Nashville Medical News August 2014

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New Report Predicts M&A Spike for Hospitals, Providers & HIT CompaniesAfter a dip in deal activity in 2013, a newly released report from Bass, Berry & Sims PLC and Mergermarket predicts increased consolidation and an uptick in activity for 2014 … particularly for hospitals, physicians, and HIT companies ... 2

Emerging & Reemerging Infectious DiseasesChikungunya and new strains of infl uenza are among a list of emerging infectious diseases that have grabbed recent headlines, but reemerging diseases including measles and pertussis are also causing epidemiologists concern across the nation ... 6

Vanderbilt’s MOON, MARS Studies Shedding Light on Ortho OutcomesAs the number of orthopaedic surgeries in the United States hits an all-time high, researchers are looking for novel ways to track patients’ progress ... 9

August 2014 >> $5

FOCUS TOPICS ORTHOPAEDICS & SPORTS MEDICINE PHYSICIAN/HOSPITAL ALIGNMENT

ONLINE:NASHVILLEMEDICALNEWS.COMNEWS.COM

Frist Joins Forces with Gates Family to Improve Global Maternal-Fetal Health

Growing Strong: Orthopaedics Expanding at Saint Thomas Health, TriStar Centennial

By MELANIE KILGORE-HILL

Orthopaedic ser-vices are on the move in Middle Tennessee with new facilities and ser-vices popping up across Nashville. According to the National Institutes of Health, the annual num-ber of total hip and knee replacements doubled between 1994 and 2004 with more than a million procedures now performed each year.

Ortho Expansion Underway at Saint Thomas In April, Saint Thomas Health received approval of their Cer-

tifi cate of Need to expand and consolidate ortho services at Saint

Thomas Midtown Hos-pital. The move is part of a larger effort to de-velop the Saint Thomas Joint Replacement In-stitute.

The eighth floor, 94,000-square- foot renovation will in-clude eight dedicated operating rooms and 60 beds. Construc-tion is expected to begin late this sum-

mer and take approximately a year and a half to complete. Part-ners in the $25 million renovation include Elite Sports Medicine and Orthopaedic Care and Tennessee Orthopaedic Alliance, which boasts 50 orthopaedic surgeons and presence on the three

(CONTINUED ON PAGE 12)

Former U.S. Senate Majority Leader Bill Frist, MD, founder of Nashville-based Hope Through Healing Hands (HTHH), and Melinda Gates, co-chair of the Bill & Melinda Gates Founda-tion, led a community conversation on improving maternal-fetal health in developing countries last month at Belmont University.

Moderated by Olympic Gold Medalist Scott Hamilton, “The Mother & Child Project: Simple Steps to Saving Lives in the Developing World” was the inaugural public event of the Faith-Based Coalition for Healthy Mothers and Children World-wide, a joint partnership of HTHH and the Gates Foundation. More than 250 individuals representing the faith community, nongovernmental global health organizations and higher educa-tion attended the discussion.


To promote your business or practice in this high profi le spot, contact Tami Pearce at Nashville Medical News.

[email protected] • 615-844-9407

(L-R) Scott Hamilton, Melinda Gates, Sen. Bill Frist, MD

Greg Mencio, MD

PAGE 10

PHYSICIAN SPOTLIGHT

2 > AUGUST 2014 n a s h v i l l e m e d i c a l n e w s . c o m

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By CINDy SANDERS

After a dip in deal activity in 2013, a newly released report from Bass, Berry & Sims PLC and Mergermarket predicts increased consolidation and an uptick in activity for 2014 … particularly for hospi-tals, physicians, and HIT companies.

Based on a series of interviews with healthcare and life sciences profession-als and investors, the survey analyzes the anticipated M&A trends and the factors behind them. Published June 30, “Health-care & Life Sciences M&A Outlook” found economies of scale and increased capital needs to be two of the major driv-ers cited for consolidation plans between hospitals and providers.

“We expect to see consolidation in healthcare across the board, driven by the increased need for in-frastructure to promote quality and efficiency and to capture the nec-essary data to comply with regulatory require-ments,” said Danielle M. Sloane, a member of the healthcare group in the Nashville offi ce of Bass, Berry & Sims.

She continued, “Another driver of M&A in the physician practice sector is compliance. These days, healthcare com-panies have to be sophisticated to make

sure they are operating in compliance with federal and state rules … there are so many of them.”

Sloane, a healthcare regulatory at-torney, added it’s very diffi cult for one person in a small organization to wear the many different hats and acquire the array of skills required to effectively manage the complex administrative and regulatory environment. Add to that the decrease in reimbursement, and Sloane said it isn’t surprising that small physician practices want to align with a hospital or larger or-ganization.

“As fee-for-service reimbursement is reduced over time and replaced with performance measures, profi tability will depend upon coordination to improve quality and promote effi ciency,” she said, adding that coordination calls for scale and a great deal of administrative man-agement. Joining forces with hospitals or other large practices has become increas-ingly attractive to physicians who want to focus on patients rather than paperwork.

Overall, 86 percent of the survey respondents expect M&A activity to in-crease in the healthcare and life science industry. Three specifi c drivers were cited most often:

• Increased demand for facility and equipment improvement (46 percent),

• Need for IT support/capabilities (42 percent), and

• Rising compliance costs (42 percent).

These bullish expectations come after a year in which deal activity took a downward turn. In 2013, healthcare saw 385 deals worth $97 billion as compared to 2012 when there were 459 deals worth $124 billion, according to Mergermarket data. The report authors opined the an-ticipated increases come amid a stronger economy and more clarity around the implementation of ACA.

Among survey respondents, 20 per-cent said physician groups would be the top area of consolidation. Key areas where that consolidation is expected to happen include physicians moving to hospitals (32 percent), insurance compa-nies (18 percent), practice management companies, (16 percent), other physician practices (14 percent), integrated delivery systems (14 percent) or going under con-tract with insurance companies or hos-pitals (6 percent). Also, the respondents picked cardiology and dermatology as the two specialties likely to see the most activ-ity in terms of consolidation.

While acquisition activity clearly is anticipated to rise, Sloane pointed out it is only one way to align physicians and hospitals. A variety of structured options including joint ventures, accountable care organizations (ACOs), co-management and gainsharing arrangements could also be utilized to help achieve clinical inte-

New Report Predicts M&A Spike for Hospitals, Providers & HIT Companies

Danielle M. Sloane

Practices Favor Informal Integration

New Medical Group Management Association research fi nds medical practices favor informal integration with other healthcare organizations over formal mergers.

More than 40 percent of medical practice executives responding to the MGMA survey, Medical Practice Today: What Members Have to Say, indicated that they have or are planning to informally integrate their practice with other healthcare organizations. This includes clinical integration with a hospital or health system, as well as forming or joining an accountable care organization (ACO), physician/hospital organization (PHO) or independent practice association (IPA). Conversely, 27 percent of respondents indicated that they have or plan to formally integrate by merging with another physician-owned practice or by selling practice ownership to a hospital or health system.

“It’s not surprising that medical practices are exploring ways to accommodate patients and combat mounting administrative pressures and are looking beyond the walls of their organization to do so,” said Susan L. Turney, MD, FACP, FACMPE, president and CEO of MGMA who recently announced plans to resign from her post at the end of this month. “Physician practices are seeking ways to work better with other care providers, and affi liating informally or clinically integrating with other organizations allows practices to adapt as needed and position themselves for success in a value-based environment.”

The survey, conducted in January and released on June 30, also outlined the biggest professional challenges in running a practice, including the struggle to adapt to rapid changes, legislative pressures and fi scal uncertainty. Details of the survey were published in the July 2014 issue of MGMA Connection magazine. For more information, go online to mgma.com and click on “Recent Articles” under the “Practice Resources” tab.

Dr. Susan L. Turney

gration and administrative collaboration. Many options, Sloane added, are going to be extremely data driven with each par-ticipant required to meet certain quality and effi ciency benchmarks.

“ACOs can be a viable alternative to acquisitions,” she pointed out, noting it’s a way to bring physicians and hospitals into alignment without having to make an out-right purchase. Bundled payments offer a similar option.

Co-management is another align-ment strategy that has gained popularity over the last few years. “Co-management is essentially where a hospital contracts with a physician group practice to manage a service line,” she said. Sloane added the physicians go beyond clinical or medical director duties and are also responsible for managing quality and effi ciency metrics.

She said such an arrangement gen-erally allows for a base salary with bonus money allocated for reaching a certain percentage threshold on various metrics like a reduction in infection rates or start-ing procedures on time. “When you de-sign them (co-management contracts), you have to be careful not to inadvertently in-centivize either overutilization on the one hand or an inappropriate reduction in care on the other hand. It’s a very delicate balance,” she noted.

Similarly, Sloane continued, “Gain-sharing arrangements engage physicians to adopt specifi ed clinical behaviors to help control costs.” Typically, the hospital would agree to share with physicians any reduction in the hospital’s cost for patient care that could be attributed in part to the physician’s efforts.

An example might be that physicians are rewarded for using a brand of device that could be purchased in bulk, thus saving money. However, Sloane stressed the physician usually still has the ability to use a different brand based on medi-cal need or patient preference. She added the Offi ce of the Inspector General has been vocal regarding gainsharing in re-cent years. “The OIG has issued numer-ous advisory opinions that can be used to help physicians and providers develop ap-propriate gainsharing arrangements,” she pointed out.

No matter what route physicians and hospitals take to join forces, Sloane said it is becoming increasingly apparent that aligning resources will be necessary to meet the clinical, quality and regulatory demands being placed on the healthcare industry.

To review the complete M&A report, go online to bassberry.com and click on “Firm News” at the top of the homepage.

n a s h v i l l e m e d i c a l n e w s . c o m AUGUST 2014 > 3

Wang Vision 3D Cataract & LASIK Center615.321.8881 | WangCataractLASIK.com

The doctors’ doctor:Dr. Ming Wang

Harvard & MIT (MD, magna cum laude); PhD (laser physics)

Performed surgeries on over 4,000 doctors

Inventions & Patents1. LASERACT: All-laser cataract surgery U.S. patent fi led.

