PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 Middle Tennessee’s Primary Source for Professional Healthcare News ON ROUNDS PRINTED ON RECYCLED PAPER Cholesterol Conversations New Guidelines Open the Door for Dialogue with Patients While guidelines are meant to clarify best practices and offer a clear clinical path, sometimes changes wind up being more confusing … leading to debate over what truly is best for patients ... 4 March of Dimes Celebrates Outstanding Community Nurses Middle Tennessee Organization Hosts Annual Nurse of the Year Awards On Dec. 10, 2013, nurses from across Middle Tennessee gathered to honor their own at the fourth annual March of Dimes Nurse of the Year Awards ... 12 February 2014 >> $5 FOCUS TOPICS CARDIOLOGY MERGERS & ACQUISITIONS David Bichell, MD PAGE 3 PHYSICIAN SPOTLIGHT ONLINE: NASHVILLE MEDICAL NEWS.COM M&A Trends in the Reform Era A Look Back at 2013 … Look Ahead in the New Year Saint Thomas Heart Debuts MitraClip Clinical Trial Offers Open-Heart Surgery Alternative for Patients with CHF, MR BY CINDY SANDERS As part of the national COAPT trial, Saint Thomas Heart debuted the ﬁrst MitraClip® implantation at Saint Thomas West Hospital in No- vember 2013. An alternative to open-heart surgery, the device offers patients with congestive heart failure and mitral regurgitation another option when they aren’t candidates for traditional invasive surgery, the standard-of-care treatment. Saint Thomas Heart, the only program in Tennessee currently participating in the COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy) trial, performs the catheter-based procedure in a hybrid operating room with collaboration between interventional cardiologists, heart failure specialists, cardiac surgeons and ad- vanced cardiac imaging physicians. Evelio Rodriguez, MD, a cardiac surgeon and the principal investigator for the trial, and Mark Stankewicz, MD, interventional cardiolo- gist, were part of the team that performed the ﬁrst MitraClip implantation. (CONTINUED ON PAGE 8) BY CINDY SANDERS The Affordable Care Act, coupled with new models of reim- bursement, has undoubtedly impacted the way the healthcare in- dustry conducts business today and strategically plans for the future. For some industry sectors within healthcare services, a ‘strength in numbers’ mentality has caused a marked uptick in mergers and ac- quisitions in comparison to a few years ago. For others, the strategy has been to take more of a ‘wait and see approach’ while trying to ﬁgure out just how the new rules will impact their speciﬁc markets. Frank Morgan, the Nashville-based managing director for Healthcare Services and Equity Re- search with RBC Capital Markets, recently shared his thoughts with Nashville Medical News on the level of activity in 2013 and his expectations for the coming year. With more than two decades experience in equity research and investment banking, Morgan primarily focuses his re- search on facility-based healthcare services including hospitals, skilled nursing and assisted living facilities, long-term acute care (LTAC), behavioral health services and rehabilitation. Morgan, who has been recognized for his expertise within the health services industry by multiple national publications and industry rankings, is a popular speaker and participant in ﬁnancial panels. Overall, Morgan said there was a general uptick in activity in 2013 compared to 2012. That was particularly true within the hos- pital sector. “’13 … if not a record year … was a very good year for M&A activity,” he noted. “You really saw it on the not-for-proﬁt side,” he added. There are several reasons for the ‘super-sizing’ of hospital sys- tems starting with implementation of ACA but exacerbated by other (CONTINUED ON PAGE 10) NASHVILLE Your Primary Source for Professional Healthcare News To promote your business or practice in this high proﬁle spot, contact Tori Hughes at Nashville Medical News. [email protected] • 615-844-9410 Frank Morgan
Middle Tennessee’s Primary Source for Professional Healthcare News
PRINTED ON RECYCLED PAPER
Cholesterol ConversationsNew Guidelines Open the Door for Dialogue with Patients
While guidelines are meant to clarify best practices and offer a clear clinical path, sometimes changes wind up being more confusing … leading to debate over what truly is best for patients ... 4
March of Dimes Celebrates Outstanding Community NursesMiddle Tennessee Organization Hosts Annual Nurse of the Year Awards
On Dec. 10, 2013, nurses from across Middle Tennessee gathered to honor their own at the fourth annual March of Dimes Nurse of the Year Awards ... 12
February 2014 >> $5
FOCUS TOPICS CARDIOLOGY MERGERS & ACQUISITIONS
David Bichell, MD
M&A Trends in the Reform EraA Look Back at 2013 … Look Ahead in the New Year
Saint Thomas Heart Debuts MitraClip Clinical Trial Offers Open-Heart Surgery Alternative for Patients with CHF, MR
By CINDy SANDERS
As part of the national COAPT trial, Saint Thomas Heart debuted the fi rst MitraClip® implantation at Saint Thomas West Hospital in No-vember 2013. An alternative to open-heart surgery, the device offers patients with congestive heart failure and mitral regurgitation another option when they aren’t candidates for traditional invasive surgery, the standard-of-care treatment.
Saint Thomas Heart, the only program in Tennessee currently participating in the COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy) trial, performs the catheter-based procedure in a hybrid operating room with collaboration between interventional cardiologists, heart failure specialists, cardiac surgeons and ad-vanced cardiac imaging physicians. Evelio Rodriguez, MD, a cardiac surgeon and the principal investigator for the trial, and Mark Stankewicz, MD, interventional cardiolo-gist, were part of the team that performed the fi rst MitraClip implantation.
(CONTINUED ON PAGE 8)
By CINDy SANDERS
The Affordable Care Act, coupled with new models of reim-bursement, has undoubtedly impacted the way the healthcare in-dustry conducts business today and strategically plans for the future. For some industry sectors within healthcare services, a ‘strength in numbers’ mentality has caused a marked uptick in mergers and ac-quisitions in comparison to a few years ago. For others, the strategy has been to take more of a ‘wait and see approach’ while trying to fi gure out just how the new rules will impact their specifi c markets.
Frank Morgan, the Nashville-based managing director for Healthcare Services and Equity Re-search with RBC Capital Markets, recently shared his thoughts with Nashville Medical News on the level of activity in 2013 and his expectations for
the coming year. With more than two decades experience in equity research and investment banking, Morgan primarily focuses his re-search on facility-based healthcare services including hospitals, skilled nursing and assisted living facilities, long-term acute care (LTAC), behavioral health services and rehabilitation. Morgan, who has been recognized for his expertise within the health services industry by multiple national publications and industry rankings, is a popular speaker and participant in fi nancial panels.
Overall, Morgan said there was a general uptick in activity in 2013 compared to 2012. That was particularly true within the hos-pital sector. “’13 … if not a record year … was a very good year for M&A activity,” he noted. “You really saw it on the not-for-profi t side,” he added.
There are several reasons for the ‘super-sizing’ of hospital sys-tems starting with implementation of ACA but exacerbated by other
(CONTINUED ON PAGE 10)
Your Primary Source for Professional Healthcare News
To promote your business or practice in this high profi le spot, contact
2 > FEBRUARY 2014 n a s h v i l l e m e d i c a l n e w s . c o m
As the number one killer in America, the sheer volume of cardio-vascular cases makes this specialty an attractive one for health systems and providers … both from the standpoint of searching for innova-tive ways to care for a large segment of the population and from the more pragmatic need to balance the bot-tom line.
While most metro areas are lucky to have one center known for delivering quality cardiac care, Nash-ville has multiple options led by three highly regarded programs with nu-merous outposts and community clin-ics. In the last few years, Nashville has seen growth at Saint Thomas Heart, TriStar Heart, and Vanderbilt Heart & Vascular Institute. The following pages highlight just a few of the new procedures and technologies being used to innovate care and improve the quality of life for patients.
In ongoing efforts to capture the hearts (bad pun intended) of patients and physicians, the area’s leading programs have raced out of the gate to be the fi rst to introduce new procedures or to achieve ac-creditations. In August 2010, Saint Thomas West became the fi rst in Middle Tennessee to earn certifi ca-tion from The Joint Commission for ventricular assist devices and destina-tion therapy, a distinction Vanderbilt now also holds. TriStar Heart was the fi rst in the state and among the fi rst in the nation to achieve chest pain accreditation, which all the area’s key players now hold. As an academic medical center, Vanderbilt has been on the cutting edge of a number of research initiatives including being the fi rst U.S. medical center to give patients recovering from heart fail-ure the drug CGF2, which has been shown in trials to help re-grow dam-aged heart muscle.
With program growth has come physical plant expansion, too. In January 2012, Saint Thomas Health announced the opening of the Saint Thomas Heart Ventricular Assist De-vice Center, which was one of only 33 dedicated VAD centers in the country at the time of opening. The following month, TriStar Centennial Medical Center opened its $150 million Heart & Vascular Center. And Vanderbilt Heart has just relocated key proce-dure areas to the Critical Care Tower, which connects to Vanderbilt Univer-sity Hospital. (For more information, see page xx.)
So who is the ‘winner’ in the highly competitive race to be crowned cardiac king in Middle Ten-nessee? Ultimately, the rivalry among the market leaders means the real winners are the patients, who are able to tap into the innovation that results from such competition, and the referring physicians, who now have a wealth of options to tailor treatment to best suit their patients’ specifi c needs.
Cindy Sanders, Editor
EDITOR’SNOTE Subcutaneous ICD Offers Viable Option for a Number of Patient Populations
By CINDy SANDERS
For nearly three decades, many patients with arrhythmias or at high risk for sudden cardiac arrest (SCA) have benefi ted from implantable cardioverter defi bril-lators (ICDs), which help regulate the heart’s electrical signaling. For some, however, the traditional ICD poses problems that a new subcutaneous iteration avoids while still effectively treating ven-tricular tachyarrhythmias.
Sharon Shen, MD, an electro-physiologist with Vanderbilt Heart, explained the difference between the traditional system and the new subcutaneous system (S-ICD). “The subcutaneous ICD doesn’t have any transvenous leads,” Shen said. “Instead of the generator sitting under the collarbone, it sits on the left lateral chest wall. From there, the defi brillator lead trav-els underneath the skin across the chest and goes up along the left of the sternum.” She added, “The benefi t of this system is it’s outside the chest wall so there are no com-ponents inside the vascular system or inside the heart.”
Shen, an assistant professor of Medi-cine at Vanderbilt, said the different routing for the leads avoids the acute complications that can come with transvenous placement, including myocardial perforation, pericar-dial tamponade, venous thrombosis and pneumothorax. “When these leads have been in the vascular system and the heart for a long time, there is the potential for occlusion of those veins, risk of infection in the veins, and potentially infection in the heart,” she noted.
Another consideration is lead failure. In younger patients, individuals can easily outlive the longevity of the leads. When that happens, the intravascular leads can be diffi cult to extract and replace since fi brosis tends to occur over time.
