from their research to date is that physicians who behave badly often can be restored to full practice with appropriate treatment or management rather than just cast aside. “We should go to all ends to preserve their ability to practice if at all possible,” Finlayson said, adding this is particularly important in light of projected shortages in a number of specialties. “I don’t think of any of these doctors that are referred to us as bad doctors,” said Neufeld. “Very often they are well thought of skill-wise. Hopefully we can make recommendations that will allow them to practice more collaboratively with colleagues and staff and thereby improve outcomes and patient safety.” While the recent paper focused on 381 physicians, Finlayson and Neufeld said VCAP has evaluated more than 500 professionals from 37 states and four Canadian provinces. The majority of referrals are physicians, but the team also sees other healthcare professionals, lawyers, and those from the entertainment industry. nashvillemedicalnews
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AACR Cancer Progress Report 2013 Making Research Count for Patients By CINDY SANDERS
The nearly 14 million cancer survivors living in the United States are proof that advances in prevention, detection, diagnoses and treatment are making a difference in homes found in every city, every state across this nation. To the scientists represented by the American Association for Cancer Research, the outcomes often represent a long path of disappointments, dead ends, new leads, and breakthroughs on the way to triumph … none of which would happen without the many decades of investments in basic, translational and clinical research. The AACR’s third annual report is both a celebratory and cautionary tale. Highlights include: • There have been more than 1 million fewer cancer deaths since 1990 and 1991 for men and women, respectively. • In the past year, the U.S. Food and Drug Administration (FDA) approved 11 new drugs to treat a variety of cancers, three new uses for previously approved
cancer drugs, and three new imaging technologies. • Cancer genomics research continues to advance precision medicine. Nearly half of the new anticancer drugs approved by the FDA in 2013 target specific defects in cancers. • More than 100 years of fundamental discoveries in immunology have now led to the development of anticancer immunotherapies that are yielding remarkable, long-lasting patient responses. Despite these advances, more than 1.6 million Americans are projected to be diagnosed with cancer this year, and more than 580,350 will die from one of the more than 200 types of cancer. The escalating prevalence of obesity and use of tobacco products by nearly one in every five Americans increases risk that could be avoided by behavioral modifications. One risk factor that can’t be avoided, however, is age … more than 75 percent of cancer diagnoses occur
in those 55 or older. As this population segment grows, cancer cases and deaths also are predicted to rise. Compounding these issues is a steadily declining federal research budget. Congressional funding for the National Institutes of Health and National Cancer Institute hasn’t kept pace with biomedical inflation. The effective result has been a 20 percent reduction in the ability of these agencies to support research. Additionally, the NIH took a direct hit of $1.6 billion in March as part of federal budget cuts. Without congressional intervention, sequestration will result in an overall budget reduction of $19 billion for the NIH by 2021. The AACR leadership warned that if the United States doesn’t increase its investments in the research required to develop more effective tools and interventions, the toll would be felt in terms of lost lives and economic burden. The latest NIH estimates indicate the economic cost of cancer
View the Full Report: www.cancerprogressreport.org
in 2008 was more than $201 billion in direct medical cost and lost productivity due to premature death. AACR researchers contend bench-to-bedside discoveries represent the best way to curb the incidence of cancer and improve survivability … therefore restoring funding is a small investment for a big return. Charles L. Sawyers, Dr. Charles L. Sawyers MD, president of the AACR and chair of the Human Oncology and Pathogenesis Program at Memorial Sloan-Kettering Cancer Center in New York, summed up the organizations findings. “One person will die of cancer every minute of every day this year. This is unacceptable,” he said. “If we are to accelerate the pace of progress toward our goal, we must continue to pursue a comprehensive understanding of the biology of cancer. This will only be possible if we make funding for cancer research and biomedical science a national priority.”