2. Phacoplasty U.S. patent fi led.

3. Amniotic membrane contact lens for photoablated corneal tissue U.S. Patent Serial No

5,932,205.

4. Amniotic membrane contact lens for injured corneal tissue U.S. Patent

Serial No 6,143,315.

5. Adaptive infrared retinoscopic device for detecting ocular aberrations U.S. Utility Patent

Application Serial No. 11/642,226.

6. Digital eye bank for virtual clinical trial U.S. Utility Patent

Application Serial No. 11/585,522.

7. Pulsed electromagnetic fi eld therapy for nonhealing corneal ulcer U.S.patent fi led.

8. A whole-genome method of assaying in vivo DNA protein interaction and gene expression regulation U.S. patent fi led

Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doc-torate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”). Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s fi rst laser-assisted artifi cial cornea implantation. He has

received an achievement award from the American Academy of Ophthalmology, and a Lifetime

Achievement Award from the American Chinese Physician Association. Dr. Wang founded a 501c(3) non-profi t charity, the Wang Foundation for Sight Restoration (www.Wangfounda-tion.com), which to date has helped patients from over 40 states in the U.S. and 55 countries worldwide, with all sight restoration surgeries performed free-of-charge.

Wang Vision 3D Cataract & LASIK Center615.321.8881 | WangCataractLASIK.com

AMNIOTIC MEMBRANECONTACT LENS

Dr. Wang’s inventionU.S. patents:

5,932,205 & 6,143,315

Used by over 1,000 eye doctors to restore sight.

Amnioticmembraneis obtained afterthe baby’s birth


By CINDy SANDERS

There’s no question healthcare deliv-ery is in the middle of a transformational period highlighted by unprecedented consolidation. While there are a number of factors impacting alignment decisions, Paul Keckley, PhD, boiled the equa-tion down to its sim-plest terms, “Economics drives behavior.”

Keckley, managing director for Navigant’s Center for Healthcare Research & Policy Anal-ysis, said physicians are having to assess their practices in light of a new reality that requires efficiency, effectiveness and contracting clout to survive.

“If you’re of a view that the econom-ics favors you being independent for the rest of your practice, you go that route,” he stated. However, the noted healthcare expert who has published three books and more than 250 articles on the industry and health reform, said that practice model is becoming increasingly rare.

For many, Keckley said practice deci-sions take a step-wise progression. Option A finds two small practices within a spe-cialty banding together. Option B brings multiple specialties together to form a large group. Option C has physicians or

practices joining forces with a hospital or payer under some type of employment, joint venture, or managed services orga-nization (MSO) agreement.

“I think most doctors are past Option A. I think most doctors realize circling the wagons around a single specialty isn’t re-alistic,” said Keckley. “Two out of three primary care doctors have already cast their lot,” he continued of aligning with hospitals, payers or very large groups.

“Frontline specialists have already gone to bigger groups. Now they are mov-ing to the next option … most look like they’re going to hospitals,” he added of orthopedists, ENTs and OB/GYNs. As for other specialists, he said the decision to remain independent, merge or consoli-date is all over the board and is specialty dependent.

Going forward, Keckley said, “I think we’re going to end up with a very few private doctors in practice indepen-dently.” He predicts seeing a few more very large, multispecialty practices. “I think the majority end up employed in the hospitals because of these new payment mechanisms.”

In fact, he noted, “It’s been incentiv-ized for the hospitals to hire physicians.” Clinical integration, outcomes-based re-imbursement and bundled payments have created an environment where hospitals and doctors are increasingly co-depen-dent.

Although hospital administrators and clinicians have always had to work together, Keckley said this new closeness highlights areas that must be addressed to maximize effectiveness. Three key stress-ors are administrative decisions, clinical performance, and … of course … alloca-tion of money.

“There’s always going to be tension around operations,” he said of administra-tive decisions. “Each presumes the other’s operating is simpler than it really is,” he continued of the chasm between blue suits and white coats.

With reimbursement tied to out-comes, he said physicians and hospitals face tougher decisions around strategy. One issue is how to address physicians not practicing effectively. “The hospital suits don’t do a very good job of changing the behavior of doctors. It takes peers,” he noted.

The biggest cause of tension is ex-pected to be around allotting payments to each of the partners in a vertically inte-grated delivery system. “And then you get down to money, and that’s where it gets ugly,” Keckley stated. However, he con-tinued, too often the perception among administrators is that it’s all about the money when it comes to physicians. “If it was just about money, there are a lot of better ways to make money … and easier, by the way. Most doctors don’t go into it to be wealthy. It’s hard work. The average

medical career is 30 years, and it’s a hard 30 years.”

That said, he added physicians do want to be successful, have a sense of satisfaction around their career choice and be well compensated for their work. However, Keckley noted, “There’s such a difference between the way doctors think things should be and the way they are.”

Keckley said too many physicians tend to dismiss data as unreliable or be-lieve their patient is an outlier. Yet, he added, “The table stakes are you’ve got to have data. You can’t just have a bunch of opinions.” To bridge that gap, Keckley said he believes it is going to take physi-cians willing to step into the hot seat and take criticism from their colleagues as the profession adapts to new economic reali-ties.

“I think physician leadership is prob-ably going to be a theme over the next 10 years,” Keckley said. “The medical pro-fession is well respected and well compen-sated … that doesn’t change … but how that profession plays in the delivery system is very much a work in progress.”

Partnering in a New Paradigm

Dr. Paul Keckley

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REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: [email protected] for information.


dec

By CINDy SANDERS

As physicians and hospitals seek to align clinically, strategically and admin-istratively in this era of consolidation and cooperation, assistance originates from a number of places ranging from national as-sociations to internal committees and con-tract consultants. Hospitals and physicians in the Southeast might also add their mal-practice insurer to that list.

MagMutual, a medical mutual com-pany founded by physicians in 1982 to provide medical liability insurance, now serves more than 19,000 physicians and two dozen hospitals in 10 Southeastern states. Considering MagMutual’s vested interest in the delivery of evidence-based, high-quality care by the professionals the company cov-ers, perhaps it shouldn’t be surprising that an insurer has taken a proactive stance in patient safety. Calling on more than three decades of risk management expertise and data analysis, the company is turning that knowledge into actionable tools that can be used by physicians and hospitals to improve communication and care coordination.

MagMutual Patient Safety Institute

In late October 2013, the company announced a $50 million investment in the formation of the MagMutual Patient Safety Institute. Mary Gregg, MD, FACS, MHA, who serves as both CMO for MagMutual and presi-dent of the Patient Safety Institute, was brought on board last spring to launch the initiative.

“I was hired by MagMutual to create the Patient Safety Institute to focus on how to begin to look at risk and begin to improve safety across all kinds of physician practices,” ex-plained the retired cardiothoracic surgeon who has previously worked in both an in-dependent practice setting and as an em-ployed physician in a large health system.

“Risk in the past was often very reac-tive,” Gregg continued. “What we’re try-ing to do is get data, analyze closed claims, and assess practices in-hospital and out-of-hospital and then identify where there are opportunities to improve.”

Johnathan Brutlag, president of the wholly owned MagMutual subsidiary Pro-fessional Security Insurance Company, added, “There are a host of risk issues in the prac-tice setting. There are a host of risk issues in the hospital setting. What we’re doing is trying to eliminate that gray area in between.”

Gregg noted, “We are working together side-by-side to ensure there is coordination of care and that there are no gaps in care between these two entities. We feel there are certain practices that if they are imple-mented every day … either by checklist or

integrated in the EMR … then these pro-cesses will improve the quality, improve the safety, and improve the outcome of care.”

In addition to the inherent expertise within the company, the Patient Safety Institute relies on a number of outside sources for evidence-based standards of care. Gregg, the former medical director of Quality and Patient Safety at Swedish Health Services in Seattle, pointed to the Institute of Healthcare Improvement as an excellent resource. The IHI, she noted, cre-ated a bundled checklist to address central line safety. “If you follow this bundle 100 percent of the time, you can and will de-crease the incidence of central line infec-tions down to zero,” she stated, adding that she wouldn’t have believed that was possible early in her career.

Brutlag added achieving optimal out-comes doesn’t just happen in the hospital but requires coordination from the min-ute a patient steps into a physician’s office through the inpatient stay and then back into the community setting.

In Defense of Good MedicineDespite best efforts and following

protocols, physicians and hospitals do find themselves named in malpractice suits. “Do we think liability is increasing? Certainly it is,” Brutlag noted of practicing in a progres-sively more litigious society.

However, he sees this as another op-portunity for physician-hospital alignment as MagMutual takes a coordinated defense approach. Rather than pointing fingers or putting the hospital and physician in an ad-versarial position, he prefers to address the claim as a team that works together.

“We really think it’s important to focus on a coordinated defense. If the standard of care was not breached, then we need to de-fend the medicine,” he said, adding, “If the medicine is good, it should be defensible.”

Turning Errors into Education “Our idea is not only defending good

medicine, but if there was an error or near miss, we need to guarantee that it doesn’t happen again,” said Gregg. “We need to help the two systems focus on the processes and increase reliability and accountability on both sides of the system.” She contin-ued, “We need to learn from our mistakes. We need to learn from our near misses, and

the culture really doesn’t support that right now.”

However, Brutlag said they are work-ing to change that culture. The Patient Safety Institute is in the process of becoming a Patient Safety Organization (PSO), which can collect protected data. In addition to compiling a database of information from physician policyholders, the Patient Safety Institute has the ability to compare those findings across other national databases. Brutlag stressed the data provided by mem-bers for research and analysis to improve processes is not shared with MagMutual, which determines premiums.

Instead, the information is used to cre-ate tools and help members instantly access resources to improve their practice. “A re-ally important component is we’re not only providing the tools to help them make a change or implement a process, but we’re also providing tools to help measure the outcome,” said Brutlag. “If we measure and there’s not improvement, we know we have to reevaluate and make change.”