Shen, who came to Vanderbilt from Northwestern University, worked with the Cameron Health subcutaneous device (now part of Boston Scientifi c) during the clinical trial phase in 2010 and 2011. The device, which has been routinely used in Europe for several years, received FDA approval for use in the United States in late September 2012. Currently, Shen said, Vanderbilt is the only site in Tennessee offering this technology.
She noted, “It is FDA approved for anyone who is a candidate for a defi brillator including primary and secondary preven-tion indications.” However, she continued, “A transvenous defi brillator also has pacing capabilities. This device does not … its sole function is to shock patients out of danger-ous arrhythmias.” She added, “If you need chronic resynchronization therapy, this would not be the device for you.”
It might, however, be just the device for several patient populations. “There is a group of patients that just don’t have the
Sumner Regional Receives Chest Pain Center Accreditation with PCI
Sumner Regional Medical Center (SRMC) in Gallatin recently announced the facility has received full accreditation with percutaneous coronary intervention from the Society of Cardiovascular Patient Care.
“When a patient is having a heart attack, the longer the time to treatment, the lower the chances of survival,” said Ray Pinkston, MD, medical director of the SRMC Emergency Department and for Sumner County Emergency Medical Services. Noting that the hospital staff and Sumner County EMS have worked diligently over the last few years to set up the best system possible for cardiac care at SRMC, he said the recent accreditation was validation that the team has been successful. “We can now treat patients as fast as … and as well as … the best hospitals in the country, right here in Sumner County.”
Dr.. Sharon Shen
venous access to allow the standard ICD,” Shen noted.
Others who could benefi t from S-ICD, she added, are those who have already ex-perienced lead failure or infection with tra-ditional ICD, younger patients with primary electrical problems who could potentially face lead issues over the long haul, and those with congenital heart abnormalities that preclude implantation of a standard transvenous defi brillator. Patients with renal failure, Shen noted, are another candidate group. With the ongoing potential for introducing bacteria into the blood-stream during dialysis, the S-ICD might help miti-gate infection risk since the subcutaneous leads leave the heart and vasculature untouched.
Instead of counting beats, the S-ICD uses a sensing algorithm to analyze the heart rhythm and deliver defi brillation when ventricular tachyarrhythmias are detected. Shen said S-ICD reads the heart more like an EKG would. In some small
studies, there is evidence that because the S-ICD “sees” the rhythm rather than just counting how
fast the beat is, it might actually help
patients avoid unnec-essary shocks by effectively
discriminating AF and SVT from the more dangerous VT/VF. However, Shen said more research with a larger study population would be required to fully establish that advantage.
Like traditional ICD, the subcu-taneous system is programmable as a single or dual zone device to tailor therapy to the patient’s needs. Unlike the transvenous method, the S-ICD
can be implanted using only anatomical landmarks, which eliminates the need for fl uoroscopy during implant thus reducing radiation exposure for both patients and physicians.
Although the subcutaneous procedure is less invasive than the traditional method, the generator used with S-ICD is actually a little larger. Yet, many patients still pre-fer it from a cosmetic standpoint because the pulse generator is implanted on the side of the chest near the armpit, making it easier to hide in clothing. Shen said the traditional ICD generator, located near the collarbone, is more noticeable when wear-ing an open-neck shirt or dress.
“The studies so far show it (S-ICD) has equal effi cacy in shocking people out of dangerous rhythms,” Shen said. How-ever, she added, this is still a new device and therefore doesn’t have the same dura-tion of follow-up as traditional implanta-tion, which has been used since the 1980s.
“I don’t see this as a replacement for the transvenous ICD,” Shen continued, “but I see it as an addition to what we can offer our medically complex patients … I see it as a tool to customize care for our patients.”
n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 3
By: MELANIE KILGORE-HILL
There’s no question that heart surgery is an art form, but Vander-bilt’s David Bichell, MD, has taken that to a new level. The chief of Pediatric Cardiac Sur-gery for Monroe Carell Jr. Children’s Hospital at Vanderbilt is an ac-complished surgeon, professor and medical illustrator, and he uses all those gifts to educate and inspire patients and staff.
Art & Medicine CollideBichell graduated from Columbia
University’s College of Physicians and Surgeons in 1987. As a post-graduate, he worked his way up to chief resident in cardiac surgery in pediatrics through Har-vard Medical School at Boston’s Brigham and Women’s Hospital and at Harvard’s Children’s Hospital. But the road to medi-cine was a winding one for the Maryland native. As a fine art major at Johns Hop-kins University, Bichell stumbled across the school’s medical illustration class and soon became the program’s only under-grad.
“The program included an overlap of curriculum with medical students, and I thought, ‘what a funky and odd and eso-teric thing to be doing,’” Bichell recalled.
His medical path narrowed further when asked to illustrate pediatric heart transplantation for a textbook publisher. “I watched this surgery that few people get to see, and I thought, ‘Well this is the cool-est thing,’” Bichell said. “You’re doing a highly technical, demanding and ex-hilarating operation that few can do and turning this child into a possible Olympic athlete. What can possibly be better than that?”
The Road to NashvilleBichell trained and remained on staff
at Boston Children’s Hospital, where he immersed himself in the elite field of pedi-atric congenital heart surgery. That path led to appointments in cities including San Diego, Chicago and Boston before land-ing in Nashville in 2006.
“Vanderbilt seemed like an extraordi-narily collaborative and civilized gem of a place, with the entire spectrum from basic science to clinicians working collabora-tively in a scientific enterprise that’s top in the country for NIH funding,” Bichell said. “There had always been a strong cardiology program thanks to (division chief) Scott Baldwin, MD, and (former chief of cardiology) Tom Graham, MD, and I attribute much of the strength of
cardiology here to what they’ve built.”
Fast-forward eight years, and Vanderbilt’s pediatric heart program boasts some of the best outcomes in the coun-try. Arterial switches, hypoplastic left heart operations and heart transplants are among the more common pro-cedures accounting for some 500-plus opera-tions each year.
Beating the Odds
Bichell said patients with hypoplas-tic left heart syndrome typically have a 75 percent survival rate, with 85 percent survival considered rare. In 2013, Monroe Carell Children’s Hospital saw a 100 per-cent survival rate among these patients.
“After 25 years, we’ve honed things
down to the finest they can be with a team of specialists who live and breath pediatric heart surgery,” Bichell explained. “That’s what you have to have to get those kinds of outcomes. This also speaks to the team-work here. There’s not one individual who accounts for the success of that. It truly is a coordination of services, from intensivists to anesthesia.”
Advances in Heart Transplantation
While the hospital averages 10 pedi-atric heart transplants each year, Bichell said advances in medication and tech-nology, such as ventricular assist devices, mean more patients are living longer, more productive lives without surgery.
“We’ve seen so much success in ‘des-tination therapy’ that it may be the future of heart replacement,” Bichell said. Still, the majority of technology is developed on the adult side, and Bichell noted the innovation required to adapt those tools to the pediatric realm is much more com-
plicated. More than half of the program’s surgery patients are under a year old, and a quarter are younger than one month.
“In the past, the success of transplant was hinged on cardiology … and it still is … but an awful lot of advances are on the surgical and technical sides, which is where change is taking place,” Bichell said. “It’s become a big segment of what we do.”
Bichell and his research team also participate in multi-center clinical trials, and the surgeon has created a heart tis-sue bank to help researchers better under-stand the genetics behind pediatric heart disease and abnormalities.
Healing through ArtThrough it all, the father of five con-
tinues to draw. While his images have been published in countless journals and textbooks, Bichell’s most enthusiastic fans are his patients.
“I’ve really gained appreciation for the adage that a picture is worth a thou-sand words,” said Bichell, who carefully sketches each patient’s heart condition while explaining the diagnosis for patients and families. “Unless someone’s in the medical field, it’s hard not to lose them within a few minutes. If you can make a drawing as you’re talking, it’s amazing how they get it and appreciate it.”
Families have asked Bichell to sign his drawings, commissioned him for projects and have even turned his drawings into tattoos to commemorate their child’s sur-gery.
“There’s a great appreciation for it among colleagues and patients … and more importantly, it lets me convey in-formation in a way few people can,” con-cluded Bichell.
David Bichell, MD: The Art of the HeartPhysicianSpotlight
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While guidelines are meant to clarify best practices and offer a clear clinical path, sometimes changes wind up being more confusing … leading to debate over what truly is best for patients. The latter seems to be the case with four guidelines released by the American Heart Association (AHA) and American College of Cardiology (ACC) last November.
A great deal of discussion has already arisen over new cholesterol treatment guidelines, which signifi cantly change the threshold for starting a statin regimen. In answer to publicity focusing on the number of Americans who might now qualify for a statin prescription, AHA President Mariell Jessup, MD, said, “The goal is not to get more people on statins. The goal is to help Americans reduce their risk of cardiovascu-lar diseases and stroke. The goal is to help people live longer.”
No matter what the goal, local cardi-ologist David Huneycutt, Jr., MD, FACC, said the reality is that the new guidelines greatly expand the number of people now recommended for statin therapy. Huney-cutt, a general cardiologist for Centennial Heart with a focus on prevention of cardio-vascular disease, said the guidelines specify four groups for statin therapy:
• Everyone with a history of cardiovascular events.
• People 21 and older who have a very high level of bad cho-lesterol (190 mg/dL or higher)
• People ages 40-75 with Type 1 or Type 2 diabetes.
• People 40-75 years old without car-diovascular disease who have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years as determined by a downloadable risk calculator (located in the professional section of the AHA website as part of the 2013 prevention guideline tools).
“I think the biggest area of controversy is over the new risk calculator,” Huneycutt said. “This risk calculator is very different than the previous one.” He explained that physicians previously used the Framing-ham Risk Calculator, which had a higher threshold and harder endpoints for deter-mining when to put a patient on statins. Huneycutt added age and gender carry great weight in the new calculator.
“It’s really pretty easy to have a 10-year risk of more than 7.5 percent,” he said. “A man can be 65 years old with no
other risk factors and still meet the thresh-old.” Huneycutt added, “If a physician is relying on the risk calculator alone to de-termine a patient’s need for a statin, then yes, we are going to see more patients on them.”
He noted the new guidelines are a mixed bag with some steps that he thinks are positives for patients. Previously, Huneycutt noted, a patient with established coronary disease with an LDL of 85, which is 15 points over the target of 70, would have gone on a high-dose statin regimen or additional drug therapy. “More side effects occur in higher doses of statins or in combination with other medicines,” he pointed out. “While the new guidelines might increase the number of overall people who are candidates for statins, it might reduce some of the very high doses of statins and the addition of non-statin medications because you’re not treating to a numeric target.”
Huneycutt’s frustration with the new guidelines is in the quickness to jump to a pill when other options are available. “Overall, I think we’re off track,” he said. “I think we use medications way too soon.”
He continued, “I don’t think we should be having conversations around medications. I think we should be having conversations around risk modifi cation. In the entire guideline, which is 85 pages, it has basically one paragraph about lifestyle modifi cation.