TPCA Receives DentaQuest Grant to Improve Oral Health Dollars Earmarked to Improve Safety Net By CINDY SANDERS
The DentaQuest Foundation, headquartered in Boston, recently announced a one-year grant of $99,648 has been awarded to the Tennessee Primary Care Association (TPCA) to support programming aimed at improving the state’s oral health. Established in 2000 with a mission to support and promote optimal oral health in the United States, DentaQuest partners
with organizations and providers across the country to raise awareness, enhance education and increase access to care. The Tennessee grant is part of DentaQuest’s Strengthening the Oral Health Safety Net Initiative. TPCA’s community health center members served more than 384,000 patients last year as the core of Tennessee’s health safety net. However, not all health centers have the capacity to include dental care services, leaving thousands of un-
Using Technology, continued from page 5 analytics team for letting providers ‘wander’ into the data. The numerous dashboards allow clinicians to see basic information and then dive deeper to look at trends or anomalies, pull in additional data sets such as weather and location information, and then drill down again.
Patient Engagement
Now, Easterwood and Hardy said, it’s time to connect the dots … to harness the power of the data analytics and EHR to make more informed decisions about complex care and to engage the patient in a much more hands-on manner. Easterwood said properly applied technology has the power to extend the appointment outside the patient visit to keep patients truly engaged in their ongoing care narranashvillemedicalnews
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tive. “We’ve got a couple of projects that have just kicked off and are going to take us in that direction and really lay the foundation for patient engagement,” he added. Hardy, who is working on a pilot project, hopes to have a patient portal that allows clients to log in on a mobile app to complete homework assignments, check their treatment plans, track progress, and communicate with their providers between sessions. Equally important, he said, is to provide reliable information on a variety of conditions. “I think information is incredibly powerful for people to achieve the highest level of recovery from an illness,” Hardy noted. “It’s especially true when you’re dealing with a mental illness that is confusing and complex.”
insured, underinsured … and even those with private health insurance … without adequate, affordable access to dental services. Oral health issues are increasingly linked to overall health through a growing body of evidence, and problems like tooth decay are almost 100 percent preventable with education, regular check-ups, routine prevention and intervention, if needed. To ensure Tennesseans have access to quality care, a new oral health coordinator will lead TPCA’s new program, convening dental and primary car providers from community health centers into a new dental workgroup focused on increasing oral health expertise and capacity across the state. The grant will help TPCA facilitate greater collaboration between dental and medical programs, strengthen the existing dental quality measures and elevate policy discussions within the State Legislature. “Oral health is a critical … but unfortunately often overlooked … component of overall health,” said Kathy Wood-Dobbins, TPCA CEO. “Now, with this support from the DentaWoodQuest Foundation, we’re Kathy Dobbins able to dedicate resources and energy to studying the coordination and delivery of oral health services in our communities.”
DentaQuest Foundation President Ralph Fuccillo noted, “With the implementation of the Affordable Care Act in 2014, nearly every child in the U.S. will have access to dental care … many for the first time. We are committed to9 strength- Ralph Fuccillo ening the oral health safety net so that it is prepared to handle the volume of new individuals seeking care.” In addition to fostering collaboration and outreach to policymakers, TPCA will also select five member community health centers to receive in-kind, direct technical assistance for practice improvement from the DentaQuest Institute’s Safety Net Solutions team. These centers will receive help in creating and achieving a financially sustainable model, methods to streamline operations and information on best practices. TPCA received the grant after a competitive request for proposals process. Tennessee is one of four state primary care associations to receive support from the DentaQuest Foundation this year, joining 10 other states that are currently working to expand the safety net for dental programming. Although the initial grant is for one year, there is an option to request renewal funding for up to two additional years.
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GrandRounds TDH Initiative Reduces Use of Antipsychotic Drugs in Nursing Homes
Tennessee nursing homes have exceeded the national goal of reducing antipsychotic drug use for residents living with dementia in nursing homes. As a result, Tennessee has moved from leading the nation in such use in the fourth quarter of 2011 to 48th for the first quarter of 2013. The national goal was to reduce the rate of antipsychotic drug use by 15 percent by the end of 2012, and further reduce rates in 2013. When the initiative was unveiled in December 2012, Tennessee had the highest usage of antipsychotic medications in the Southeast Region at 30.1 percent for long-stay residents, with the national average being only 23.8 percent. CMS has released the national reduction rates through the first quarter of 2013, and Tennessee nursing homes have exceeded the initial goal, having reduced overall antipsychotic medication use by 16.46 percent. “We can all be pleased with Tennessee’s clear evidence of improvement in the wise use of these powerful medications by our committed nursing homes and caregivers,” said TDH Commissioner John Dreyzehner, MD, MPH. “While there is much work left to do, it is appropriate to celebrate the initial success of this initiative and thank the dedicated stakeholders who are collaborating with each other and our department toward healthier aging in Tennessee.”