Gregg concluded, “We’re using qual-ity improvement tools to improve safety and decrease risk … so that’s closing the loop.”

United We Stand

By CINDy SANDERS

Increased Competition to Recruit in Private Practices

By no means are all physicians seek-ing hospital employment, but consolida-tion coupled with a provider shortage has increased the competitiveness for practices to recruit and retain physicians.

According to the Medical Group Management Association, this competi-tive environment has increased first-year median guaranteed compensation for pro-viders. Primary care physicians reported $186,475 in median first-year guaranteed compensation when placed in a new prac-tice, and specialists reported $260,000 when placed in a new practice, according to the MGMA Physician Placement Start-ing Salary Survey: 2014 Report Based on 2013 Data.

In addition to offering competitive compensation packages, some practices have enhanced their benefit offerings to re-cruit physicians — 60 percent of physicians placed in a new practice reported receiving signing bonuses, and 72 percent accepted paid relocation packages as part of their employment offers.

“Medical practices are offering a number of benefits to recruit physicians,” said Laura Palmer, FAC-MPE, MGMA senior in-dustry analyst. “With the initial uncertainty sur-rounding how ACA in-surance exchanges would impact healthcare organi-zations, medical practices were very savvy in plan-

ning ahead and anticipating how potential changes to their population may affect their ability to accommodate patients.”

The most recent MGMA Physician Placement Starting Salary Survey contains data on 5,318 providers in 567 medical or-ganizations. For more information, go to mgma.com.

NSCHB Releases Annual Medical and Dental Statistics on Income and Expenses

In late June, the National Society of Certified Healthcare Business Consultants (NSCHBC) released the “2013 Joint Statis-tics Report of Medical and Dental Statis-tics on Income and Expenses.” Each year the NSCHBC and the Academy of Den-tal CPAs compiles statistics report on key cost and revenue components of medical/dental practices utilizing actual data from financial statements and income tax returns of its members. The report includes infor-mation on overhead percentages, average monthly charges in accounts receivables, full time equivalent staff ratios, and more.

“The cost and expense of running a business is a major concern of physicians in independent private practices today,” said NSCHBC President Reed Tinsley. “Many physicians and practice managers don’t know the cost of keeping their doors open to serve patients, much less know what those costs should appropriately be. Finance and business management is not something typi-cally taught in medical schools.”

The report features data from more than 2,492 professional practices represent-ing more than 5,252 full time equivalent (FTE) doctors. It covers 60 dental and medi-

cal specialties including family practice, gen-eral dentistry, internal medicine, obstetrics and gynecology, and orthodontics.

Key findings of the report include:• Net income for all primary care

practices increased in the last five years (2009-2013), but family prac-tice without OB increased the most at 144 percent.

• Cardiology, OB/GYN and plastic surgery net income decreased over the same period by 46 percent, 2 percent and 12 percent, respectively.

• OB/GYN and plastic surgery prac-tice incomes were on a track to greater loss from 2009 to 2011 but have experienced an upswing in the last two years.

• During the same five-year period, general dentistry and orthodontics have stayed relatively even with just a small increase in practice income.

• General surgery practices have had the most consistent income in the last five years.

“Physicians are accustomed to apply-ing scientific methodology to patient care, but often fail to apply similar methodolo-gies to monitor the ‘business health’ of their practices. The same physician that is closely monitoring a diabetic patient’s lab-results against statistical norms may be ignoring her own practice’s expenses versus specialty benchmarks, to the risk of her practice’s fi-nancial health,” stated Tinsley.

For additional details, including the list of specialties, a sample report and pricing, visit the NSCHBC website at nschbc.org/statistics/index.cfm.

From the Private Practice PerspectiveNews of Note from National Organizations

Laura Palmer

Dr. Mary Gregg

Johnathan Brutlag


By CINDy SANDERS

Chikungunya and new strains of influenza are among a list of emerging infectious diseases that have grabbed recent headlines, but reemerging diseases including measles and pertussis are also causing epidemiologists concern across the nation.

“There are newly emerging diseases and reemerging diseases … and both are disturb-ing,” stated Tim Jones, MD, state epidemiolo-gist for the Tennessee Department of Health (TDH). Jones, whose past experience includes working in the Centers for Disease Control and Prevention’s Epidemic Intelligence Ser-vices, recently provided insight into the old and new. He also shared his thoughts on why we’re seeing a resurgence of some diseases, such as polio, that the medical community thought would be a distant memory at this point in history.

“Internationally, we had hoped that polio would be eradicated by the turn of the century, but here we are in 2014 with it expanding into additional countries,” he said.

Jones, who is the immediate past president of the Council of State and Ter-

ritorial Epidemiologists, noted the spread of new diseases and return of some of the older ones is multifactorial with global mobility and increasing refusals to be vac-cinated contributing to the problem.

Emerging Infectious Disease“The majority of these new diseases

are what we call zoonotic. As the name suggests, they are diseases that have jumped from the animal world into hu-mans,” Jones explained, adding exam-ples include SARS, West Nile Virus and H1N1.

The most recent mosquito-borne dis-ease to make its way to the United States is chikungunya. “We just started seeing it in the last few months,” Jones noted of the disease’s migration primarily from the Ca-ribbean where there have been large out-breaks. “Our first cases in Tennessee were in May. We’d never seen it before. As of today, there are 37 suspected cases, and all of them are people who have recently returned from the Caribbean.”

Jones added, “This new one, chikun-gunya, luckily does not have a reservoir out in the wild.” He explained the viral disease doesn’t live in birds or other ani-mals and only transmits between mosqui-tos and humans. “For me to get it, the mosquito would have to bite an infected person and then me. So far we haven’t seen any jump from infected travelers

to someone local, but that’s what we’re afraid of.”

(Editor’s Note: At the time of the interview in early July, there had not been any cases of chikun-gunya originating in the United States. However, the CDC has since confirmed the first cases of the virus being locally acquired. The virus is transmit-ted through two species of mosquitoes, Aedes ae-gypti and Aedes albopictus, which are found in a number of regions across the country including the Southeast.)

Primary symptoms include joint pain and fever. Although there is no vaccine, Jones noted, “It’s rarely fatal, but it makes you feel terrible for about a week, and 10 to 15 percent of people will have very bad arthralgias for up to a year.”

Dengue is another mosquito-borne virus that epidemiologists are closely mon-itoring. “Generally, it’s pretty endemic in the Caribbean and South and Cen-tral America, but it seems to be moving north,” Jones said. “As these vector-borne diseases move into new areas, it raises con-cerns as to whether it could be related to climate change.”

With no vaccine or treatment, den-gue is a leading cause of illness and death in the tropics and subtropics and is caused by any of four related viruses transmitted by mosquitos. “Unfortunately, dengue you can get more than once, and if you get it a second time, it’s usually much more severe,” Jones said, adding it’s nickname is ‘breakbone fever’ because the intense joint and muscle pain can cause those with den-gue to have contortions.

The first 2014 human case of yet an-other mosquito-borne disease, West Nile Virus, was confirmed in Tennessee in late June. WNV has been present in the state since 2001.

The common thread with all three of these viruses is that there is no vaccine so prevention remains the best way to con-tain the spread of the virus. The TDH lists a number of recommendations on their website for individuals to prevent mos-quito bites including the use of insect re-pellants and elimination of standing water near homes.

Reemerging DiseasesAlthough ‘officially’ eradicated from

the United States in 2000, measles is still present in other regions of the world and has begun to reappear in this country. In fact, the CDC recently announced they have confirmed more cases of measles in the United States so far in 2014 than in any other year in the past two decades.

This spring, the TDH identified the first case of measles in the state in three years. As with most cases now seen in this country, the virus was traced to an inter-national traveler and then spread to those who weren’t immune to the disease.

“We had one person who returned from overseas from an area that was hav-ing an outbreak, and we ended up hav-ing five people infected before we got it under control,” Jones said. Transmittable through the air, he added, “Measles is very serious and really, really easy to spread.”

Although the state has a very high rate of compliance for the measles vaccine, Jones pointed out that the vaccine was re-ally only recommended for those born after 1957 since many older citizens were exposed to measles in childhood. A two-part vaccine, Jones said the state probably only has 2-3 percent of the population that isn’t fully immunized.

Pertussis, or whooping cough, is an-other disease spreading throughout the country. Although Jones said Tennessee has only had light activity with 100-200 cases per year, other parts of the country have been much more heavily affected. “There are some states in the Midwest and now California that have had many hundreds and thousands.”

The problem, Jones continued is a combination of under-immunization and the fact that it isn’t a perfect vac-cine. Because of some concern about the immunization wearing off, a booster is now recommended. “In the last couple of years, we began recommending all adults that haven’t had this new Tdap (tetanus, diphtheria and acellular pertussis) vaccine get a dose no matter when the last time they had a tetanus shot,” Jones said.

In Tennessee, the continuing concern over tuberculosis comes with some good news and some bad news. “For the first time this year, Tennessee is below the na-tional average, which is exciting … but as the numbers go down, the complexity of each case is going up,” Jones said.

He added, “While we’re having a real impact on domestic TB, now nationally the majority of TB cases are in the foreign-born population. We’re seeing much more imported TB.”

Although contagious, Jones said it takes close, prolonged contact rather than casual proximity to spread the disease. In the absence of a good vaccine for TB, test-ing becomes important … particularly for healthcare workers.

A major issue with reemerging dis-eases is a lack of recognition by healthcare providers since they are so rare. “There are very few physicians in the U.S. who have ever seen a true case of measles,” Jones said. “Likewise for TB … most physicians are never going to have seen a real case, and that makes it challenging.” He added, “With TB, for example, we’re increasingly seeing people who went to a healthcare professional and were treated for bronchitis, smoker’s cough, etc. We’ve got to keep these diseases in the back of our minds as possibilities.”