“It is a failing of these guidelines and the medical community. I think 90 per-cent of the conversation should revolve around nutritional counseling and lifestyle modifi cation and 10 percent around drug therapy. Unfortunately, right now with the state of healthcare, it’s exactly opposite.”
In counseling patients, Huneycutt said he encourages a healthy diet. “For me, that means a plant-based diet that includes veg-
etables, fruits, whole grains and beans and is devoid of animal products, highly pro-cessed foods and oils.”
He recognizes this is a more aggres-sive diet than is recommended by the AHA. However, Huneycutt added, “In my clinical practice, many patients are able to reduce their risk factor profi le without re-quiring drug therapy.”
He said the nutrition recommendation is in combination with physical activity and is typically the fi rst step he takes as part of primary prevention. Huneycutt was quick to add that he absolutely uses drug therapy when warranted but noted statins, like all medications, do have side effects … some signifi cant.
And, he continued, medication and lifestyle modifi cation certainly aren’t mu-tually exclusive. “Many patients with es-tablished heart disease benefi t from both. I like to try lifestyle modifi cation fi rst, when possible, making that the cornerstone of treatment,” he concluded.
Cholesterol ConversationsNew Guidelines Open the Door for Dialogue with Patients
Dr. David Huneycutt, Jr.
For More on Nonpharmacologic Interventions
David Huneycutt, Jr., MD, a general cardiologist with Centennial Heart, fashions his practice around primary and secondary prevention of cardiovascular disease. Lifestyle modifi cation plays a key role in his toolkit. He suggested a couple of resources for physicians or patients interested in learning more about the nutritional changes that can play a major role in keeping hearts healthy.
“Forks Over Knives”: a 2011 documentary, directed by Lee Fulkerson, available on Netfl ix and YouTube.
“Eat to Live: The Amazing Nutrient-Rich Program”: book by Joel Fuhrman, MD.
New Space for VHVIOn Feb. 3, Vanderbilt Heart and Vascular Institute moved all of its key procedure
areas to a new home in the Critical Care tower, which originally opened in 2010. VHVI has just completed building out the fi fth fl oor of the 11-story tower to meet the needs of providers and patients better.
The fi fth fl oor, which connects to Vander-bilt University Hospital and offers direct access to the cardiovascular intensive care unit, central-izes services and includes the electrophysiology lab, cardiac catheterization lab and cardiac ob-servation unit. The new area also allowed for two additional procedure rooms, taking the total to nine, and features two hybrid OR suites, which could be converted into full operating rooms if needed. The space also makes the most of tech-nology, including teleconferencing capabilities and a hemodynamic monitoring system with direct visualization of right ventricular func-tion following surgery. Additionally, there is dedicated research space included on the fl oor.
Patients and families will have larger, more private waiting areas and holding rooms. For the most acute patients, four bays open to the nurses’ station for direct observation.
“Consolidating our procedure rooms, holding and waiting areas, and staff work space on one fl oor will result in improved care for our patients and greater effi ciency for the staff caring for them,” said Keith Churchwell, MD, executive director and chief medical offi cer of Vanderbilt Heart.
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When noted cardiac surgeon Simon Maltais, MD, PhD, FRCSC arrived in Nashville in July 2011 to lead the Heart Transplantation and Ventricular Assist Device (VAD) programs for Vanderbilt Heart & Vascular In-stitute (VHVI), he was given a mandate … to grow Vanderbilt into one of the top-ranked programs in the nation.
Since then, the team has garnered na-tional accolades, but it doesn’t mean they see their work as ‘mission accomplished.’ Instead, Maltais and col-leagues are focused on continued program growth, research expansion, and setting new benchmarks in outcomes and patient satisfaction.
Some of Vanderbilt’s growth in transplantation was a natural byproduct of the Saint Thomas Health decision to discontinue the city’s oldest heart trans-plant program in January 2012 in order to concentrate on a new VAD Center with a focus on destination therapy. But that doesn’t tell the whole story.
Although Saint Thomas was respon-sible for approximately 350 heart trans-plants since performing the state’s first one in 1985, volumes had been on the decline in recent years with only eight such sur-geries in 2010 and 10 heart transplants in 2011, according to the Organ Procure-ment and Transplantation Network. By then, Vanderbilt’s numbers were already climbing. In 2013, Vanderbilt hit new heights in terms of volume.
“This last year, we had our busiest year ever with over 40 heart transplants,” said Maltais. “That’s putting us in the top 10 programs in the country for heart trans-plantation.”
Although volume is an important marker, it’s the survival rates that have really set Vanderbilt’s program apart. “There are only two programs in the U.S. with 100 percent survival rate at one year … Vanderbilt and the Cleveland Clinic,” said Maltais, a native of Canada who came to VHVI by way of the Mayo Clinic.
Like Saint Thomas, Vanderbilt also has a dedicated VAD center, which has taken an active role in device trials over the past decade. The VHVI program became certified for destination therapy in 2012. Previously, Vanderbilt implanted VADs as a bridge therapy to heart transplantation.
The volume of LVAD implants, however, has really soared since Maltais arrived. From 2009-2011, Vanderbilt per-formed 12 LVAD implants (with nine com-ing in 2011). By 2012, that number had increased to 33. Last year, Vanderbilt’s LVAD program hit a major milestone. On July 30, 2013, patient William Whit-well became the 100th patient to receive a
VAD implant at Vanderbilt. Maltais noted the growth in the VAD program has put Vanderbilt among the top five in the nation with more than 80 long-term implants in 2013.
Last year also saw the introduction of the new HeartWare ven-tricular assistance system (VAS) for bridge im-plants. VHVI became the first program in Tennessee to implant the minia-turized circulatory support device in January 2013, follow-ing HeartWare’s FDA approval the previ-ous November. By year’s end, Vanderbilt ranked first in the nation for the number of HeartWare device systems implanted in patients with end-stage heart failure bridged to transplantation.
“It can be used in a larger popula-tion because it can be implanted with dif-ferent strategies or with different implant configurations,” explained Maltais, noting HeartWare also provides the team with more options for patients with congenital heart disease. The pump, he continued, doesn’t need a pocket. “It’s completely within the pericardium. We have much more versatility for patients with small habitus,” he added.
As for the outflow portion of the de-vice, Maltais said it is much easier to im-plant at different arterial sites. “With our new minimally invasive … sometimes off-pump … HeartWare implant approaches, we avoid a full sternotomy. We don’t have to split the breastbone open,” he contin-ued.
According to Maltais, the small size and minimally invasive surgical require-ments make HeartWare easier to implant and decrease the risk of perioperative bleeding and infection. At present, Heart-Ware is only approved for bridge therapy. However, Maltais said it is highly effective, allowing patients to remain on the support system for as long as needed. In fact, he anticipates a change in the HeartWare ap-proval status pending completion of cur-rent trial evaluation. “Hopefully a year from now, the indication will expand to destination therapy.”
Although Vanderbilt employs several devices in the acute setting, Maltais said the team depends on the HeartMate II and HeartWare devices for long-term implan-tation to achieve haemodynamic stabiliza-tion. “The technology is better. The risk of complication has gone down dramatically with those two devices,” he noted.
With the increases in transplant and VAD volumes has come significant growth in staff. Maltais said three years ago, the VAD program had one coordinator. “We
have a very large team now in our LVAD Center. We have four VAD coordinators plus dedicated ancil-
lary staff,” he noted, adding the integrated clini-
cal team includes p h a r m a c i s t s , nutritionists and social workers in
addition to physi-cians and nurses.
“With Dr. Mary E. Keebler as the medi-
cal director of our LVAD program, we have four advanced
heart failure cardiologists and just hired two (more). By July 2014, we’ll be at six cardiologists that are focused on LVAD and transplant,” he said. In addition, the team has just hired another surgeon who will join Maltais at the beginning of April.
The increased manpower and re-sources undoubtedly will be put to good use as more than five million Americans suffer from heart failure with nearly 5 per-cent of them facing end-stage disease.
Vanderbilt Grows, Expands LVAD & Heart Transplant Program
Dr. Simon Maltais
By the end of 2013, Vanderbilt led the nation in HeartWare implantations as a bridge therapy.
Middle Tennessee Schools Participate in American Heart Month
It’s never too early to start learn-ing about … and taking care of … your heart. That’s a message being spread throughout Middle Tennes-see during February, American Heart Month.
To promote student health, more than 250 Middle Tennessee schools are teaching heart health and the importance of physical activity, partici-pating in the American Heart Asso-ciation’s “Jump Rope for Heart” and “Hoops for Heart” events, and raising awareness and funds for AHA research and educa-tion programs. High school students will participate in RED OUT, raising awareness of the AHA mission by sell-ing T-shirts and then wearing them at sporting events.
Participating schools include 54 in Davidson County, 29 in Rutherford County, 28 in Sumner County, 14 in Wilson County and 11 in Williamson County.
6 > FEBRUARY 2014 n a s h v i l l e m e d i c a l n e w s . c o m
Bonus EditorialEven after you’ve read the entire February issue of Nashville Medical News, there’s still more news to uncover. Go online to nashvillemedicalnews.com for online exclusives including:
• Vanderbilt Expansion Plans
• Preparing for ICD-10 Conversion
• Detecting Lung Cancer Earlier
• Physicians Selling Practices
By CINDy SANDERS
What if gathering critical heart health information from around the world was as simple as entering a few keystrokes on a laptop or smartphone? Turns out there is an app for that … actually several apps … and researchers with the Health eHeart Study hope to turn those rich data sources into powerful tools to predict, prevent and treat heart disease and stroke.
“In my 30-year career as a researcher and physician, I’ve never seen a study as in-novative as the Health eHeart Study,” said Elliott Antman, MD, president-elect of the American Heart Associa-tion (AHA) and co-chair of the study’s Scientifi c Advisory Board. “This is a seamless way to partici-pate in a research study while going about your daily activities.”
Launched last year, the AHA has joined forces with the University of California, San Francisco (UCSF) to support this long-term, large-scale health research project. The transformative study is led by three USCF faculty members — Jeffrey Olgin, MD, professor of Medicine and chief of the Division of Cardiology; Greg Marcus, MD,
MAS, director of Clinical Research for the Division of Cardiology; and Mark Pletcher, MD, MPH, a cardiovascular epidemiolo-gist and the director of Research Consulta-tion for UCSF’s Clinical and Translational Research Institute.
The goal is to enroll one million adults from around the globe, and the only inclu-sion criteria are that participants be over 18
and have access to the Internet. Researchers are seeking individuals across the spectrum … from the very healthy to those diagnosed with cardiovascular disease or other chronic conditions. Rather than having to make an appointment to see a physician to submit or update health and activity information for the study, participants can log info on the go and at their convenience via computer or mobile device. Antman and colleagues are hopeful that the ease of participation will translate into more robust data collection.