Let’s Give Them Something to Talk About! Awards, Honors, Recognitions
Three of Modern Healthcare’s “100 Most Influential People in Healthcare” hail from Nashville. The prestigious list included HCA Chairman and outgoing CEO Richard Bracken (#7), Community Health Systems Chairman, President and CEO Wayne Smith (#17) and LifePoint Hospital’s Chairman and CEO Bill Carpenter (#40). The Tennessee Chapter of the American Academy of Pediatrics has named Julie Ware, MD, of the Shelby County Breastfeeding Coalition and All Better Pediatrics the “Pediatrician of the Year.” TNAAP also presented the Lifetime Achievement Award to Quentin Humberd, MD, FAAP, Blanchfield Army Community Hospital in Fort Campbell, during the annual awards ceremony in Nashville last month. Last month, the White House honored Marion Kainer, MD, MPH, director of the Tennessee Department of Health’s Healthcare-Associated Infections and Antimicrobial Resistance Program, as one of eight local heroes who are “Champions of Change” for prevention and public health. Kainer is being honored in part for her work on the investigation of an outbreak of infections linked to tainted steroid injections. State Volunteer Mutual Insurance Company (SVMIC) has again received an “A” (Excellent) financial strength rating
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from A.M. Best Company. This marks the 30th consecutive year SVMIC has maintained an “A” or better rating. LBMC Technologies was one of eight firms national to be awarded Intacct’s 2013 President’s Club. Intacct, a leader in cloud financial management and accounting software, recognizes its top-performing partners through their annual President’s Club. Healthways has ranked 13th on this year’s InformationWeek 500. The annual list, in its 25th year, recognizes the most innovative users of business technology in the country. Healthways has been recognized six years in a row, this year for its work using cloud-based technologies to more flexibly accommodate varying volumes of users taking its well-being survey.
Recent Certifications, Accreditations & Commendations
Franklin-based HealthTech announced last month that its patient portal, YourCareCommunity.Com v1, has been tested and certified as a modular EHR under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Certification Body (ONC-ACB) program. This EHR software is compliant in accordance with the criteria adopted by the Secretary of the U.S. Department of Health and Human Services and can put providers on the path to attestation for the 2014 Edition of Meaningful Use. The Vanderbilt Breast Center, located at Vanderbilt Health One Hundred Oaks, has been awarded a threeyear full accreditation from the National Accreditation Program for Breast Centers (NAPBC).
TriStar Summit Welcomes New Hospitalist TriStar Summit Medical Center recently welcomed Saad Khan, MD, hospitalist, to its medical staff. Khan received his medical degree from Bagai Medical College in Karachi, Pakistan and completed his residency in internal medicine at East Tennes- Dr. Saad Khan see State University and his fellowship in infectious diseases at the University at Buffalo in New York. He is double board certified by the American Board of Internal Medicine and the American Board of Infectious Diseases.
Insurance Co-op Adds TriStar to Plan Officials with new insurance co-operative Community Health Alliance have signed a partnership agreement with the TriStar Health division of HCA Holdings. The collaboration between the two organizations will give future members of CHA — a member-governed nonprofit created under the umbrella of the Affordable Care Act — access to TriStar’s 18 hospital and 10 ambulatory surgery centers in Tennessee, South Central Kentucky and North Georgia.
CHA will begin marketing health plans to qualified individuals and small businesses in Tennessee beginning Oct. 1 as part of the new insurance exchange network and policies will become effective Jan. 1, 2014. Headquartered in Knoxville, CHA has opened a Nashville office in Maryland Farms.