Jones said education and awareness are key to catching infectious diseases early. The CDC has extensive information on both emerging and reemerging public health threats. Likewise, the TDH pro-vides resources and local updates about diseases present in Tennessee. For more information, go online to cdc.gov and to the TDH section on communicable and environmental diseases and emergency preparedness (CEDS) at health.state.tn.us/ceds.

Emerging & Reemerging Infectious Diseases

Dr. Tim Jones

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HealthcareEnterprise

Entrada Health Transforming Physician DocumentationBy MELANIE KILGORE-HILL

If you’re a physician, odds are docu-mentation consumes much of your work-day. Too much. In fact, some studies estimate that paperwork, including dicta-tion, can consume up to 40 percent of a doctor’s workday, signifi cantly impacting the amount of time spent with patients and their own families. In Middle Tennessee, one company is working to correct that.Brentwood-based Entrada Health is revo-lutionizing the field of documentation for physicians. Their unique mobile-doc-umentation technology increases pro-ductivity for physicians while tightening integration with clinical electronic health records systems – a win-win for both prac-titioners and EHRs.

Filling a Need“There are many government incen-

tives to put into place systems that don’t necessarily talk well together, and that leaves gaps for compa-nies to come in and help make things better,” said Bill Brown, CEO of Entrada Health. “Ev-erything we do is predicated on driving extra time and let-ting doctors get charting done quicker and more accurately.” Available on any smart phone or tablet, Entrada’s voice-recognition technology works with the provider’s EHR sys-tem to knock out the time-consuming, fi eld-driven EHR tasks required for each patient. Physicians select the patient’s name on the app, and in one to two minutes vocally complete the otherwise lengthy fi elds. The patient’s quality of care could also be improved by the program’s ability to capture more robust details in-

cluding a richer and more complete patient record

There’s an App for ThatIn 2014, Entrada added the

ability to securely take and share photos from mobile devices. The app bypasses the standard cam-era feature on the phone or tablet and delivers the encrypted image directly into the patient’s record. Soon, secure messaging capabili-ties will let users send texts directly to the patient’s chart through En-trada’s messaging program or by tying into one of the 50-plus secure messaging companies already on the market. Deeper research and development efforts also are un-derway to identify ways to increase productivity and effi ciency for care-givers and to become more highly integrative with current systems.

“While many EHR com-panies have their own mo-bile apps, much of the EHR software was written 20 years ago before implementation of Meaningful Use and ICD-10,” Brown said. “Smart phones have only been around for about seven years, so we’re on the front end of smart phone-based chart support and are still evolving.”

A Friend to EHRsAnother homerun, Brown said, is that

Entrada’s ease of use encourages doctors to utilize EHRs, increasing both sign-off rates and satisfaction with EHR provid-ers. That’s a big plus for EHR companies, which are embracing Entrada as a high-tech partner. NextGen Healthcare Infor-

mation Systems,

athenahealth, Greenway and Allscripts all have launched partnerships with Entrada. The company also has rolled out a com-bined app with Ingenious Med, the na-tion’s leading patient encounter platform used by 25,000 providers. Those partner-ships have helped account for the com-pany’s double and triple revenue growth annually over the past four years.

Orthopaedics & EntradaEntrada’s 120-plus clients represent

nearly 15 specialties including a large subset of orthopaedic groups nationwide.“Since our initial main platform includes dictation specifi c parts of a medical en-counter, it appeals more toward medi-cal specialists who see high volumes of patients and complicated cases,” Brown said. “Orthopaedics gravitated to En-

trada early since ortho surgeons are so busy, and switching to an EHR can

affect a practice’s productivity from the provider perspective.”In 2013, Entrada added OrthoTen-nessee to its client list. OrthoTen-nessee physicians dictate with Entrada’s digital dictation solution via iPod Touches centrally man-aged through secure VPN connec-tions. Administration also chose to deploy the devices for remote use only, ensuring full compli-ance with mandatory ordinances, as well as HIPAA regulations.“Since Entrada’s mobile applica-tion runs on iPod Touches, our physicians were already so familiar with the iOS platform that it made adoption of this digital dictation solution very simple and easy,” re-

marked Karen Clark, chief informa-tion offi cer at OrthoTennessee.

Maximizing EHRsBrown said one of the greatest

challenges facing providers is decid-ing whether to move beyond status quo. Once the Meaningful Use dust has settled and an EHR system is ad-opted, practice managers must decide if they want to supplement the program with other tools to increase effi ciency. “Entrada plays a role as a consultant to a lot of these groups,” Brown said. “The key from the product effi ciency standpoint is fi nding the right workfl ow into how a com-pany does business. What we try to do is understand the workfl ow solution that will best accommodate their practice.”

While increased EHR use is ben-efi cial across the healthcare spectrum, Brown said Entrada’s greatest offering is the quality of life value proposition offered to physicians. Shortly after implementing Entrada for a San Antonio orthopaedic group, Brown received a very encouraging call. In just six weeks, the technology had cut nearly three days off their clinic time.

“We go in and talk to these sur-geons who were forgoing family dinner or couldn’t attend their kid’s soccer practice because of the extra hours required every evening to complete documentation,” Brown said. “We’re focused on doctors and improving quality of life for this seg-ment of the population.”

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By: MELANIE KILGORE-HILL

As the number of orthopaedic sur-geries in the United States hits an all-time high, re-searchers are looking for novel ways to track pa-tients’ progress and identify pre-surgery those at risk for poorer out-comes. In Nashville, Vanderbilt Sports Medicine is leading a national re-search effort to measure both short- and long-term outcomes of knee and shoulder surgeries.

Vanderbilt’s MOON StudyIn 2001, the Multicenter Orthopae-

dic Outcomes Network was established to examine how patients fare following anterior cruciate ligament reconstruction. Founded by former Vanderbilt profes-sor Kurt Spindler, MD, this NIH-funded consortium consists of 13 sports medicine physicians across seven sites and relies heavily on the work of Vanderbilt’s bio-statistics and epidemiologists, research coordinators and assistants. Goals of the study were to identify both the short and long-term prognoses and predictors of sports function, activity level and general health through validated patient-reported

outcomes; to identify symptoms and signs of osteoarthritis; and to quantify the inci-dence of ACL reconstruction graft and/or contralateral ACL failures and additional surgical procedures.

Since 2002, MOON has attained over 85 percent follow-up at both two and six years post-surgery from more than 3,500 enrolled patients.

Results MOON’s results have already

changed the way ACL surgeries are per-formed in certain populations including high school, college and competitive ath-letes in their primary ACL reconstruc-tions. That’s because first-time surgery

failure was often predicted by age and graft choice – autograft was more ef-fective among younger patients than al-

lograft. An unanticipated positive result was the stable outcomes seen at six years, as compared to two years. The six-year

follow-up also found revision ACLR and allograft are universal to both

sports outcomes and activity level. Smoking, higher BMI, and older age also were predictors for some outcomes, while gender was not a

predictor of sports outcomes.MOON continues to enroll and fol-

low patients with the goal of identifying predictors of who does and does not do well after surgery.

MOON Shoulder GroupIn 2004, VUMC recruited John

E. Kuhn, MD, MS, as chief of shoulder surgery for Vanderbilt Sports Medicine. Under Kuhn’s direction, the MOON Shoulder Group was established to study disorders of the shoulder using a multi-center collaboration. Kuhn’s shoulder study looked at the nonoperative treat-ment of full thickness rotator cuff tears in order to help understand indications for

surgery. A decade later, MOON Shoulder now includes 23 surgeons at 12 sites across the U.S., with each site examining a different disorder.

Objectives of the MOON Shou lder Group’s research are to lend insight into the natu-ral history of rotator cuff disease; identify patients at risk for progression of rotator cuff disease; and to assist physicians in the management of patients with shoulder in-juries.

“In our first study, our research group could not come to a consensus on how best to treat patients with shoulder pain who had rotator cuff tears without a his-tory of an injury,” said Kuhn. “We knew there was a lot of geographic variation in surgery rates. We also knew that surgeons did not agree on who needed surgery and who didn’t.”

The decision was made to conduct a study where all patients with symptom-atic atraumatic full thickness rotator cuff tears would be sent through a standard, evidence-based physical therapy program. Patients were offered surgery if at any time

Vanderbilt’s MOON, MARS Studies Shedding Light on Ortho Outcomes

Dr. John E. Kuhn



Greg Mencio, MDDirector of Pediatric Orthopaedics at Monroe Carell Jr. Children’s Hospital at Vanderbilt

PhysicianSpotlight

By CINDy SANDERS

Growing up in Naugatuck, Conn., an industrial area about 15 minutes north of New Haven, the active and healthy Greg Mencio didn’t have much experience with physicians outside of routine physicals. However, the young athlete and good stu-dent soon became drawn to orthopaedics, which combined his love of sports, wish to help people, and desire for a challenging career.

After high school, Mencio accepted an offer to play four years of baseball and foot-ball for the Duke University Blue Devils. “When I went to Duke, I had exposure to a very charismatic man, the team doctor for Duke athletics. That sort of solidifi ed my decision to do medicine,” Mencio recalled of his great mentor and role model Frank Bassett, MD.

Mencio stayed at Duke for medical school. Interestingly, what proved to be such a strong draw to orthopaedics didn’t wind up being his fi eld of choice within the specialty. “I had played sports all these years. I saw the inside of the locker room … and I was not sure I wanted to care for athletes,” he said.

Instead, a rotation at the Shriner’s

Hospital in Greenville, N.C. led him in another direction. There, he met another former Duke football player and his sec-ond role model, pediatric orthopaedist Bob Fitch, MD.

“In the end,” noted Mencio, part of it is your gut … you like what you do. I liked

the kids; I liked the diagnostic challenges; I liked the surgery; I liked impacting some-one over their lifetime.”

In addition to loving the fi eld he chose, Mencio said the icing on the cake is the people with whom he works … both kids and colleagues. “The people that I’ve met and become friends with in pediatrics are all good people. It’s been a bonus as I’ve gotten further and further in my career. Colleagues around the country are really good guys.”