Initially, participants are asked to an-swer a series of demographic questions, in-cluding information on lifestyle habits and personal and family medical history, to es-tablish a baseline. Then every six months, they are asked to answer additional ques-tions about activities and health events. Additionally, participants have the oppor-tunity to share information gathered from smartphone apps and wireless devices (such as blood sugar monitors, at-home blood pressure equipment, and digital scales) with the study’s protected data system. A number of apps are free, and sites includ-ing iHealth (ihealthlabs.com) and With-ings (withings.com) have electronic health tracking devices that sync with the Health eHeart Study data collection.
“Getting a blood pressure reading or an ECG in your doctor’s offi ce is just a snapshot of the given moment, but now we’ll be able to see big data streamed al-most in real time as people are going about their daily activities,” noted Antman. “This presents a total paradigm shift in how we learn about human health.”
Antman, a professor of Medicine at Brigham & Women’s Hospital and as-sociate dean for Clinical/Translational Research at Harvard Medical School, is clearly excited about the possibilities af-forded by such a large collection of data among global populations. “This research initiative makes use of cutting-edge digital technology to perform not only a state-of-the-art observational study but also to provide the platform to facilitate random-ization. This is really an electronic, decen-tralized cohort,” he said.
“The goal,” he continued, “is to use
the big data to predict who is going to develop heart or stroke problems.” How-ever, Antman noted, the immediacy of the media also opens up possibilities to test the effi cacy of various treatments and behav-ioral modifi cations.
“This is nimble and has the potential to change the way we study health behav-iors and test interventions to modify those behaviors,” he explained.
For example, Antman noted a sub-group of participants who identifi ed them-selves as regular smokers on the baseline questionnaire could be pulled from the larger study. From that subset, one group could be randomized to receive a weekly email from a health coach reminding them not to smoke, while another group might receive a link to a website with information on how to make behavioral changes. Sub-sequent follow-up could show one method to be more effective than the other. That, noted Antman, is where the nimbleness of the technology comes into play by allow-ing researchers to quickly switch all partici-pants to the more effective intervention.
Antman said physicians and other pro-viders could be major allies in helping get pa-tients signed up for the study. He encouraged physicians to go online to learn more about the project and to share the website informa-tion with their adult patients. Antman added the AHA has brochures available for distri-bution at clinic and offi ce sites, as well.
Again, he stressed, the goal is to include everyone across the health spectrum from young, active adults to those with multiple comorbid conditions. Antman also noted that while this is a long-term commitment, participation is extremely easy. “This is a study that doesn’t impose on a person’s time the way other research studies do,” he said.
Signing up is simple, too. Just go to health-eheartstudy.org to learn more about the project and join the thousands already enrolled.
Health eHeartAmbitious Research Project Launched to Advance Heart & Stroke Science
Dr. Elliott Antman
Join the Movement to Stop Heart Disease & Stroke www.health-eheartstudy.org
The Health eHeart Study makes it easy to log important data without disrupting the day.
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Vanderbilt Leaders Dr. Andre Chruchwell, Senior Associate Dean of Diversity, Vanderbilt School of Medicine Traci Nordberg, Chief of Human Resources Panel Moderator: Vicki Yates, News Channel 5
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n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 7
Meredith Douglas Debbie Elliott
Shatita Daniels Kelly MillerJeremy Conner Jenny Harvey
Jayme, a Certified Public Accountant, has diversified experience with a variety of issues in the area of tax compliance and tax consulting. She currently performs tax compliance and consulting services for Corporate, Partnership, Individual, and Fiduciary clients. Jayme is a member of the firm’s healthcare tax practice and Leadership Health Care. A native of Murfreesboro, her hobbies are golfing, reading, going to concerts, playing with her one year old son, her puppy and spending time with her family.
By CINDy SANDERS
Time is muscle.When someone experiences a
major cardiac event, every second counts. Getting data into the right hands in a timely manner can liter-ally be the difference between life and death.
Even before the new TriStar Cen-tennial Heart and Vascular Center opened in February 2012, the leader-ship was already focused on finding sophisticated technologies to enhance care delivery, save valuable time and minimize heart damage. COO Jim Drumwright said AirStrip Cardiology is one of the solutions Centennial added to its armamentarium.
“We were early adopters of the tech-nology,” Drumwright said. “We saw an op-portunity to improve the care we provide our patients and make our cardiologists more efficient.”
A mobile health application, AirStrip Cardiology allows physi-cians to remotely moni-tor a patient’s heartbeat by viewing a live elec-trocardiogram (ECG) with diagnostic imaging clarity. Previ-
ously, paramedics would obtain a 12-lead ECG for patients with symptoms of acute myocardial infarction and then send the information to the hospital Emergency De-partment via fax or PDF. However, quality was often degraded in transmission. If the images then had to be faxed from the ED to a cardiologist for review, visual clarity suf-fered even more.
Explaining the benefits of the technol-ogy, Todd Dorfman, MD, an interventional cardiologist with Centennial Heart, said, “When a patient has a heart attack, the goal is to restore blood supply to the heart within 90 minutes. The TriStar hospitals are the only hospitals in the state that have AirStrip technology. It reduces door-to-balloon time by probably 10, maybe 15, minutes.”
Dorfman noted that being able to see the ECG data in real time allows him
to activate the cath lab whether he’s in his office or at home. The sooner that blood supply is re-stored, he said, the less damage there is to the heart and the less likely the patient is to face recurrent heart failure.
L o o k i n g at year-end 2013 data, Drumwright said, “In December, our 12-month average for door-to-balloon was under 50 minutes, which is well below the national standard. It’s technology like this that allows us to bring better care quicker to the patient.”
With AirStrip, emergency responders with the capability of transmitting 12-lead ECGs can get detailed images to provid-ers from the field. Similarly, an ED physi-cian can quickly consult with a cardiologist whether the specialist is onsite or not.
“AirStrip allows us to digitize that image and get it into the hands of the car-diologist on his iPhone or iPad. It’s a diag-nostic quality image no matter where he or she is,” Drumwright said. “It’s like having
a cardiologist in the ED or the ambulance with the patient when they’re not really there,” he continued. “We’re able to start that treatment sooner.”
It also can help ensure treatment oc-curs in the correct setting. Drumwright noted a patient presenting at the ED with an acute AFib episode would typically be admitted by an emergency medicine phy-sician and a consult with an electrophysi-ologist scheduled for the next day. AirStrip allows the EP to see what is happening with the patient and assess the severity to avoid unnecessary admissions.
While emergency care is one major use for the technology, Drumwright said it has a number of other applications, as well. “We use it frequently for consults,” he noted. AirStrip is used to alert physicians of changes among cardiac inpatients. Since the app stores the tracings, a physician is able to compare images and alter treatment plans if warranted.
Already used extensively, Drumwright said Centennial Medical Center plans to grow with the technology. Future applica-tions, such as remote hemodynamic moni-toring, will be adopted as the company rolls out new iterations. In addition to Centen-nial, TriStar Skyline and TriStar Summit also use AirStrip Cardiology.
When Minutes MatterAirStrip Technology Provides Critical Data in a Heartbeat
Dr. Todd Dorfman
8 > FEBRUARY 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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Now, this is just what the doctor ordered.
The two specialists explained mitral regurgitation (MR), the most common type of heart valve insufficiency in the United States, occurs when blood flows backwards into the heart or lungs because the leaflets in the mitral valve don’t seal tightly when closed. Symptomatic patients often experience fatigue, shortness of breath, a dry cough (especially when lying down), poor exercise tolerance, lighthead-edness, heart palpitations and swelling in the legs. There are two forms of MR:
Degenerative (or primary), which is a mechanical problem with the valve itself, and
Functional (or secondary), which typically results from a problem with the heart that hinders the otherwise normal mitral valve from operating properly. An example of functional MR might be an enlarged heart that keeps the mitral leaf-lets from meeting all the way.
Rodriguez said MitraClip, a product of Abbott Vascular, received FDA approval in late October 2013 for pa-tients with degenerative MR at prohibitive risk for mitral valve surgery. The COAPT trial is studying the efficacy of the device to impact the progression of heart failure in high-risk patients with functional MR. “Saint Thomas is the only site in Tennessee that has the technol-ogy at this point,” Rodriguez said. “With the
trial, we are enrolling patients right now.”
After patients matching inclusion criteria are selected and appropriately screened, they are randomized to receive either the MitraClip or maxi-mal medical management. Currently, medication therapy treats symptoms but does not halt disease progression.
In those receiving the clip, Stankewicz explained, “A small tube is inserted near the groin and goes up through the cir-culation to the heart, crossing the interatrial septum.” The placement device, he continued, is inserted through the tube, through the heart, and directed down towards the mitral valve. With the heart still beating, the moving leaflets have to be captured and aligned. “Once we’re able to grab both leaflets and ensure we’re in the correct spot, then the clip is deployed and catches.” Stankewicz added, the placement device is then removed from the catheter and the small incision above the femoral vein is closed.
Although the ideal in younger or healthier patients would be to open the chest and repair or replace the valve, which has been proven to offer a
durable result over the years, a significant number of patients are deemed too un-stable to survive the operation or to do so with a reasonable quality of life. “Anytime you open the heart, you have to go on the bypass machine,” Rodriguez pointed out.
“It’s a big stress to go on bypass,” Stankewicz agreed, adding the risk of stroke and clot is higher with traditional surgery than with MitraClip.
The first patient to receive the Mi-traClip has done extremely well to date. “As soon as she woke up, she said she felt better,” noted Stankewicz. “The evening of the procedure, she was sitting up in her chair. The next day, she was walk-ing around and basically wanting to go home.” The patient went from extreme fatigue to cooking a large Thanksgiving
dinner for her family just a few days after leaving the hospital.
Although still an investi-gational procedure, outcomes data does exist from an earlier U.S. trial, EVEREST, which was conducted in association with degenerative MR prior to FDA approval. “All the patients had severe mitral regurgitation. After their first clip, 64 percent of them had less than 2+ mitral regurgitation,” said Stankewicz. He added that number rises to 84 percent when including pa-tients who ultimately had ad-ditional clips or procedures. At
2+ MR, patients are considered to have mild regurgitation and are most likely as-ymptomatic. “It was durable at 36 months and significantly improved quality of life,” he added of the three-year follow-up.
Rodriguez pointed out that patients who receive the MitraClip are not pre-cluded from having open-heart surgery at a later date if their risk profile improves and the need still exists. He noted the MitraClip procedure is a complement to Saint Thomas Heart’s transcatheter aortic valve replacement (TAVR) program for patients with severe aortic stenosis. Mitra-Clip is the only valve repair alternative for many of these patients.
Stankewicz concluded. “To be able to offer a new technology to patients who had no options before is very exciting.”