NextGxDx Adds Cancer Genetics, Inc. to Genetic Testing Platform Last month, Nashville-based NextGxDx Inc., which provides an online genetic testing marketplace for healthcare professionals and hospitals, announced an agreement with genetic testing laboratory Cancer Genetics, Inc. (Nasdaq: CGIX), to offer Cancer Genetics’ genomic-based, proprietary oncology tests and services through the NextGxDx platform.
Insight Genetics Adds Four Nashville-based molecular diagnostics company Insight Genetics recently added four new team members. David Burg has been hired as associate director of business development. He will lead the sales and marketing programs of Insight Genetics’ CLIA-certified laboratory, Insight Molecular Labs. PreviousDavid Burg ly he was regional sales director for Response Genetics, where he was responsible for the sale of predictive biomarker assays covering 26 western states. Dan Bailey, MBA, has been named senior associate for new product planning and will lead the management and administration of Insight’s proprietary Biomarker Decision Support System and intellectual property portDan Bailey folio. He interned with Insight while completing his MBA at Vanderbilt University’s Owen Graduate School of Management. Previously, he was a technical services engineer for Epic Systems Corporation. Bailey received his undergraduate degree in biomedical engineering from Northwestern University. Tyler Nielsen, MBS, has been hired as a research associate and will design and conduct experiments as part of the R&D team, contributing to both current projects Tyler Nielson and those in the pipeline. He received his graduate degree in biomedical science from Des Moines University. Previously, he worked with Pioneer Hi-Bred and Aegis Sciences Corporation. Lindsay Chatfield has also joined as a research associate. She will utilize her molecular biology skills to advance projects within the R&D team, including contributing to multiple National Can-
cer Institute contracts. Chatfield initially started with Insight in the fall of 2012 as an intern. She graduated with honors from Vanderbilt University with degrees in neuroscience and molecular & cellular biology.
Lindsay Chatfield
TriStar Centennial Medical Welcomes Wright TriStar Centennial Medical Center recently welcomed Craig T. Wright, MD, a board certified family medicine physician, to its medical staff. Wright has joined Sterling Primary Care, part of TriStar Medical Group. He received his medical degree from the University of Tennessee and completed his family medicine residency at the University of Tennessee in Jackson, where he also served as chief resident.
Saint Thomas Health Welcomes New Physicians Last month, Saint Thomas health announced three new medical staff additions. Brett Inglis, DO, an internal medicine physician and board certified gastroenterologist, is seeing patients at Nashville Medical Group located at Saint Thomas Midtown Hospital. Previously, he practiced at Hennepin County Medical Center in Minneapolis, Minn. and also served on the DepartDr. Brett Inglis ment of Medicine faculty. Inglis earned his medical degree from Lake Erie College of Osteopathic Medicine in Pennsylvania and completed his internal medicine residency and a fellowship in gastroenterology at Albert Einstein Medical Center in Philadelphia. Andrew Morse, MD, an interventional cardiologist specializing in percutaneous therapy of valvular and structural heart disease conditions, is seeing patients at Saint Thomas West Hospital. In addition, he will be part of Saint Thomas Health’s TAVR program, which provides minimally invasive alternatives for highrisk patients with severe aortic stenosis. Morse is board certified in internal medicine, cardiology, and interventional cardiology, scoring in the top 10 percent on all of his national board exams. He completed fellowships in cardiology at the University of North Carolina, interventional cardiology at Emory University and advanced structural interventional cardiology at Northwestern University. He completed his residency in internal medicine at Northwestern after graduating from the VCU School of Medicine. Mathew Ninan, MD, a general thoracic surgeon with a focus on thoracic oncology, has joined the team at Saint Thomas West Hospital. Previously, Ninan served as director of the lung transplant program at Vanderbilt University and chief of surgical oncology at the University of Tennessee Health Sciences Center. He nashvillemedicalnews
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GrandRounds was also a thoracic surgical oncologist at Vanderbilt University Medical Center and the Sarah Cannon Cancer Center in Nashville. After earning his medical degree from J.N. Medical College in India, Ninan completed a general surgery residency at the University of London in the United Kingdom and a fellowship in cardiothoracic surgery at the University of Pittsburgh Medical Center. In 2004, he earned a master’s degree in clinical investigation from Vanderbilt University, concentrating on methods of clinical research, epidemiology and advanced biostatistics. He is a Fellow of the American College of Surgeons, Royal College of Surgeons and the European Board of Thoracic Surgery.