Before moving to Vanderbilt as an as-sistant professor, Mencio completed his in-ternship and residency at Duke, a surgical residency at the University of Pittsburgh, and a fellowship at Newington Children’s Hospital (now called Connecticut Chil-dren’s Medical Center). After fi nishing his fellowship in 1988, Mencio noted, “I was on staff at Newington until June of 1991, and I started at Vanderbilt in July of ‘91.”

Today, the board-certifi ed orthopae-dic surgeon is a professor of Orthopaedics and Rehabilitation and vice chair of the Department of Orthopaedics for Vander-bilt University Medical Center, director of Pediatric Orthopaedics at the Monroe Carell Jr. Children’s Hospital, and director of the Spina Bifi da Clinic. His specialties include pediatric trauma, spinal trauma, musculoskeletal aspects of neuromuscular disorders, gait analysis and scoliosis and spinal deformities.

“My main area of interest is spinal deformity and pediatric trauma,” he said. Mencio added that whereas adult orthopae-dic specialists are generally procedure spe-cifi c, it’s different for peds. “Our specialty is defi ned by age. We do a little bit of every-thing.” However, he added, “We’re starting to see our specialty sub-specialize more.”

Certainly Mencio is in position to view the latest trends. Currently, he is president of the Pediatric Orthopaedic Society of North America (POSNA).

“Our big focus in the Pediatric Society is quality, safety and value,” he said. Men-cio noted that in addition to those major initiatives, continuing education is a critical

component of the society’s work. “And re-search,” he continued. “We can’t do any of this without research. Last year we funded $430,000 (in research). We hope to do that again this year.”

Mencio took office with POSNA in May 2014 for a one-year term, which means he’ll have a few months of overlap with his other presidential duties. As pres-ident-elect of the Tennessee Orthopaedic Society (see box), he will take the helm of the statewide organization at the conclu-sion of next month’s annual conference and preside over his fi rst board meeting at the beginning of 2015. Mencio noted the work of TOS is more advocacy based. “We try to stay in tune with what our members’ needs are and what it takes to practice good, pa-tient-centered care.”

Although Connecticut and North Carolina claimed his childhood and early career, it’s Nashville that the Mencios now consider home. “Our kids grew up here. We came when the girls were three and fi ve,” he said of relocating to Music City. “It’s been fun to see the city grow, and we love it here,” he added.

Mencio might have been the first doctor in his family, but he isn’t the last. He and wife Madelyn, a nurse educator at Saint Thomas Health, are the proud parents of two grown daughters. Alyson, a certifi ed fi nancial planner, is with Wiley Bros.-Aintree Capital in Nashville. Marissa has just started her general surgery intern-ship at the University of Tennessee Chat-tanooga at Erlanger. The family is also looking forward to Alyson’s wedding later this year.

Between his commitments to patients, Vanderbilt, TOS, POSNA and family, Mencio knows the coming year will be hec-tic, but he wouldn’t have it any other way. “My wife says the only person I can say ‘no’ to is her,” he said with a laugh.

Despite the long days, Mencio said it’s well worth it. “It does take a little bit of time, but I think it’s rewarding. I think if you have an opportunity, it’s good to be involved,” he concluded.

TOS Annual Conference Set for Sept. 26-28

The Tennessee Orthopaedic Society will host their 635rd annual conference Sept. 26-28 at the Hutton Hotel in midtown Nashville. The three-day event will include legislative updates and more than 20 general, scientifi c and management sessions led by industry experts, including remarks by Frederick Azar, MD, president of the American Academy of Orthopaedic Surgeons. The conference culminates with a morning golf tournament Sept. 28. Exhibit and sponsorship opportunities also are available.

Founded in 1948, TOS is dedicated to increasing public awareness and healthcare improvement for persons with musculoskeletal impairments. TOS supports continuing medical education for its more than 350 members across the state and monitors the effects of socio-economic and legislative measures impacting the quality, availability, and cost of healthcare in orthopaedics.

For more information, visit www.tosweb.org.

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major campuses of Saint Thomas Health. “This project comes as the result of ongo-ing dialogue between Saint Thomas Health and its physicians to identify collaborative efforts to enhance the quality of clinical services to our patients,” Saint Thomas Health CEO Bernie Sherry said in an-nouncing the plans.

Southern Joint Replacement Institute Relocating

On the same day, Saint Thomas affili-ate Southern Joint Replacement Institute announced plans to transition to TriStar Centennial Medical Center at the end of 2014. The move will relocate SJRI’s 2,000-plus yearly procedures, along with ortho-paedic surgeons Michael Christie, MD, David DeBoer, MD, Jeffrey Hodrick, MD, and J. Craig Morrison, MD, bringing Tri-Star Centennial’s number of active ortho-paedic surgeons to 26.

“Our practice is founded on the four pillars of excellence in patient care, educa-tion of orthopedic surgeons and staff, clini-cal research, and philanthropy through our work with WalkStrong [non-profit medical foundation],” said Christie. “We feel that our relationship with TriStar Centennial Medical Center will enhance these founda-tion principals in our effort to build a best-in-nation program.”

The move also will bring SJRI’s novel examination technique – radiostereomet-ric analysis – to ortho patients at TriStar. Following implantation of poppyseed-size beads made of tantalum (a metal often used in implants), RSA enables accurate 3-D measurements from radiographs. The 3-D kinematics of skeletal or implant move-ments can be determined between repeated examinations and may also help the sur-geon predict how long the implant will last.

The announcement represents a stra-tegic move by TriStar Centennial to create its own total joint center. A Certificate of Need filed July 15 includes $94 million in growth to the Patterson Street hospital: a Joint Replacement Center of Excellence to include 10 additional surgical beds, an emergency department renovation, and more licensed beds to boost TriStar Cen-tennial from 657 to 682. Once approved, the CON will kick-start the design and build of their new joint center, slated for

completion early 2016. In the meantime, SJRI will be

located on the first floor of TriS-tar Centennial’s Medical Park physi-cian office building starting late 2014. “SJRI presented a great opportunity to re-ally work with a program with a lot of po-tential and energy,” said Bubba McIntosh, FACHE, orthopaedics service line administra-tor at TriStar Centen-nial. “We want to create a very comprehensive program by building a destination center isolated from the general hospital where patients can access the ortho unit, surgery, and rehab in one loca-tion. We want to create an environment where patients can come in to one place to get rehabilitated very quickly and be able to move back on with life.”

TriStar Ortho in the Community

It’s not the first time TriStar’s or-thopaedic team has made news in recent months. In January 2012, TriStar Hen-dersonville became the second community hospital in the state to gain accreditation by the Joint Commission as a Total Joint Center. Four months later, TriStar South-ern Hills partnered with Premier Ortho-paedic Surgery Center in a joint venture to expand outpatient surgery capabilities and partnerships.

In October 2013, TriStar Southern Hills opened the fifth-floor, boutique-like Joint and Spine Center, investing $3.5 million to construct and equip the 20-bed, 18,000-square-foot facility. And in Janu-ary of this year, TriStar Summit Medical Center opened a new Total Joint Center, a $5 million, 12-bed inpatient rehab center specializing in patients recovering from a total hip or knee replacement.

“We have services in so many loca-tions around the state, and we want people to be able to get services close to home,” McIntosh said. “Patients might come into Nashville for more complex procedures like hip revisions, but they can also get pri-mary joint replacement done in their own neighborhoods.”

By MELANIE KILGORE-HILL

Each year, U.S. emergency depart-ments treat an estimated 173,285 sports- and recreation-related traumatic brain injuries, including concussions, among children and adolescents from birth to 19 years. According to the Centers for Dis-ease Control and Prevention, those visits have increased by 60 percent over the past decade with bicycling, football, play-ground activities, basketball, and soccer leading the charge as culprits.

In April 2013, Tennessee became the 44th state to pass a sports concus-sion law designed to reduce youth sports concussions and increase awareness of traumatic brain injuries for all public and private school sports and under-18 recreational leagues that require a fee. The legislation, Public Chapter 148, has three main components:

• To inform and educate coaches, youth athletes and their parents and to require them to sign a con-cussion information form before competing,

• To require the removal of a youth athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion, and

• To require a youth athlete to be cleared by a licensed healthcare pro-fessional before returning to play or practice.

While the law is a step in the right di-rection, Belmont University professor and exercise physiologist Patrick Sells, DA, said getting athletes to actually fess up to possible injury is the toughest part. “Kids are hesitant to tell you if they took a blow to head because they know what the ramifications are and how long they could be out of the game,” Sells said. “I’ve seen kids go head-to-head or head-to-ground with no headache reported and find out later on they were afraid of the repercussions. That’s the com-petitive spirit of an athlete – they don’t want to quit because of injury … so as a parent, coach or doctor, you have to take measures to get kids to buy into this.”

Sells said it’s essential to educate ath-letes on the importance of telling an adult when something isn’t right. He stresses to students, parents and coaches the im-portance of being able to identify key symptoms including headache, confusion, difficulty remembering or paying atten-tion, balance problems or dizziness, loss of

consciousness, feeling sluggish, nausea or vomiting, or blurry vision. He also encour-ages parents to understand the qualifica-tion of the league and the system children are playing under and to take the time to verify the coaches understand risks and Tennessee’s newest sports concussion law. Identifying and preventing concussions is of special interest to Sells, who has performed baseline tests on local youth football leagues pre- and post-season to determine changes in memory recall. He said several area schools are wising up and offering similar

testing to athletes as a standard practice. Another tool used to gauge players’ health is a specially designed football helmet that measures the G-force behind each hit. “It’s ultimately the responsibility of the school, athletic league and state organization to ensure coaches are knowledgeable about designing safer practices, hydration, and concussion signs and symptoms,” Sells said. “Coaches especially need to be well versed in a multitude of assessments in order to make that decision as there’s not one certain way to tell if a player might be in trouble.”