Saint Thomas Heart Debuts MitraClip, continued from page 1
Dr. Evelio Rodriguez
Dr. Mark Stankewicz
Dr. Stankewicz (L) and Dr. Rogriguez (R) led the team effort to implant the first MitraClip as part of the COAPT trial.
n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 9
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By CINDy SANDERS
With changes in reimbursement and new collaborative models on the horizon, medical practices and hospital facilities that have long operated independently have begun dipping their toes into the M&A waters.
Large systems and corporate opera-tors who have deep experience in ventures that merge, join or purchase facilities out-right are well aware of the intricacies in-volved in crafting such deals and employ a team of seasoned lawyers, accountants and consultants to ensure regulatory man-dates don’t sink the transaction. For the newer, smaller players who arrive at the M&A shores expecting smooth sailing, the legal and regulatory undertow can quickly make them feel like they’ve gotten in over their heads.
ACA ImpactJay Hardcastle, partner with Brad-
ley Arant Boult Cummings and chair of the firm’s Healthcare Practice Group, said the Affordable Care Act impacted the M&A landscape in two very signfi cant ways. In the pre-ACA world, he said hospitals expected their rate of reimbursement would rise each year as part of the market basket update. Second, many hospitals relied heavily on the Med-icaid Disproportionate Share Hospital (DSH) payments that helped offset costs from uncompensated care.
The idea behind Obamacare, Hard-castle said, was to balance DSH and market basket reductions with increases in Medicaid and private coverage. Of
course, he continued, the Supreme Court desicion that each state has the right to decide whether or not to expand its Med-icaid program has left many hospitals in states like Tennessee in fi nancial pergatory with reduced federal payments and no in-crease in Medicaid rolls.
“You’re running into some very cash-strapped hospitals who are looking for partners to help them weather the storm,” he said.
Hardcastle noted that although these facilities don’t seem like very attactive tar-gets in the short term, there are investors
and partners who believe they can acquire facilities at a bargain price today with an eye toward long-term returns as effi ciency improves and reimbursements are revis-ited in the future.
On the practice side, he noted physi-cians were selling to hospitals long before ACA. However, healthcare reform has probably magnifi ed some of the trigger points that prompt physicians to sell their practice. Hardcastle said three reasons often given are that physicians believe 1) a hospital system has more clout and can negotiate better payer rates; 2) hospitals
are generally willing to pay a base salary, perhaps with productivity incentives, that exceed what the physician could do on his or her own; and 3) the physicians are sim-ply tired of the administrative hassel to run a practice. “Rightly or wrongly, physicians belive if they are with a ‘cash rich’ hospital system, they can feel safer ... have more security,” he said.
Easier Said Than Done“I think people underestimate the op-
erational diffi culties of these sorts of en-
M&A Legal Nuances
(CONTINUED ON PAGE 10)
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market forces including an increase in physicians seeking an employment model, implementation of EHR and changing payment methodologies.
“The overarching uncertainty about how the world is going to play out over the next four or five years has led to the leveraging of strengths,” said Morgan. He added the leaders of individual hospitals or small systems are faced with deciding to weather the changes on their own or join forces to be part of a bigger group that has the infrastructure in place to manage and deal with the new healthcare delivery land-scape.
From mergers to acquisitions to strate-gic joint ventures, there was a lot of move-ment on the not-for-profit side, which makes up about 80 percent of hospitals in America. Dallas-based Baylor Health Care System and Temple, Texas-based Scott & White Healthcare completed their merger in late September to create the largest not-for-profit health system in Texas. Earlier in the year, Michigan-based Trinity Health merged with Pennsylvania-based Catholic East in one of the largest nonprofit merg-ers of 2013.
And some interesting partnerships occurred between not-for-profit hospitals
and systems and publicly traded operators. LifePoint Hospitals and Duke continued to acquire hospitals for their joint ven-ture. One of the largest mergers occurred between a nonprofit hospital system and a major insurer when the Pennsylvania Insurance Department approved the af-filiation between Highmark (a BlueCross BlueShield subsidiary) and West Penn Allegheny Health System, both based in Pittsburgh. After closing that deal in April, Highmark went on to add two more Penn-sylvania-based hospital systems to its inte-grated delivery system, Allegheny Health Network.
While a lot happened on the non-profit side, Morgan noted there were also major acquisitions within the publicly traded hospital space. “On the for-profit side, there were two notable deals com-pleted or announced in 2013 — Tenet Healthcare & Vanguard Health Systems and Community Health Systems & Health Management Associates.”
In the first deal, Nashville-based Vanguard was the target of Dallas-based Tenet. The latter completed its acquisition of Vanguard at the beginning of October in a deal valued at approximately $4.3 billion ($1.8 billion purchase price plus
assumption of $2.5 billion of Vanguard debt).
The second deal, Morgan said, was announced last year and is anticipated to close in the first quarter of 2014. In this case, Community Health Systems, head-quarered in nearby Franklin, seeks to ac-quire HMA, which is based out of Naples, Fla. Just before Thanksgiving, CHS and HMA announced the companies’ pro-posed merger had been declared effective by the Securities and Exchange Commis-sion (SEC), clearing the way for a vote by HMA stockholders, who approved the deal last month with 98.7 percent of votes in favor of the merger. With a purchase price close to $4 billion plus assumption of debt, the overall value of the merger is anticipated to be in excess of $7.5 billion, making it the largest deal since the HCA buyout in 2006. Once the merger is ex-ecuted, CHS will own and/or operate 206 facilities with more than 30,000 licensed beds.
“From and M&A perspective, I would expect to see a continued robust level of activity,” Morgan said of 2014. However, given the limited number of publicly traded companies and the amount of activity that has already occurred in that space, he said
M&A Trends in the Reform Era, continued from page 1
deavors,” Hardcastle said. He added there are cultural hurdles
to address, particularly when a non-profit is being acquired by or merging with a for-profit system. Religous and ethical directives also come into play when two
hospitals or a practice and a hospital stand on opposite sides of hot button issues such as abortion, birth control and end-of-life decisions.
“When you go through an acquisi-tion, there’s uncertainty about who is
going to be runing the hospital, and that often causes stress and friction,” Hard-castle said. “The bigger hospital tells the smaller hospital, ‘Look, you’re losing dol-lars so do it our way.’ A classic example of that is with staffing ratios,” he continued. “It’s just a lot harder than it sounds to cut your cost and not hurt quality.”
Hardcastle added, the leaders of small hospitals typically play a prominent role in the community so selling the hospital im-pacts more than just staff and patients ... it can have a much broader effect on the larger community, as well.
“Often the smaller hospital will ex-tract from the bigger hospital some sort of concession to infuse the community with a certain amount of capital,” Hardcastle noted. However, he added, there are dif-ferent ways to structure the sale and legal considerations to creating a foundation.
Closing the DealWhile some M&A deals might be
more complex than others, all have a level of difficulty that require outside expertise. However, Hardcastle said, it isn’t enough to simply bring in an attorney to represent your interests. Instead, he noted, “You have to bring in attorneys who buy hospi-tals as part of their practice. There are too many nuances.”
A good resource for physicians or hos-pitals looking for that type of expertise is the American Health Lawyers Association (healthlawyers.org). The American Bar As-sociation and most state bar affiliates also have sections on health law. In Middle Tennessee, where healthcare is a $70 bil-lion industry, there are numerous attorneys and firms that have the specialized knowl-edge necessary to close the deal.
M&A Legal Nuances, continued from page 9
The Antitrust Issue“Healthcare deals have become more of a focus for the Federal Trade Commission,”
stated Beth Vessel, a partner at Waller. She added the FTC has been forthright in saying their investigators are looking at mergers and acqui-sitions that might tend to lessen competition in a market.
Vessel, who works extensively in the healthcare sector and often advises clients on antitrust law related to due diligence, noted it isn’t enough to think about a deal only in terms of how it effects the main participants ... it’s equally critical to look at the larger implications of the transaction.
“You also want to look at your documentation creation policy,” she continued. “If you are talking about a transaction, you want to be very careful what you put in writing, even emails.” An off-the-cuff remark in an email along the lines of — ‘with this merger, we’ll really dominate the cardiac market’ — could be enough to have federal agents knocking on your door.
Vessell said the Hart-Scott-Rodino Act created a federal pre-merger notification pro-gram where buyers and sellers involved in large transactions must provide information about competition, their market share and plans. Currently, transactions valued at $70.9 million are subject to HSR filings. However, the valuation trigger point tpically changes early in the year so that figure is expected to shift this month.
Smaller transactions, she noted, also are subject to proving the rules were followed when it comes to antitrust allegations. “Just because you don’t have to file a report under Hart-Scott doesn’t mean you won’t have to provide documents in connection with an investigation,” she said. A complaint by another provider or a payer could be enough for the FTC to step in and examine the deal more closely.
Vessel also said those involved in a proposed transaction must remember not every deal closes. Being a little too free with information in the beginnning could cause prob-lems down the road.
“When you are doing due dilligence on the front end, you need to be careful not to provide competitively sensitive information on pricing,” she explained. “If you are com-petitors and if the transaction falls apart, it might be viewed as price fixing. You want to be careful not to to appear like there is price collusion.”
To avoid this issue, the two parties might consider bringing in ‘clean teams’ — out-side lawyers and accountants who can aggregate information so that each side has the information needed to make decisions without having specific price points.
“You’re supposed to act like competitors until the deal goes through, as much as you can,” Vessel concluded.
he expects much of the future activity to be in the not-for-profit world.
Behavioral health had a “decent” 2013, Morgan said. Franklin-based Aca-dia Healthcare enjoyed another healthy year of growth. The company began the year by completing previously announced deals acquiring Behavioral Centers of America and AmiCare Behavioral Cen-ters and then proceeded to acquire ad-ditional individual facilities in Georgia, Tennessee, Florida, and Puerto Rico dur-ing the remainder of the year. Morgan said he expected the company to continue to grow in 2014.
A behavioral health “marriage” an-nounced in late 2013 is expected to come to fruition in 2014. In November, the lead-ership of Centerstone, which has a major presence in Tennessee and Indiana, and the H Group, with facilities in Illinois and Kentucky, announced their intent to af-filiate. Although the H Group will operate under the Centerstone flag, David Guth, CEO of Centerstone of America, said the affiliation had no money or assets chang-ing hands and was instead a joint effort to “create a stronger and more effective behavioral health service organization.” Earlier in November, Hazelden and the Betty Ford Foundation also announced a mega-merger in the addiction space.
After a slow start, Morgan noted home health saw some movement by late 2013. “In home healthcare, we did see a little bit of pick up at the end of the year,” he said, noting Louisville, Ky.-based Almost Family acquired Nashville-based SunCrest Healthcare in December. Going forward, Morgan said, “2014 could potentially be a year where you see more consolidation in the home health space.”
Other sectors, said Morgan, were con-siderably quieter in 2013. Senior housing saw some limited activity, as did dialysis. Morgan said the latter was already pretty consolidated with the two big players being DaVita and Fresenius. “Between the two, they already control about 55 percent of the domestic market,” he pointed out.