Feagins Medical Group Opens Second Location Family medical practice, Feagins Medical Group (FMG) recently expanded services to the Madison and Goodlettsville area, significantly growing the practice’s ability to serve more patients and meet increasing demand. The practice is led by Shindana Feagins, MD, who established FMG in 2009. The new location is located at 607 W. Due West Avenue in Madison. The practice specializes in well women’s services, nutritional counseling, massage therapy, house calls and the signature “Walk with Your Doctor” weight loss program. Feagins received her medical degree from Meharry.
Schweitzer Joins TriStar Southern Hills TriStar Southern Hills Medical Center recently announced family medicine physician Meredith Schweitzer, DO, has joined the medical team. Schweitzer received her doctor of osteopathy from Nova Southeastern University in Davie, Dr. Meredith Fla. followed by an internSchweitzer ship and residency at Palmetto General Hospital in Hialeah, Fla.
TriStar Summit Welcomes New Pediatrician TriStar Summit Medical Center recently welcomed Sam Orr, MD, a board certified pediatrician to its medical staff. Orr received his medical degree from the University Of Mississippi School Of Medicine in Jackson and completed his residency in pediatrics at Scott & White/Texas A&M College of Medicine in Temple, Texas. He most Dr. Sam Orr recently served as a pediatrician at Scott & White Children’s Clinic in Waco.
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Cunliffe Named Life Care Center of Sparta’s First Onsite Physician
Life Care Physician Services, LLC, a subsidiary of Life Care Centers of America, recently placed Ronald Cunliffe, DO, as on-site physician at Life Care Center of Sparta. He was hired as part of the company’s initiative to place physicians in Dr. Ronald each of its buildings and Cunliffe will work with the facility’s interdisciplinary team, medical director and other attending physicians in caring for patients. His presence in the nursing home will enhance physician accessibility to patients and families and allow him to personally respond to medical changes or emergencies. Most recently, Cunliffe served as Life Care Center of Sparta’s medical director, helping coordinate medical care for the facility’s patients. Concurrently, he had a full-time primary and geriatric practice in Sparta. Board certified in family practice and in geriatrics, Cunliffe earned his doctor of osteopathy degree from the College of Osteopathic Medicine at Michigan State University.
McElroy Named CFO for Saint Thomas Physician Services Saint Thomas Physician Services recently named Justin McElroy chief financial officer. As CFO, McElroy will oversee all Saint Thomas Health physician practices’ financial functions including accounting, statistical reporting, Justin McElroy budgeting, tax and audit activities. Previously he served as CFO of Saint Thomas Hickman Hospital and has 12 years of healthcare experience resulting in broad expertise in financial planning, reimbursement and financial reporting. McElroy earned his bachelor’s degree from Purdue University and obtained his masters from Indiana Wesleyan University.
Vanderbilt Names New Chief Medical Informatics Officer Neal Patel, MD, MPH has been named chief medical informatics officer for Vanderbilt University Health System. A professor of clinical pediatrics, Patel has spent the past decade as of the hospital systems top informatics Dr. Neal Patel executives. Prior to his new role, Patel served as inpatient chief medical information officer. He replaces Jim Jirjis, MD, who moved to HCA as chief health information officer in late August.
been serving in that role on an interim basis for several months. Hill, a partner at Waller, had been with the firm for more than 30 years and previously served as head of the firm’s healthcare industry group. Jason Chaffin has been promoted to vice president of Clinical Solutions Enablement. Previously, he worked with HCA and Community Health Systems. He re- Jason Chaffin ceived his undergraduate degree in computer information systems from Western Kentucky and has an MBA from Tennessee State University. Sam Hutcheson has been promoted to vice president of Strategic Growth & Development. He has held a number of leadership roles within development during his Sam Hutcheson tenure with LifePoint. Previously, he worked as a consultant for AIM Healthcare. He holds a bachelor’s degree from the University of Tennessee and an MBA from the Owen Graduate School of Management at Vanderbilt.