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Identifying & Preventing Concussions Now a Statewide Effort

Growing Strong, continued from page 1

Bubba McIntosh

Dr. Pat Sells


By CINDy SANDERS

In an effort to improve patient access to appropriate, evidence-based care, the North American Spine Society (NASS) recently released detailed policy recom-mendations for coverage of 13 common spine care treatments, procedures and di-agnostics.

The fi rst-of-their-kind reference docu-ments outline when it is … and when it is not … appropriate to utilize each of the op-tions based on an extensive review of cur-rent literature by a multidisciplinary team of experts.

William Watters, MD, president of NASS, said, “Maintaining patient ac-cess to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission. It is our hope that payers, spine specialists and their patients will use these evidence-based cover-age recommendations as a reference to advocate for appropriate care for patients.”

Watters added the society was uniquely positioned to take the lead on such an extensive project because of the multispecialty nature of the organization, which includes the expertise of surgeons and allied health professionals. “We cover the full spectrum of spine care,” he noted.

Watters, who is a board certifi ed or-thopaedic surgeon in private practice at the Bone & Joint Clinic of Houston and a clini-cal associate professor at both the Univer-sity of Texas Medical Branch in Galveston and Baylor College of Medicine, said the society already had experience weighing the evidence at the request of physicians, patients and payers. “NASS began a num-ber of years ago becoming involved in third party payer coverage decisions,” he noted. However, he continued, the turnaround time was often tight and the number of studies to consider extensive.

“We decided to proactively create our own coverage decisions based on the best evidence available … and where evidence was lacking, based on the expertise in this group,” he explained. “We came up with what we feel is the most sound group of rec-ommendations based on the best evidence available at this point and time.”

Watters continued, “One of the hopes that we have is that we bring a bit of unifor-mity to the whole process of spinal care.”

Christopher Kauff-man, MD, health pol-icy council director for NASS, concurred. He said allowed treatments and diagnostics vary by state and by payer. These recommendations outline the scope and clinical in-dications for a therapeutic

measure when a patient meets appropriate inclusion criteria. They also clearly state scenarios in which employing the measure is not indicated.

While not recommending payers re-imburse for every procedure under every circumstance might be controversial among some providers, Kauffman said, “People who understand where medicine is going with outcome measures get it. So far, the response has been overwhelmingly positive.”

He added, “People may confuse cov-erage with medical appropriateness. The two are not equal. People assume pay-ment equals medical appropriateness. I can’t stress enough this isn’t true. Payment equals treatments where the literature has reached a certain bar of evidence.”

Kauffman, a board certifi ed orthopae-dic surgeon in practice at Premier Ortho-paedics in Nashville, said, “For everything we recommend, we think the evidence does reach the bar for coverage. This is what we think should be covered by any payer.”

However, he continued, it doesn’t mean other treatments being employed don’t have therapeutic benefi ts. “You can’t ever throw out the art of medicine.” Yet, Kauffman noted, “If you’re falling outside the clinical guidelines, you have to expect that you’re going to do a peer-to-peer re-view, or it might not be a covered service.” He added the recommendations would be routinely revisited to incorporate new evi-dence.

In addition to the 13 coverage policy

recommendations published in May, Wat-ters said NASS is already in process or planning to create documents for 14 addi-tional diagnostic and therapeutic modali-ties including annular repair, cervical and lumbar radiofrequency neurotomy, cervi-cal fusion, cervical laminectomy and lami-noplasty, minimally invasive lumbar fusion, SI joint fusion and injections, DNA-based scoliosis test and electrical stimulation for bone healing, among others. “The remain-der will be released within a year,” he said.

“The plan is to reassess the literature at least every two years,” he continued, em-phasizing the need to stay current as new studies are published and new treatment options become available. “This has to be a living document.”

He added it’s a nearly impossible task to ask physicians, surgeons, nurses, thera-pists and other providers to wade through all the literature required to practice evi-dence-based, contemporary medicine. Having the committee go through the best, most soundly crafted studies to create each of the 5-30 page recommendations, which include supporting details behind the ra-tionale and a thorough list of references, simplifi es the process for practitioners and their patients. “These turned out to be re-markably educational documents,” Wat-ters stated.

Both Kauffman and Watters stressed at the end of the day, the coverage recom-mendations are an effort to ensure patients have equal access to the best possible treat-ments.

“It’s making sure that good spine care is available for patients across the U.S.,” Kauffman concluded.

NASS Takes a Proactive Approach to Evidence-Based Coverage Decisions

Dr. William Watters

Dr. Christopher Kauffman

Coverage Policy RecommendationsTo access the documents for each of the procedures listed below, go online to www.spine.org and click on the “Policy & Practice” heading.

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“As I began to talk with women around the world, it became very clear to me the spacing and timing of pregnan-cies we take for granted in the U.S. is a matter of life and death for them,” said Gates. “So I got very involved in contra-ceptives, because it truly starts the cycle of life, where they can feed their children, get their children in school, and honestly, not die themselves.”

Frist agreed, saying, “Contraception is a pro-life cause.” He went on to explain, “If you delay fi rst pregnancy to 18 years old, you can increase survival in countries where one in 39 women die in childbirth and cut the chance of children dying by 30 percent, enabling them to stay in school and become productive members of fami-lies.” He continued, “Second, if you can push out the interval between pregnancies to (a) three year period, the child is twice as likely to survive the newborn stage.”

During the event, Gates refl ected on her upbringing in Dallas where she attended Catholic parochial school and confi rmed she remains a practicing mem-ber of the Catholic Church. While Gates said she recognizes the tension between her work and the Church’s position on contraceptives, she has found common

ground on healthy timing and spacing of pregnancies, even though organizations embrace different tools to achieve it.

Frist noted the Faith-Based Coalition for Healthy Mothers and Children World-wide has a critical role to play in engaging members of the faith community to help disseminate the message. He likened this new initiative to a similar movement of Americans in 2002 that shared a vision across all faiths, leading to the support and eventual funding of PEPFAR, the largest health initiative in history that turned the tide on HIV/AIDS.

“The millions of people dying of HIV/AIDS worldwide led to a major U.S. tax-payer led movement to save lives, resulting in more than what is now 12.9 million individuals currently on anti-retro-viral medicine,” he said. Frist added such an impact on what is rapidly becoming another global pandemic is again possible. Currently 287,000 women in developing nations die from preventable complica-tions during childbirth, and 6.6 million children die before their fi fth birthday each year.

Several faith leaders already involved in this issue also participated in the pro-gram by echoing their support of this new initiative. “The best way to see change in Africa is to change the lives of African mothers,” said Steve Taylor, recording artist and fi lmmaker.

Mike Glenn, pastor of Brentwood Baptist Church, added, “The Evangelical church is often accused of loving the child and not the mother; but in doing so, we lose God’s mosaic. We believe in ‘Imago Dei,’ the dignity of every human being.”

“It all comes down to the mother and child nexus and the healthy timing and spacing of births,” Frist concluded.

For more information, go online to hopethroughhealinghands.org.

The American Heart Association re-cently announced four major institutions would band together in a new research network aimed at preventing heart dis-ease and stroke. The Strategically Focused Prevention Research Network Centers — funded by a $15 million AHA grant — is designed to help people live longer, healthier lives.

Obesity, high blood pressure and heart failure are among the areas being studied by the collaborative network, which is made up of investigators at Vanderbilt University in Nashville, Northwestern University in Chicago, the Icahn School of Medicine at Mount Sinai in New York City, and the University of Texas-Southwestern Medical Center in Dallas.

“The best way to reduce premature mortality from cardiovascular diseases and stroke is to prevent the development of the risk factors that lead to these conditions,” said AHA President Elliott Antman, MD, professor of medicine at Harvard Medical School and a senior physician in the car-diovascular division of the Brigham and Women’s Hospital in Boston. “Scientists

working in these research centers are help-ing to discover the mechanisms that will allow all Americans to live healthier lives, helping lead us to a culture of health.”

The concept is critical to the associa-tion’s goal to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent by 2020.

Two major hurdles — an overly salty diet and the frequent need to take mul-tiple, expensive medications — is spurring Vanderbilt University to develop new ap-proaches for preventing high blood pres-sure. The goals are to understand how salt causes tissue injury, develop a method to detect and lower excess salt, and de-termine if a simple treatment in one pill could improve cardiovascular health.

That’s an “enormous opportunity,” said Vanderbilt’s David G. Harrison, MD, the Betty and Jack Bailey Professor of Medicine and Pharmacology and direc-tor of the division of Clinical Pharmacol-ogy. “Our center will focus on preventing hypertension, which is an enormous risk factor for heart disease, stroke and kidney disease. We are beginning to understand

how common risk factors like diet and lifestyle pre-dispose to hypertension and (are) taking mea-sures to correct these,” Harrison said.

The other centers are focusing on other major issues.

Northwestern Uni-versity will take a closer look at why heart-health measures decline from child-hood to middle age and see if the latest techniques can help maintain ideal heart health and reverse declines. The goal is to learn how to implement behavior change programs on a large scale.

Nearly one-third of adults and chil-dren in the United States are obese, with rates even higher in Hispanic and Afri-

can-American communities. The Icahn School of Medicine at Mt. Sinai will aim to build a culture of health in Harlem with an urban-based, family-centric health program targeting kids as young as three years of age, as well as their caregivers.

Heart failure is one of the most com-mon reasons people ages 65 and older go to the hospital. There are no proven therapies to prevent heart failure with preserved ejection fraction (hFpEF), which occurs in about half of heart fail-ure patients. Additionally, patient prog-nosis has remained relatively unchanged over the past two decades. The University of Texas-Southwestern Medical Center wants to shift the focus to prevention.

Funding began July 1, and each net-work center will receive about $3.8 million during the next four years.