It was also a fairly quite year for labs, hospice, skilled nursing and LTACs as these sectors restructure and re-evaluate expectations under ACA and the impact of post-acute bundled payments. In the lab space, Morgan noted, “They’re not redeploying capital for growth right now. They’re trying to pacify stockholders by buying back shares and paying dividends because of the weaker organic growth be-cause of pricing and volume pressures.”
In general, Morgan concluded, there was good news in the equity markets for a number of healthcare sectors in 2013. “The S&P was up almost 30 percent … healthcare services was up over 37 per-cent,” he noted. For some, the gains were even greater. Morgan said behavioral healthcare was up over 100 percent and hospitals up over 44 percent.
Looking ahead, he said, “I still think you can have really attractive returns for 2014 given valuations are still reasonable and the growth opportunities presented by the Affordable Care Act, but I think you need to pick your subsectors carefully.”
n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 11
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By KELLy PRICE
The 12 South Community Clinic is a big player in the Nashville neighbor-hood where it is located. It has gained traction, creditability ... and admiration ... throughout the broader Nashville com-munity since opening its doors in the fall of 2012.
An Idea Takes ShapeIn 2010, six students at Meharry
Medical College discussed their concern about the rising numbers of uninsured Tennesseans and the way the healthcare resources in Nashville treated — or failed to treat — a significant number of them. Instead of just talking about the situation, they decided to find a way to help.
Their solution was to design and cre-ate a clinic that would provide free care to an underserved community.
A nucleus of medical students, led by upperclassman Rebecca Ptaff, founded the clinic to have wide-ranging, tangible implications on the community by pro-viding top-quality healthcare, while also providing a venue for medical students to hone their skills by applying and augment-
ing their classroom and laboratory studies with ‘real world’ experience.
“It all started with a few students who were interested in starting a free clinic so that they could cultivate a training ground for future primary care physicians and also provide access to care,” said Naomi Bitow, now co-director of Case Manage-ment.
Four years later, those ideas and ide-als have been incorporated into the 12 South Community Clinic.
Feet on the GroundWith the support of Meharry’s School
of Medicine Dean Charles P. Mouton, MD, and the faculty Advisory Board, these students — and the many others
who have since joined them — have been able to establish and sustain the clinic through its first year of operation with re-sults that would be deemed a success by any measure.
Student-run under faculty supervi-sion, the clinic was established in partner-ship with United Neighborhood Health Services clinic network, which has a similar mission. Since opening in October 2012, the clinic has provided an estimated $46,500 in care — $42,630 in free office visits; $3,091 in free diagnostic laboratory studies; $434 in free prescriptions; and $373 in radiology services. Clinic students and staff also work to assist patients who need additional access to diagnostics, pre-scriptions, specialty referral and transpor-tation.
“The services that we provide are comprehensive care, primary care for children and adults, and we refer patients to social services providers,” said Veronica Ralls, co-executive director of the clinic with Nicholas Kramer. She added, “We have recently started doing screenings for oral cancer.”
And – they give flu shots. This latest
Meharry’s 12 South Community ClinicReaching Out to the Neighborhood
Whether teaching easy onsite exercises or smart shopping strategies, CHP strives to help employees adopt healthier lifestyles at work and home.
Dr. James Sullivan with Student Volunteers from the Meharry 12 South Community Clinic
(CONTINUED ON PAGE 12)
12 > FEBRUARY 2014 n a s h v i l l e m e d i c a l n e w s . c o m
By: CINDy SANDERS
On Dec. 10, 2013, nurses from across Middle Tennessee gathered to honor their own at the fourth annual March of Dimes Nurse of the Year Awards.
HighPoint Health System CEO Susan Peach, RN, BSN, served as the gala event’s chair with Cathy Taylor, DrPH, MSN, RN, dean of Belmont University’s College of Health Sciences and Nursing, in the role of honorary chair. Sumner Regional Medical Center, a LifePoint Hospitals’ facility under the HighPoint umbrella, was the event’s presenting sponsor. Continuing tradition, Nashville Medical News served as media sponsor and Dan Thomas, WSMV - Channel 4 meteorologist, as the evening’s emcee.
While top nurses were recognized for their body of work in 16 categories, all of the more than 160 nominees represent the March of Dimes vision for healthier, happier, stronger, safer infants and families.
Advance Practice Sponsored by Cigna HealthSpringRene Love, DNP, PMHNP/CNS-BCVanderbilt University School of Nursing
Love is described as a consummate practitioner, educator and scholar with more than 25 years experience. An assistant professor and the director of the Psychiatric-Mental Health Nurse Practitioner Program, she has spent her nursing career collabo-rating with professionals from multiple dis-ciplines and organizations. Love’s work has focused on helping those who have experi-enced crisis or disaster. In addition to coor-dinating relief for individuals, she has trained public school systems to provide mental health support after unexpected deaths, natural disasters and school shootings.
Behavioral Health Jessica Walker, RN, BSNVanderbilt University Medical Center
Walker has been in practice in Tennessee for only two years but has al-ready gained a reputation for exhibiting leadership skills while being a team player. Passionate about psychiatric nursing, she has a heart for service that allows her to connect with patients facing tremendous behavioral health barriers. When not with patients, she is thinking about ways to improve care through evidence-based practice and research. Walker has been heavily involved in a recent project looking at sensory rooms for de-esca-lation at Vanderbilt Psychiatric Hospital.
CardiacDenise Gould, LPNSumner Regional Medical Center
Four years into her second career as a nurse after working as a teacher for eight years, Gould brings the skills she learned in the classroom to the cardiac care arena. She has incorporated a ‘leading by example’ attitude to help train other nurses as they join the staff. Patient welfare and sat-isfaction are her top two priorities. To ensure every patient receives the appropriate level of care, she relies on her personal motto of “See a need; fill a need.”
Critical CareSponsored by Sumner Regional Medical CenterDiane Comer, RNC-NIC, MSN, BSNMonroe Carell Jr. Children’s Hospital at Vanderbilt
An experienced NICU nurse, Comer brings 25 years of experience to her passion for quality improvement and patient safety.
In recent years, she has dedicated her lead-ership efforts to promoting and modeling best practices to reduce hospital-acquired infections and appropriate completion of the required newborn screening tests for the nurses of the Monroe Carell NICU. Her concern for patient safety helps assure Tennessee’s tiniest residents have the best chance at optimal short-term and long-term outcomes.
EmergencySponsored by Sumner Regional Medical CenterMelissa Perkins, RN, BSN, EMT-P, CENTriStar Horizon Medical Center
Awesome, effervescent, inspiring, self-less, unbeatable, superhero … these are just some of the words colleagues use to describe Perkins. The clinical coordinator for Horizon’s Emergency Department, Per-kins has been a nurse for nine years. While working as a paramedic, she experienced a life-changing accident that created physi-cal and emotional challenges, which many would find difficult to overcome. Instead, Perkins used those challenges to fuel her desire to pursue a graduate degree in nurs-ing while keeping her paramedic licensure current. She epitomizes the ‘grace under pressure’ mindset required of emergency medicine nurses.
Entry to Practice Nursing EducationSponsored by Lipscomb Univ. School of NursingRobin Seaton, MSN, RNC-OB, FNP-BC, C-EFMVanderbilt University Medical Center
A nurse for 16 years and practicing in Tennessee for 11 years, this nurse educa-tor invests herself fully in ensuring new staff nurses are well prepared and actively men-
preventive care service recently has been heavily publicized in local media outlets in light of this year’s deadly flu epidemic. On one recent cold evening, more than 79 patients showed up to take part in the Influenza Vaccination Program. A stu-dent, Andrews Marshall, recipient of the Martha Ingram Scholarship, funded an initiative that has allowed the clinic to provide free influenza vaccines to patients throughout the entire flu season. On this January night, the flu shots were given by 35 first- and second-year medical students who received training to administer the vaccines.
The medical students, who receive no pay or school credit for working, have learned that clinics aren’t just about onsite patient care. In the clinic, they learn about connecting patients to other resources, fig-uring out how to help them pay for the procedures or follow-ups in hospital set-tings, helping patients figure out potential Medicaid eligibility, and a myriad of prac-tical information about how the health-care system works.
The clinic is open from 6-9 pm every Thursday evening and is staffed by Meharry medical students and faculty physicians who volunteer their time. An attending physician is on site every week to oversee operations, and Jim Sullivan, MD, serves as chief clinical adviser and regular volunteer.
“As our patient numbers grow, we hope to move eventually to having two physicians each Thursday night, which would allow us to see twice as many pa-tients, and then we hope to move to two nights a week,” Ralls said of future plans. “We want to both enhance the educa-tional experience of students, as well as to offer top-quality healthcare at no cost to an underserved community.”
The 12 South Community Clinic is located two blocks from a neighborhood that is recognized as a Medically Under-served Area Population and a Primary Care Health Professionals Shortage Area. The clinic augments these barriers to care by seeing patients with appointments and on a walk-in basis.
With their evening hours, Ralls noted, “We also serve as a convenient option for uninsured and underinsured community members who often must visit an emer-gency department for primary care needs. All patient care and training is conducted and tracked in compliance with MMC standards of practice and in accordance with the patient-centered medical home model of care.” She continued, “Our case management model ensures individual-ized care for all patients.”
The clinic is currently working with the Meharry School of Dentistry, Ten-nessee State University School of Social Work, Vanderbilt University, and other local institutions to best provide a holis-tic package of services for patients and to foster inter-professional collaboration and learning.
HC Enterprise, continued from page 11
March of Dimes Celebrates Outstanding Community NursesMiddle Tennessee Organization Hosts Annual Nurse of the Year Awards
n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 13
save the date
Wednesday, April 30, 2014
7:30 am - 9:00 am
N O A H L I F E O P E R A C E N T E R
We look forward to having you celebrate 10
women who are achieving great things in the
Middle Tennessee healthcare industry.
tored along their journey. Seaton strives to foster a team spirit atmosphere and is will-ing to stand up for her patients and nurs-ing colleagues … even when it might be the unpopular position. She is known and respected for her integrity, passion and in-tellect.
Graduate Nursing EducationSponsored by Belmont Univ. College of Health Sciences and NursingAbby Parish, DNP, MSNVanderbilt University School of Nursing
Recognizing educators have the re-sponsibility … and amazing opportunity … to showcase the values and behaviors the nursing profession hopes to cultivate in students, Parish models a collaborative, respectful, professional practice both in the classroom and clinical settings. The assistant professor makes it a priority to know each student as individuals and recognize the dif-ferent learning styles to best prepare nurses for the responsibility of advanced practice.