Payne Joins LBMC Technologies Officials with LBMC Technologies, LLC recently announced the addition of Terry Payne to the network operations division in its Brentwood office. Previously, he was with Vanderbilt Medical Center where he worked as web developer and research intern with Vanderbilt’s Biomedical Informatics Department. Payne graduated from MTSU with a degree in Computer Science.
COA Unveils Latest Edition of Senior Services Director The 17th edition of the Directory of Services for Seniors was recently released by the Council on Aging of Greater Nashville. The directory — an unbiased source document for seniors, caregivers and the healthcare professionals who work with them in Middle Tennessee — is a comprehensive listing of 19 service categories important to seniors. The directory is free for older adults (age 55+) and their families. Professionals can purchase a spiral bound copy for $5. An on-line version of the printed book is updated monthly and is available at www. coamidtn.org.
DMA Addresses Men’s Health Issues Dickson Medical Associates recently held a free men’s health screening in partnership with Goodlark Pharmacy, Select Physical Therapy, Guardian Hospice, Dickson Orthotics & Prosthetics, and HomeCare Solutions to offer a variety of information and health screenings tailored just for men. “This type of event is important because men tend to shy away from visiting the doctor as frequently as women and as a result, put their health and longevity at risk,” said Cindy Lighthill, executive director of DMA. “By offering this program we feel that we can contribute to affecting their behavior and ultimately make them more active participants in their own health maintenance. Dickson Medical Associates is one of the first in Middle Tennessee to organize a free health awareness program of this magnitude for men only. We plan to expand these services to other focus groups, such as diabetes and obesity, in the future. ”
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LifePoint Staff Moves
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GrandRounds TriStar Centennial Offers Non-Surgical Treatment for Barrett’s Esophagus
Affiliation Links Vanderbilt, Cumberland Pediatric Alliance
An innovative, minimally invasive outpatient treatment that destroys precancerous tissue in the lining of the esophagus is being performed at TriStar Centennial Medical Center. The procedure, endoscopic radiofrequency ablation therapy using the HALO System, has been featured in the New England Journal of Medicine as a highly effective treatment for the eradication of Barrett’s esophagus. During the 30-minute procedure, an ablation catheter is positioned on the abnormal esophageal tissue, and using controlled bursts of heat, the physician removes a very thin layer of the diseased esophagus.
Cumberland Pediatric Alliance (CPA) is joining the Vanderbilt Health Affiliated Network (VHAN). The announcement comes after a year in which the two organizations worked together to improve the coordination of care and saved more than 9 percent of the expected cost of health care services for children in the Vanderbilt Employee Health Plan. Through the new affiliation, CPA physicians will become more closely aligned with VHAN’s pursuit of innovative approaches to outcomes-based care while helping to further expand its footprint in an effort to reach pediatricians in other areas of the state. CPA membership includes 35 pediatric practices with more than 300 pediatricians, all of whom have been invited to join VHAN. The transition of operations is expected to be complete this month.
Urgent Team Names New VP Nashville-based Urgent Team, formerly WellNow Urgent Care, recently announced Lynn Scarbrough has joined the company as vice president of Clinical Operations. Scarbrough will oversee clinical operations at Urgent Team’s 18 centers throughout Arkansas, Mississippi and Tennessee. Scarbrough, who has nearly 20 years of healthcare experience, comes to Urgent Team from H2U: Health 2 You Wellness, a wholly owned subsidiary of HCA, where she was director of clinical operations. Scarbrough received both her bachelor’s and master’s degrees in nursing from Loyola University in Chicago.