Frist Joins Forces, continued from page 1

AHA Funding New Heart Disease, Stroke Research NetworkVanderbilt One of Four Major Institutions Named

Dr. David G. Harrison

Online Event Calendar



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several interesting findings:• Physical therapy was effective in

preventing surgery in over 80 per-cent of patients.

• Effects of the physical therapy pro-gram lasted at least two years.

• The patient’s expectations with regard to treatment drove the de-cision to have surgery: If a patient believed therapy would work, it would. If the patient did not believe therapy would work, it did not.

• Severity of the rotator cuff disease had very little to do with the pa-tient’s symptoms. It did not cor-relate with patient pain, duration of symptoms, activity level, or the decision to have surgery.

“This work is important, as many patients are told they need to have sur-gery with atraumatic full thickness rota-tor cuff tears, but this does not seem to be the case,” Kuhn said. “We know there are over 5 million Americans with rotator cuff tears, yet fewer than 5 percent come to surgery. We also know that if the rota-tor cuff repair fails, patients still feel bet-ter suggesting the tear was not the source

of pain. Our study demonstrated that the therapy program was effective, even if done at home for the majority of the time. This has important implications with re-gard to healthcare costs.”

MARS Undertakes Knee Revisions

In 2006, a third study was launched to examine outcomes of Multicenter ACL Revision Surgery (MARS) at two, six and 10 years post-surgery. More than 1,200 par-ticipants have enrolled in MARS to date. According to Kuhn, the infrequency of revi-sion surgery constituted the need for a mul-ticenter approach. There are 87 surgeons from more than 53 sites in North America contributing to the body of knowledge.

While MARS is under the leader-ship of Rick Wright, MD, at Washington University in St. Louis, Kuhn said a large number of Vanderbilt resources and fac-ulty assist in the ongoing study.

In addition to the MARS work, Kuhn said, “Literally dozens of research person-nel at Vanderbilt play a role in conducting the studies these groups perform, making Vanderbilt the ‘hub’ for the MOON ACL and MOON Rotator Cuff Studies.”

Vanderbilt’s MOON, continued from page 9

GrandRounds

Sept. 15-17 • Healthcare Deal Making Summit 2014 • Nashville Music City Center

This annual event brings together senior executives from some of today’s most innovative and leading healthcare organizations along with investors and financial service providers to explore a variety of business models and strate-gies for success in the evolving post-Affordable Care Act world. For more information or to register, go online to informationforecastnet.com.

Oct. 4 • Greater Nashville Heart Walk • Festival Starts 8 am • Walk Begins 10 am • Vanderbilt Campus, Corner of Natchez Trace & Blakemore

More than 10,000 walkers are ex-pected to participate in the annual 5K Nashville Heart Walk, which is the area’s largest fundraiser for the Ameri-can Heart Association with a 2014 goal of raising $2 million. Ben Leedle, presi-dent and CEO of Healthways, and Peter Weien, manager of Gaylord Opryland Resort and Attractions are co-chairs for the 2014 campaign. For more informa-tion or to register as a team, go online to nashvilleheartwalk.org. There is no registration fee.

MissionPoint, Monroe Carell Join Forces

The Monroe Carell Jr. Children’s Hospital at Vanderbilt has signed on to be part of the hospital and physician network run by MissionPoint Health Partners, the accountable care orga-

nization launched by Saint Thomas Health Services in 2012. As part of the agreement between two of the region’s largest healthcare providers, the 271-bed main Monroe Carell facility and its more than 20 outpatient centers around the region will be the exclusive provider of pediatric care to MissionPoint’s more than 100,000 members.

Bowers Named Corizon President, COO

Effective Aug. 4, Scott A. Bowers will assume the role of president and chief operating officer of Brentwood-based Corizon Health. Most recently, Bowers was president and CEO of UnitedHealthcare Com-munity Plan of Tennes-see. He brings 18 years of healthcare management experience to the correction healthcare industry com-pany. Past experience includes serving as president and CEO of Unison Health Plan in Ohio and as executive direc-tor of Harmony Health Plan in Illinois. Bowers earned his undergraduate de-gree from Princeton and his MBA from Washington University in St. Louis.

Corizon recently announced it had retained the Missouri Department of Corrections healthcare contract and expanded to include the behavioral health component. The contract, which was awarded through a competitive bid process, is for three years with four po-tential one-year renewals and is valued at $1.1 billion over the seven-year term.

Scott A. Bowers


Apply at: https://jobs.etsu.eduInquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of

Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622,

Johnson City, TN 37614. Phone (423)439-6367; email: [email protected].

Academic Internal Medicine Opportunities

Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE

Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.

GrandRounds

Mathis Named VUMC Chief Compliance Officer

Recently, Vanderbilt University Med-ical Center announced James Mathis has been promoted to chief compliance officer. Previously he served as the chief clinical enter-prise compliance officer and assistant vice chan-cellor for Health Affairs at VUMC.

Mathis, who has been with Vander-bilt almost 18 months, has also served as chief compliance officer at Omnicare and held positions at Waller and Frese-nius Medical Care. He received both his undergraduate and law degrees from Vanderbilt.

Let’s Give Them Something to Talk About!Awards, Honors, Achievements

The LUNGevity Foundation has awarded a 2014 Career Development Award for Translational Research to Christine Lovly, MD, PhD, assistant professor of Medicine and Cancer Bi-ology at Vanderbilt-Ingram Cancer Center. Lovly is one of three recipients of the annual grants, which provide $300,000 over three years for lung can-cer research.

Jim Moore, CEO of Cumberland Heights, has been awarded the pres-

tigious Administrator of the Year award by the National Association of Addiction Treatment Pro-viders (NAATP). Moore is nationally recognized as an administrator in alco-hol and drug treatment with over 30 years experience in addic-tion treatment.

Vanderbilt University Medical Center is one of six medical centers around the country to be selected to participate in a network to develop effective approaches for diagnosing hard-to-solve medical cases. Undiag-nosed diseases are conditions that even skilled physicians can’t diagnose despite extensive clinical investigation. They may not be recognized by doctors because they are rarely seen, are pre-viously undescribed or are rare forms of more common diseases. Vanderbilt received a $7.2 million grant from the National Institutes of Health to assist in scientific investigation and clinical evaluation. The six new sites join a clini-cal site already established at the NIH in Bethesda, Md., that has been active for six years.

H. Newton Williams of Nashville has been named to the American Heart Association’s Greater Southeast Affili-ate board of directors for the 2014-2015 fiscal year. The Greater Southeast Af-

filiate services the region covering Alabama, Flor-ida, Georgia, Louisiana, Mississippi, Tennessee and Puerto Rico. Williams has worked with the AHA for a decade in various advocacy roles and was named “Volunteer Advocate of the Year” for the nation in 2011.

Locally, Angela Humphreys, part-ner, Bass, Berry, & Sims, has been named the 2014-15 board chair for the Greater Nashville chapter of the Ameri-can Heart Association.

Last month, the National Health Care for the Homeless Council, a Nashville-based national nonprofit or-ganization, announced it was one of 39 Health Care Innovation Award recipi-ents from the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation (CMMI) and will be used to demon-strate improved health outcomes and reduced spending when homeless pa-tients have access to medical respite care following a hospital stay.

Murfreesboro dentist William R. “Roy” Thompson, DDS, MAGD, received the

national Academy of General Dentistry’s Hu-manitarian Award during the AGD

2014 Annual Meet-ing at the end of June in Detroit. Thompson, who is currently chairman of Nashville’s In-terfaith Dental Clinic, was honored in part for his work to bring low-cost, com-prehensive care to low-income and un-insured individuals. The AGD has only given this national award out 16 times in the past 32 years.

HCA recently announced that for a sixth consecutive year the company has earned national recognition as one of the best workplaces for information technology professionals. HCA, which has 165 hospitals and 115 surgery cen-ters in 20 states, ranked No. 42 on Com-puterworld’s 2014 “Best Places to Work in Information Technology” list of 100 companies.

Kelly A. Carden, MD, a sleep med-icine expert with Saint Thomas Sleep Specialists, has been named president of the American Board of Sleep Medicine (ABSM). She is also beginning her sec-ond year serving on the Board of Directors of the American Academy of Sleep Medicine (AASM). Carden previ-ously served as chairman of the AASM’s Committee on Coding and Compliance, vice chairman of the Health Care Policy Committee, and was named a fellow of the AASM in 2005 for her accomplish-ments in the field of sleep medicine.

Michael Moran, a vice president for Interim HealthCare, recently announced

Interim HealthCare of Middle Tennes-see was the recipient of the Ownership Group of the Year – New Franchise Award. The Award was presented for the fastest growing new franchise in 2013 at the company’s annual meeting in Fort Lauderdale, Fla. Owner and CEO Carol Penterman and her team achieved over 240 percent overall growth in one year after opening in December 2012. The greatest increase in sales was in Interim HealthCare of Middle Tennessee’s staff-ing of skilled care for long-term care in-surance companies, which increased by 1,205 percent.

Ardent Appoints Miller VP of Physicians Services

Nashville-based Ardent Health Ser-vices recently announced the appoint-ment of Marc Miller, MBA, FACHE, FACMPE, as vice president of Physician Services, a newly created position dedicated to building strong relation-ships with the company’s growing network of physi-cian clinics.

Miller brings more than 25 years of practice management experience to Ardent, where he will assist market lead-ership in establishing new strategies, opportunities, and options for enhanc-ing physician practices throughout the company. Most recently, he served as president of Physician Health Partners ACO/CIN and senior vice president of Physician Services and Business De-velopment at Munroe Regional Health System in Ocala, Fla.

Moves & ExpansionsSeveral area practices have made

moves or announced expansions over the last few months.

Last month, Nashville-based Am-Surg Corp. effectively doubled its size with the completion of its previously an-nounced acquisition of Florida-based Sheridan Healthcare in a cash and stock transaction valued at approximately $2.35 billion. Sheridan provides anes-thesia and other specialty services to more than 300 facilities in 25 states. Through this transaction, AmSurg sig-nificantly diversifies its revenue streams as both the operator of the largest num-ber of ambulatory surgery centers in the country and as a leading provider of outsourced physician services.