Managed CareSponsored by BlueCross BlueShield of Tennessee Community TrustKathy Shinkle, RN, BSNUnitedHealthcare
A problem-solver by nature, Shinkle is constantly looking for in-novative solutions to improve the patient experience. She embraces opportunities to build a collaborative environment and bridge communications between depart-ments. Her passion for nursing extends well past the workday. She is actively engaged in assisting organizations that support families going through the adoption process and promotes awareness of human trafficking. Shinkle also volunteers her time and skills overseas including two mission trips to Thai-land to work with an orphanage.
Nursing AdministrationSponsored by Healthcare REITLori Ferranti, RN, BSN, MSN, PhD, MBATennessee Department of Health
As director of the TDH Office of Pol-icy, Planning and Assessment, Ferranti is a population health champion. The way she leads her team is rooted in her early career experiences as the lone registered nurse in a rural hospital more than two decades ago. With ink barely dry on her diploma, she instinctively realized the best way to be an effective leader and clinician was to engage colleagues and work side-by-side with staff. Today, that collaborative mindset helps inform evidence-based practices and programming designed to promote, protect and improve the health of Tennesseans.
PediatricSponsored by Monroe Carell Jr. Children’s Hospital at VanderbiltApril Graves, RN, BSNSaint Thomas Midtown Hospital
Graves, who has been practicing for nearly a decade, looks at her profession as a calling. She embraces her responsibility as a healthcare provider to deliver evidence-based care consistently and with the high-est quality to patients and their families. Admittedly inquisitive, Graves isn’t afraid to ask questions when encountering new chal-lenges or processes that don’t make sense. Never satisfied with a “that’s just the way we’ve always done it” reply, she looks at those types of responses as reasons to re-view current practices to ensure they offer the best options for optimal patient out-comes.
Public HealthSponsored by AmerigroupCarolyn Riviere, BSN, MSMetro Public Health Department
Described by col-leagues as one of the “gladi-ators” in public health, this 43-year nursing veteran is passionate about harnessing her many personal and professional experiences to improve the health of Tennessee families. Riviere energetically works with staff, clients and community partners to formulate pro-grams and influence policy aimed at im-proving infant mortality rates at a time when many in her position would be considering retirement. Actually, Riviere did retire once … only to find she missed nursing too much to stay home. Those who depend on her in-sight and experience are certainly glad she returned to the workforce.
Quality and Risk ManagementSponsored by Community Health SystemsSherree Spry, RN, BS, CPHRMTriStar Centennial Medical Center
As vice president of Quality and Risk Management at TriStar Centennial, Spry brings more than 35 years of experience to her crusade to assist healthcare profession-als in identifying the processes and meth-ods to help them deliver care in the safest, most effective manner possible. While part of her job is to share rules and expectations, she takes the time to explain the rationale behind the processes. Colleagues say she models her mantra — quality is doing what’s right … even when no one is looking.
ResearchSponsored by Vanderbilt Univ. School of NursingMelanie Lutenbacher, RN, FNP/PNP, MSN, PhD, FAANVanderbilt University School of Nursing
This dedicated nurse researcher and associate professor of Nursing and Medi-cine works on projects impacting children and families in crisis. Recent projects have focused on community and home-based interventions to prevent or reduce risks as-sociated with preterm births, family violence and at-risk parenting. Lutenbacher, who has nearly 40 years of nursing experience, is en-ergized by the dynamic interchanges with women, children, clinicians, students and
policymakers … whether it’s hearing their stories, helping their voices be heard or join-ing forces to speak up for lasting change.
Student Nurse of the YearSponsored by Lipscomb Univ. School of NursingJohn HaltomBelmont University School of Nursing
A third year student, Haltom recognizes outcomes are defined as being specific and measurable … yet, he also realizes the nu-ances of his chosen profession as nurses impact the lives of families dealing with in-timate emotions and situations. Sometimes, it’s the ‘gray’ areas that aren’t so easily de-fined or measured that leave the strongest imprint. This belief was reinforced during a recent mission trip to Cambodia. Participat-ing in home visits for HIV positive families, Haltom witnessed the emotional healing that comes from listening to a patient’s ex-periences and connecting on both a per-sonal and professional level.
Surgical ServicesGay Ensey, RN, BSNSaint Thomas Rutherford Hospital
Drawing on 38 years nursing experience, Ensey strives to set an example of nurturing in a spiritual way through her nurs-ing leadership and daily interactions with colleagues, patients and families. Although she holds high expectations for nurses and
addresses issues in a straightforward manner to correct mistakes, Ensey does so in a way that is supportive of professional growth. Her colleagues say she models the type of caring, personal interaction that is the cor-nerstone of creating an environment condu-cive to patient satisfaction.
Women’s HealthSponsored by The Center for Women’s Research at Meharry Medical CollegeNancy Donoho, RNC-OB, RNC-HROB, RNC-MNN, RN-BCTriStar Centennial Medical Center
Donoho takes new staff under her wing and helps them find their footing and build the solid foundation needed to grow in the ever-evolving healthcare landscape. Lead-ing by example, this nurse of 30 years also encourages younger colleagues to become actively engaged in supporting their profes-sion. Donoho is involved in a multitude of activities including membership on boards, councils, advisory groups and educational consortiums that enhance the field of nurs-ing. Whether in a clinical setting or a board meeting, her ‘can-do’ attitude is infectious.
14 > FEBRUARY 2014 n a s h v i l l e m e d i c a l n e w s . c o m
Save the DateMarch 7 • 2014 Healthcare Di-
versity Forum • Vanderbilt University Student Life Center • 7:30 am-1 pm
The Council on Workforce Innova-tion is presenting this half-day semi-nar on trends and resources impacting diversity in the healthcare workforce. Moderated by NewsChannel 5 Anchor Vicki Yates, panelists include Health-Stream Founder & CEO Bobby Frist; Nashville Mayor Karl Dean; Memphis Mayor AC Wharton, Jr., JD; Vander-bilt Associate Dean of Diversity Andre Churchwell, MD; and Vanderbilt Chief Human Resource Officer Traci Nord-berg, JD. For more information, call (615) 830-0201 or go online to www.nowdiversity.org. Registration deadline is March 1.
TriStar StoneCrest Names Caputo CEO
Last month, Steve Corbeil, presi-dent of TriStar Health, announced Louis F. Caputo has been named CEO of HCA’s Tri-Star StoneCrest Medical Center, effective March 3. Currently, Caputo, who has more than 10 years of executive leadership with HCA, serves as CEO of Summerville Medical Center in Sum-merville, S.C.
Caputo earned a bachelor’s degree in economics from the University of the South in Sewanee, Tenn., and a master’s in business administration from Bel-mont University.
Vanderbilt Announces Recent Autism Discoveries
Last month, Vanderbilt researchers announced the findings of two separate studies on autism.
The first, which was released in the Journal of Autism and Developmental
Disorders, found more independent work environments might lead to reduc-tions in autism symptoms and improve daily living in adults with the disorder.
The study examined 153 adults with autism and found that greater vocation-al independence and engagement led to improvements in core features of au-tism, other problem behaviors and abil-ity to take care of oneself. Participants averaged 30 years of age and were part of a larger longitudinal study on adoles-cents and adults with autism. Data were collected at two time points separated by 5.5 years.
“We found that if you put the per-son with autism in a more independent vocational placement, this led to mea-surable improvements in their behav-iors and daily living skills overall,” said lead author Julie Lounds Taylor, PhD, assistant professor of Pediatrics and Special Education and Vanderbilt Ken-nedy Center investigator.
The second study revealed the senses of sight and sound are separat-ed in children with autism. Published in The Journal of Neuroscience, the study found children with autism spectrum disorders have trouble integrating si-multaneous information from their eyes and their ears … much like watching a foreign movie that has been badly dubbed.
The study, led by Mark Wallace, PhD, director of the Vanderbilt Brain In-stitute, is the first to illus-trate the link and strongly suggests that deficits in the sensory building blocks for language and communication can ulti-mately hamper social and communication skills in children with autism.
“There is a huge amount of effort and energy going into the treatment of children with autism, virtually none of it
is based on a strong empirical founda-tion tied to sensory function,” Wallace said. “If we can fix this deficit in early sensory function then maybe we can see benefits in language and communi-cation and social interactions.” Wallace added, the findings could have much broader applications because sensory functioning is also changed in develop-mental disabilities such as dyslexia and schizophrenia.
The study found that children with autism have an enlargement in the tem-poral binding window (TBW), meaning the brain has trouble associating visual and auditory events that happen within a certain period of time. A second part of the study found that children with autism also showed weaknesses in how strongly they “bound” or associated audiovisual speech stimuli.
Rash Returns to Top Post at RegionalCare
After less than a year in the top spot at RegionalCare Hospital Partners, Kent Wallace has resigned and founder Marty Rash has stepped back into the CEO role. Wallace joined the Brentwood-based ru-ral hospital company last February from Vanguard Health Systems, which was bought out by Tenet in 2013. In addition to his resumed CEO position, Rash continues as executive chairman of RegionalCare.
In other company news, Rob Jay, another former Vanguard employee, has been named RegionalCare’s new executive vice presi-dent and chief operating officer. The promotion was announced in late January. Jay joined Re-gionalCare in May 2013 as senior vice
CALL FOR NOMINATIONS!To nominate, please go online to:
nashvillemedicalnews.com & click the Women to Watch icon.
NOMINATION DEADLINE: FEBURARY 10, 2014
Dr. Mark Wallace
Louis F. Caputo
n a s h v i l l e m e d i c a l n e w s . c o m FEBRUARY 2014 > 15
Kraft Healthcare Consulting, LLC presents:
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president of operations. Prior to his work at Vanguard, Jay served as the corporate controller for HMA, which has just been purchased by CHS.
Let’s Give Them Something to Talk About!Awards, Honors, Recognitions
Bass Berry & Sims has announced Danielle Sloane has been elected to membership. The new partner focuses her prac-tice exclusively in the healthcare industry with a particular emphasis on regulatory, operational, compliance and transac-tional issues.
Tennessee Health eShare Direct Project hit a milestone in late January when more than 4,000 physicians have participated in the state’s Direct Tech-nology initiative since its launch last July. The push to adopt the technology, which allows secure communication, is a national effort, and Tennessee has been recognized for having one of the most rapid adoption rates.
Judge Daniel B. Eisenstein was recently honored during the inaugural NAMI (National Alliance on Mental Illness) Ten-nessee Vision of Hope Gala. The judge was pre-sented with the Vision of Hope Award for his work with the Davidson County Mental Health Court over the last decade, as well as his collabo-ration with NAMI Tennessee and advo-cacy for people with mental illness.
Wishes GrantedAccording to annual figures avail-
able through the National Institute of Health, Vanderbilt University School of Medicine is now ranked ninth in the national among U.S. medical schools in total grant support provided through the nation’s medical research agency. During the calendar year 2013, VUSM received more than $292 million in NIH grant support. VUSM moved up four places in the rankings since 2012.