Qualifacts Grows, Celebrates Customer Successes
Nashville-based Qualifacts Systems, Inc., the largest provider of cloudbased electronic health records for behavioral health and human services, recently announced the company is hiring 12 new JAVA software developers in the next 90 days. This 50-percent increase in the application development staff is needed to accommodate the quick-
Vanderbilt’s Level 1 Trauma Center Celebrates 25 Years For a quarter of a century, nearly 60,000 of the region’s most critically injured patients have passed through the doors of the Vanderbilt Trauma Center, which celebrated its 25th anniversary as the region’s only provider of Level 1 trauma care on Aug. 30, 2013. Covering a 65,000-squaremile territory, 58,000 patients have been admitted to the Trauma Center over the past 25 years, including more than 25,000 motor vehicle accident victims, nearly 4,500 gunshot victims, 1,700 stabbing victims and more than 7,000 fall victims, along with a high volume of other injuries ranging from construction accidents to pedestrians hit by cars to recreational accidents. Although trauma is the leading cause of death in person under age 44, receiving care at a Level 1 Trauma Center can lower risk of death by 25 percent, according to the Centers for Disease Control and Prevention. In Middle Tennessee, patients who survive their injuries long enough to arrive alive at Vanderbilt have a 95 percent chance of survival. Vanderbilt’s trauma patients are cared for by nine board-certified trauma surgeons and eight trauma fellows, along with Emergency Medicine physicians and nurses with the extensive experience necessary to care for the most critically injured patients. This team also works closely with orthopaedic trauma surgeons and subspecialists in neurosurgery, facial trauma, radiology and vascular and spine surgery. Vanderbilt also operates the region’s only burn center, with 20 beds dedicated to burn care. The academic medical center also has the largest American College of Surgeons-certified trauma fellowship program in the country and is among the oldest programs nationwide. Vanderbilt’s trauma care also includes a fleet of five LifeFlight helicopters combined with fixed-wing craft and ground ambulance transportation plus an Emergency Department that sees more than 60,000 patients annually, providing an integrated approach to care that has been emulated in hospitals nationwide. LifeFlight will celebrate 30 years of service in 2014 and has transported more than 33,000 patients since its inception in 1984.
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ening pace of federal- and state-mandated reporting fueled by healthcare reform and Qualifacts’ rapid growth. In late August, the company also made its first acquisition, purchasing the behavioral health line of business of Georgiabased Mitchell & McCormick. Qualifacts’ growth is aligned with customer success stories. Company officials recently announced the increase in working capital across all customers amounts to $40 million in the first year after implementing the company’s CareLogic Enterprise electronic health record. The improvement is attributed primarily to the average 33-percent decrease in the claim life cycle behavioral health agencies experience in their first year with the EHR.
LifePoint Signs Definitive Agreements with Michigan, Virginia Hospitals Over the last couple of months, the boards at Fauquier Health in Virginia and Portage Health in Michigan have signed definitive agreements to form a joint venture with LifePoint Hospitals. In Virginia, LifePoint will own 80 percent with Fauquier Health and the Warrenton community retaining a 20 percent ownership stake. The health system will receive more than $52 million in capital investments over the next decade and more than $100 million to fund a new community foundation. In Michigan, the 80/20 ownership structure is repeated with governance split evenly between the two parties. Portage Health will receive $60 million in capital investments over the next 10 years and approximately $40 million more to create a locally governed charitable foundation. In both cases, the state attorney general must approve the plan before the deals can be finalized.
MTENT Offers Groundbreaking Hearing System for Single-Sided Deafness Middle Tennessee Ear, Nose & Throat (MTENT) is the first private medical practice in Tennessee to offer the SoundBite™ Hearing System, an innovative approach to treating patients with single-sided deafness (SSD). In the U.S., an estimated 50,000 people per year experience unilateral hearing loss, typically caused by viral infections, Meniere’s disease, head or ear trauma, or through surgical intervention to remove acoustic neuromas or other brain tumor removal procedures. SoundBite is the world’s first removable and non-surgical hearing solution to use the well-established principle of bone conduction to imperceptibly transmit sound via the teeth to the inner ear. It is designed to help people regain their spatial hearing ability.
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