Brookdale Senior Living is leasing 28,000 square feet of space previously occupied by LifePoint in the Highwoods Properties’ building Harpeth on the Green V.

Garza Plastic & Reconstructive Surgery has expanded operations to downtown Nashville, complementing the Belle Meade practice that was es-tablished in 2009. The downtown loca-tion is at 3rd and Church Health Care on the corner of Third Avenue South and Church Street.

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GrandRounds

Ankle, which has four Middle Tennes-see locations, has moved its Brentwood office from TriStar Medical Plaza on No-lensville Pike to 10644 Concord Road and extended office hours so that it is now open until 5 p.m. Monday-Friday in Brentwood.

The practice has also added staff, including welcoming new doctor Aar-on Allred, DPM, who begins with the practice this month. Allred earned his doctorate from Des Moines University and completed his residency training in reconstructive foot and ankle surgery at Mineral Area Regional Medical Center in St. Louis.

Nix Joins LBMC, Lawson Promoted

Lattimore Black Morgan & Cain, PC (LBMC) recently announced Lisa Nix, CPA, has joined the firm as a partner leading the Transaction Advisory Ser-vices Practice Division with a focus on healthcare services. Prior to joining LBMC, Nix was a director with Deloitte’s National Health Care and Life Sciences Transac-tion Services practice.

She has over 20 years of public ac-counting experience with more than 10 years of experience in healthcare trans-

action services, including leading multi-functional healthcare M&A teams on transactions ranging in size from several million to over $7 billion dollars for both strategic and financial buyers. A gradu-ate of Middle Tennessee State Universi-ty, Nix has been named a Power Leader in Accounting and is a past recipient of the Volunteer of the Year Award from Leadership Health Care.

Additionally, Lauren Lawson in the Human Resources division of LBMC has been promoted to man-ager. She has more than 8 years of experience in HR and recruiting. Prior to her role at LBMC, Law-son served as an agent with Randstad General Staffing. She is a gradu-ate of the University of Tennessee and is certified as a Professional in Human Resources through the HR Certification Institute.

VUMC Names Marnett Associate Vice Chancellor of Research

Vanderbilt University Medical Center recently announced Larry Marnett, PhD, has been named associate vice chan-cellor for Research and senior associate dean for Biomedical Sciences where he will support the operations and strate-

gic development of basic sciences throughout the medical center. He suc-ceeds Susan Wente, PhD, who is transitioning to provost and vice chancel-lor for Academic Affairs at Vanderbilt University.

Marnett is also the Mary Gedds Stahlman Professor of Cancer Research, director of the A.B. Hancock Jr. Memo-rial Laboratory for Cancer Research, director of the Vanderbilt Institute for Chemical Biology and professor of pharmacology. He received his under-graduate degree from Rockhurst Col-lege and a doctorate in chemistry from Duke University. Marnett completed post-doctoral work at the Karolinska In-stitute and Wayne State University and joined Vanderbilt in 1989.

Tackett Joins Sumner Regional

Megan Tackett, MD, has joined Sum-ner Regional Medical Center’s medical staff and is offering pedi-atric services to patients throughout Gallatin and the surrounding commu-nities at both the hospital and local VIP MidSouth Children’s Clinic loca-tions.

Tackett received her medical degree from the University of Tennessee Col-lege of Medicine in Memphis and com-pleted her residency at Emory Univer-sity in Atlanta. She is a member of the Kids Health First Pediatric Alliance and is board certified in Pediatrics.

Gold Skin Care Adds New Products

Gold Skin Care Center (GSCC) now offers the newly FDA-approved Ulthera-py Décolletage Treatment to patients to improve lines and wrinkles on the chest through the Ulthera System, which was previously only approved for the neck, eyebrow and under the chin. The treat-ment is the only non-invasive procedure specifically indicated by the FDA to im-prove lines and wrinkles on the chest and is delivered in a single treatment that takes about 30 minutes.

Advanced Aesthetics Medical Spa at GSCC became one of the first providers in the state to offer the Clarisonic Smart Profile, which removes skin-damaging pollution 30 times better than hands alone and has brush heads that are indi-vidually programmed to engage when the device is on. “This will be a profes-sional only model — and we are glad to bring it to the area for our clients and patients to benefit from,” said Michael Gold, MD, medical director of GSCC.

Lisa Nix

Lauren Lawson

Dr. Larry Marnett

Dr. Megan Tackett


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GrandRounds

SVMIC Declares $7.5 M Dividend

State Volunteer Mutual Insurance Company’s Board of Directors declared a dividend of $7.5 million to be re-turned to all policyholders renewing in the 12-month period following May 15, 2014. This is the seventh consecutive year SVMIC has declared dividends for its physician policyholders. Policyhold-ers will receive the dividend in the form of a credit on the renewal premium. Ad-ditionally, rates will remain unchanged for 2014.

In other news, SVMIC was again awarded an “A” (Excellent) financial strength rating from A.M. Best Com-pany. SVMIC has maintained an “A” or better rating for more than 30 years.

Schneider Joins Tennessee Retina

Tennessee Retina recently an-nounced the addition of Eric W. Schnei-der, MD, to its physician staff. Schneider graduat-ed from the University of Michigan Medical School and completed his resi-dency and served as chief resident at the University of Michigan Kellogg Eye Center. He then com-pleted his two-year Retina Fellowship at Duke University. Schneider’s award-winning research has primarily focused on diseases of the vitreoretinal interface and novel applications of ophthalmic imaging technology. He is seeing pa-tients at multiple Tennessee Retina lo-cations, including Nashville, Murfrees-boro, Hendersonville and Cookeville.

News from TriStar SummitIn late May, the State of Tennes-

see’s Health Services and Development Agency approved a Certificate of Need for TriStar Summit Medical Center to add eight new medical surgical beds due to growth of their cardiac and neu-

roscience service lines. The project will cost approximately $1.8 million and will increase the hospital’s licensed bed count from 188 beds to 196 beds.

The medical center also recently named Bryan E. Shep-herd as CFO. Shepherd was previously the divi-sion controller at TriStar Health. Prior to moving to Tennessee, he was controller at St. David’s Medical Center in Aus-tin, Texas. A graduate of Ohio University, Shepherd is a certified public accountant.

In late July, TriStar Summit became the first community hospital in Middle Tennessee, and one of the first hospitals in the state, to implant the Medtronic Reveal LINQ Insertable Cardiac Moni-tor (ICM) System, also known as a loop recorder, in a patient. The monitor, used in patients with irregular heartbeats or fainting episodes, is the smallest de-vice available that continuously moni-tors cardiac rhythms coming in at about one-third the size of a AAA battery, which makes it 80 percent smaller than other ICMs. In addition to its continu-ous and wireless monitoring capabili-ties, the system provides remote moni-toring through the Carelink® Network. Through this network, physicians can re-quest notifications to alert them if their patients have had cardiac events.

Healthcare Partner Perry, Life Sciences Litigator Goodman Joins BABC

Bradley Arant Boult Cummings LLP recently announced the addition of two partners to the Nashville office.

John M. Perry, Jr. has joined the firm’s local office as a partner in the Health Care Practice Group. Highly experienced in advising not-for-profit health care providers, Perry had been working from the firm’s Birmingham, Ala., office since rejoining the firm in

January 2014. He began his legal career in the Birmingham office as an associate in 1997. Perry has over 14 years of expe-rience advising and representing not-for-profit integrated health systems, healthcare providers, and physician practices. He earned his undergradu-ate degree from Vanderbilt and his law degree from the University of Virginia School of Law.

William F. Goodman, III, a partner and nationally known life sciences litiga-tor has also joined the Nashville office, moving from the firm’s Jackson, Miss. office where he has worked since join-ing BABC in January 2014. A member of the firm’s Litigation Practice Group and Life Sciences Industry Team, Good-man has more than 35 years in practice, serving as lead national defense coun-sel to life sciences companies involved in complex commercial and personal injury litigation. He earned his under-graduate degree from Millsaps College and his law degree from the University of Mississippi.

Bank of Nashville/Synovus Expands Mortgage Division

Two mortgage bank-ers with extensive experi-ence working with medi-cal professionals have joined the Bank of Nash-ville/Synovus Mortgage Division. Carolyn Dan-iels joined as vice presi-dent in the Green Hills lo-cation, and Alene Gnyp joined as vice president in the West End location. Both more than 20 years of mortgage lending ex-perience and were previously consul-tants with SunTrust Mortgage.

Net Health Acquires ReDocPittsburgh-based Net Health, a

leading provider of software solutions for outpatient specialty care, recently announced its acquisition of Brent-wood-based The Rehab Documenta-tion Company (ReDoc), a provider of in-tegrated clinical EMR and management solutions for the physical, occupational, and speech therapy markets.

Net Health is a portfolio company of Spectrum Equity and is advised by Healthcare Growth Partners. Terms of the transaction were not disclosed. Brentwood Capital Advisors LLC served as exclusive financial advisor to ReDoc in the transaction.

Meharry Medical College Unveils Henry Schein Cares Graduate Programs Residency Center

Through the collaboration of Meharry Medical College and the Henry Schein Cares Foundation, Inc., the world’s largest provider of healthcare products and services to office-based dental, animal health and medical practitioners, Me-harry’s School of Dentistry now has a newly renovated, advanced general practice residency clinic. The cost of the Henry Schein Cares Graduate Programs Residency Clinic, in-clusive of equipment and renovations, was $1.1 million dollars.

(L-R) Stanley Bergman, Sen. Thelma Harper, Dental School Dean Dr. Cherae Farmer-Dixon, Dr. Louis W. Sullivan and Dr. Daphne C. Ferguson-Young, professor and program director of the General Practice Residency Program.

Dr. Eric W. Schneider

Bryan E. Shepherd

Carolyn Daniels

Alene Gnyp

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Documents

Nashville Medical News August 2014