Centerstone Research Institute (CSI) is teaming up with Indiana Univer-sity – Bloomington, Regenstrief Insti-tute, Wake Forest School of Medicine and other organizations in a three-year, $686,000 research grant to study the advance use of artificial intelligence in healthcare decision support. The grant is funded by the National Science Foun-dation and National Institute of Health.
The Martha O’Bryan Center has received a $100,000 grant from Unit-edHealthcare Community Plan of Ten-nessee to support the parent education programming, Tied Together. The 10-week program brings together commu-nity partners to support young parents … some as young as 14 years old … as they raise their children.
Vanderbilt-Ingram Cancer Cen-ter has received a $100,000 ovarian
cancer grant from the Kay Yow Cancer Fund. The fund, in partnership with the Women’s Basketball Coaches Associa-tion and the V Foundation, presents an award annually to an institution based in the host city of the NCAA Women’s Final Four®, which will be held in Nash-ville April 6 and 8 at Bridgestone Arena. The grant will be used to continue VICC research on imaging ovarian cancer with novel small molecule radiotracers of cyclooxygenase-1 (COX-1).
TriStar StoneCrest Names Wagster Lab Director
TriStar StoneCrest Medical Center recently welcomed Marvin Wagster as administrative director of laboratory services where he will oversee a staff that processes about 270,000 inpatient tests annually. With more than 20 years of laboratory services experience, he has extensive leadership expertise in the hospital laboratory setting. Most re-cently, Wagster was with Saint Thomas Health Services. He earned his under-graduate degree in medical technol-ogy/biology and chemistry from the University of Tennessee and his master’s degree in health services administration from University of St. Francis in Joliet, Ill.
Beverly Joins UNHS as CMOSteven Beverly, MD, recently joined
United Neighborhood Health Services as chief medical officer. In his new role, he will pro-vide oversight of the or-ganization as a member of the leadership team and will maintain respon-sibility for clinical ac-tivities. A board-certified OB/GYN, he has practiced medicine for 13 years, most recently serving as man-aging partner of Dobson and Beverly in Bowling Green, Ky. Beverly is a Fellow of the American Congress of Obstetri-
cians and Gynecologists.
TriStar Buys Capella FacilityLast month it was announced that
HCA’s TriStar division had signed a de-finitive agreement to purchase Grand-view Medical Center near Chattanooga from Capella Healthcare. The 70-bed hospital located in Jasper, Tenn., serves five counties in Tennessee, Georgia and Alabama. It will become part of TriS-tar’s growing Parkridge Health System, which will grow to five facilities in the Chattanooga metropolitan market with the completion of this acquisition. The transaction, which is subject to custom-ary regulatory approvals, is expected to close the first quarter of 2014.
PearlPoint Releases New App on Cancer Side Effects
Last month, PearlPoint Cancer Sup-port announced the release of a new, free mobile app called, “Cancer Side Effects Helper.” The app, which can be downloaded by oncology patients and their caregivers from ITunes and Google Play, provides information to help mini-mize common side effects from cancer treatments. The app features a compre-hensive list of side effects and the medi-cally approved, practical tips that could help decrease their impact.
The Keckley ReportHealthcare guru, political pundit,
and former Nashvillian Paul Keckley, PhD, recently launched The Keckley Report. The weekly report – billed as simplifying the world of health policy so you don’t have to – shares insights and explanations from Keckley, who is the ex-ecutive director of the Deloitte Center for Health Solutions and a nationally renowned speaker on health policy. You
can subscribe to the free report at www.paulkeckley.com.
Healthways Inks Three-Year Agreement with California Blue
In late January, Healthways an-nounced Franklin-based company had signed a three-year agreement with BlueShield of California to provide well-being solutions to the insurer’s Well-volution health and wellness program. The program will touch three million commercial members plus more than a dozen employer groups. This latest agreement marked the fourth such deal inked by Healthways in January. Other contracts to start 2014 included ones with UCLA, Carondelet Health Network in Arizona and a health coaching pro-gram ‘down under’ in Australia.
Duke LifePoint Signs Agreement with Wilson Medical Center
It was recently announced that Duke LifePoint Healthcare has signed a definitive agreement with Wilson Medi-cal Center in Wilson, N.C., to form a joint venture, including $120 million in capital investments and resources over the next decade, following a vote by the Wilson County Board of Commission-ers. The agreement is now under review by the state attorney general.
Under the terms of the agreement, Duke LifePoint would own 80 percent of the joint venture, while Wilson Medical Center and the community would have a 20 percent ownership stake. Gover-nance of Wilson Medical Center will be shared equally by Duke LifePoint and Wilson though the creation of a 10-member board with equal represen-tation from both organizations.
Judge Daniel B. Eisenstein
Dr. Steven Beverly
Dr. Paul Keckley
Suzy Gore spent the last 10 years watching her eyesight decline. Unable to see the vision chart at her doctor’s office without corrective lenses, tired of halo effects around lights and the challenge of driving at night, Gore decided to undergo laser cataract surgery. Now she is looking forward to the next few decades of seeing the world from a clearer point of view thanks to the work of Daniel Weikert, M.D., assistant professor of Clinical Ophthalmology at the Vanderbilt Eye Institute. The leading cause of blindness in the world, cataracts affect more than 22 million people in the U.S. “I must admit, when Dr. Weikert told me I was developing cataracts when I was 50, I was floored,” said Gore, a longtime patient of Weikert. “I just didn’t think I was in that category yet and they were not interfering with my eyesight then. “When we discussed it again this past August, I remember asking him, ‘now, if I was your mama, what would you tell her to do?’” “He looked right at me and said: ‘I think having the procedure would make a big difference, and in fact, I did my mother’s cataracts.’” Gore, 60, is now one of nearly
100 patients who have elected to undergo the corrective surgery, which is done by Vanderbilt oph-thalmologists at the Cool Springs Surgery Center.
Ophthalmologists at VEI offer laser cataract technology as well as traditional cataract surgery using hand-made incisions with a surgical blade (used in 80 percent of cases). “In time, the laser will become a larger part of the cataract practice because it gives the potential for better optical results,” Weikert said. “The laser allows for precise inci-sions every time, reduced complica-tions post-surgery and the ability to treat astigmatism that will sharpen their vision. “This tool is putting Vanderbilt
on the cutting edge of eye care. Since utilizing this procedure, we have had a steady influx of area surgeons wanting to be trained at our facility. As we are certifying other community surgeons, it goes further than Vander-bilt. We are reaching past our own patient popula-tion,” Weikert said. Although the proce-dure is not yet covered by insurance, many patients are electing to have the laser cataract surgery because studies are showing it is safer, more effective and efficient. Patients are awake throughout the entire 30-minute procedure. During the laser portion, which takes about two minutes, the patient is given anesthetic drops to numb the eye. Afterward, the patient receives an intravenous sedative before going to the OR suite, where the cataract is removed and the lens is implanted.Gore, retired from a 30-year teach-ing career, is still giddy over the success of her cataract surgery. She
no longer requires glasses or readers. “I have been wearing glasses since I was 9 years old,” she said. “And they were a pretty strong prescrip-tion. The potential for waking up and not having to search for my glasses was so attractive to me. And I wanted to give my eyes the best chance. “It’s funny because I am still reaching to take off my glasses when
I turn off the light at night when I go to sleep,” she said.
Vanderbilt leads region in laser cataract surgeryBY JESSIC A PASLE Y
“This tool is putting Vanderbilt on the cutting edge of eye care…We are reaching past our own patient population.”Daniel Weikert, M.D.,
Medical Center Welcomes
Evan Brittain, M.D.Specialty: CardiologyMedical School: Cornell Medical CollegeResidency: Vanderbilt University Medical CenterFellowship: Vanderbilt University
School of MedicinePractice Location: Vanderbilt University
Referrals: (615) 322-2318
Jessica Delaney, M.D.Specialty: CardiologyMedical School: Albert Einstein College of
Medicine Residency: Albert Einstein College of Medicine/
Montefiore Medical Center Fellowships: St Luke’s-Roosevelt Medical Center
and Vanderbilt University Medical CenterPractice Location: Vanderbilt University
Referrals: (615) 322-2318
Deepak Gupta, M.D.Specialty: CardiologyMedical School: The Ohio State University
College of MedicineResidency: Duke University Medical Center Fellowship: Northwestern University and
Brigham & Women’s Hospital Practice Location: Vanderbilt University
Referrals: (615) 322-2318
Arvindh Kanagasundram, M.D.Specialty: Cardiac electrophysiologyMedical School: Vanderbilt University School
of MedicineResidency: Stanford University Medical CenterFellowships: New York Presbyterian Hospital/
Weill-Cornell Medical Center and Vanderbilt University Medical Center
Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
David Kim, M.D.Specialty: CardiologyMedical School: Northwestern University Residency: McGaw Medical Center of
Northwestern UniversityFellowship: Vanderbilt University Medical CenterPractice Location: Nashville General
Hospital at Meharry
Referrals: (615) 341-4250
Casey Miller, MSN Specialty: CardiologyNursing School: Vanderbilt University
School of NursingPractice Location: Vanderbilt University
Referrals: (615) 322-2318
Daniel Muñoz, M.D., M.P.ASpecialty: CardiologyMedical School: Johns Hopkins University
School of MedicineResidency: Johns Hopkins Hospital Fellowships: Johns Hopkins Hospital,
Duke Clinical Research Institute and Vanderbilt University Medical Center
Practice Location: Vanderbilt University Medical Center
Referrals: (615) 322-2318
Sharon Shen, M.D.Specialty: CardiologyMedical School: Northwestern University Residency in Internal Medicine:
Northwestern UniversityFellowship: Northwestern UniversityPractice Location: Vanderbilt University
Referrals: (615) 322-2318
Quinn Wells, M.D., Ph.D.Specialty: CardiologyMedical School: University of Alabama
School of MedicineResidency: Massachusetts General Hospital
Fellowship: Vanderbilt University
School of Medicine
Practice Location: Vanderbilt University
Referrals: (615) 322-2318
Molly Cone, M.D.Specialty: Colorectal Surgery
Medical School: Oregon Health & Science
Residency: Oregon Health & Science University
Fellowship: Ochsner Clinic
Practice location: Vanderbilt University
Referrals: (615) 343-4612
Luis G. Vega, D.D.S.Specialty: Oral and Maxillofacial Surgery
Dental School: University of Costa Rica
Residency: University of Alabama Hospital
Practice location: The Vanderbilt Clinic
Referrals: (615) 343-9403
Soheyl Asadsangabi, CNMSpecialty: Midwifery
Medical School: Vanderbilt School of Nursing
Practice Location: NorthCrest Medical Center
Referrals: (615) 343-5700
Dawn R. Norman, M.S.N., CNMSpecialty: Midwifery
Medical School: University of Texas Medical
Branch School of Nursing
Practice Location: NorthCrest Medical Center
Referrals: (615) 343-5700Valerie L. Nunley, CNMSpecialty: Midwifery